Coherent High-Frequency Axial Oscillations in a Partially Magnetized Direct Current Magnetron Discharge.

High-frequency oscillations are observed in a neon plasma of a direct current magnetron discharge. At low discharge currents, we see highly coherent 60 MHz fluctuations. Above a distinct current threshold, secondary 5-10 MHz fluctuations emerge in addition to turbulent fluctuations in the 60-100 MHz range. The oscillations in the total discharge current suggest axial wave propagation. A lower-hybrid wave theory is invoked to model the high-frequency oscillations. We attribute the low-frequency modes to a turbulence-driven inverse cascade process, as suggested by recent simulations.

Developing "inverted-corona" fusion targets as high-fluence neutron sources.

We present experimental studies of inverted-corona targets as neutron sources at the OMEGA Laser Facility and the National Ignition Facility (NIF). Laser beams are directed onto the inner walls of a capsule via laser-entrance holes (LEHs), heating the target interior to fusion conditions. The fusion fuel is provided either as a wall liner, e.g., deuterated plastic (CD), or as a gas fill, e.g., D2 gas. Such targets are robust to low-mode drive asymmetries, allowing for single-sided laser drive. On OMEGA, 1.8-mm-diameter targets with either a 10-µm CD liner or up to 2 atm of D2-gas fill were driven with up to 18 kJ of laser energy in a 1-ns square pulse. Neutron yields of up to 1.5 × 1010 generally followed expected trends with fill pressure or laser energy, although the data imply some mix of the CH wall into the fusion fuel for either design. Comparable performance was observed with single-sided (1x LEH) or double-sided (2x LEH) drive. NIF experiments tested the platform at scaled up dimensions and energies, combining a 15-µm CD liner and a 3-atm D2-gas fill in a 4.5-mm diameter target, laser-driven with up to 330 kJ. Neutron yields up to 2.6 × 1012 were measured, exceeding the scaled yield expectation from the OMEGA data. The observed energy scaling on the NIF implies that the neutron production is gas dominated, suggesting a performance boost from using deuterium-tritium (DT) gas. We estimate that neutron yields exceeding 1014 should be readily achievable using a modest laser drive of ∼300 kJ with a DT fill.

Dual-polarization Dirac cones in a simple 2D square lattice photonic crystal.

We report on dual-polarization Dirac cones in a simple square lattice two-dimensional (2D) photonic crystal (PC) based on transmission at accidental degeneracies centered at the $k = {0}$k=0 symmetry ($ \Gamma $Γ) point. Finite difference time domain simulations are used to identify the material and geometric parameters for Dirac-like dispersion. A configuration that produces a Dirac-like point for both transverse electric and transverse magnetic polarizations at the same frequency is presented. The PC dispersion shows the expected threefold degenerate linear branch crossings at the Dirac-like point. Full-field electromagnetic wave simulations exhibit some common behaviors of devices based on Dirac-like dispersion, such as cloaking and waveguiding. The configuration works for a considerable range of the parameter space, and thus is experimentally realizable with a wide range of materials.

Food-borne botulism in Apulia region, Italy: an expert witness testimony.

We report the epidemiology of food-borne botulism in Puglia, Italy, between 1977-2017, using surveillance data and Experts' personal observations. As the disease is rare, the diagnosis is often missed or delayed, and cases are initially misdiagnosed. This was the case of a family outbreak of botulism in the 1970s.

Evaluation of measles and rubella integrated surveillance system in Apulia region, Italy, 3 years after its introduction.

This study aimed at evaluating the integrated measles and rubella surveillance system (IMRSS) in Apulia region, Italy, from its introduction in 2013 to 30 June 2016. Measles and rubella case reports were extracted from IMRSS. We estimated system sensitivity at the level of case reporting, using the capture-recapture method for three data sources. Data quality was described as the completeness of variables and timeliness of notification as the median-time interval from symptoms onset to initial alert. The proportion of suspected cases with laboratory investigation, the rate of discarded cases and the origin of infection were also computed. A total of 127 measles and four rubella suspected cases were reported to IMRSS and 82 were laboratory confirmed. Focusing our analysis on measles, IMRSS sensitivity was 82% (95% CI: 75-87). Completeness was >98% for mandatory variables and 57% for 'genotyping'. The median-time interval from symptoms onset to initial alert was 4.5 days, with a timeliness of notification of 33% (41 cases reported ⩽48 h). The proportion of laboratory investigation was 87%. The rate of discarded cases was 0.1 per 100 000 inhabitants per year. The origin of infection was identified for 85% of cases. It is concluded that IMRSS provides good quality data and has good sensitivity; still efforts should be made to improve the completeness of laboratory-related variables, timeliness and to increase the rate of discarded cases.

Predictors of Repeated Visits to a Pediatric Emergency Department Crisis Intervention Program.

OBJECTIVES: Despite documented increases in emergency department (ED) mental health (MH) presentations, there are inconsistent findings on the characteristics of patients with repeat presentations to pediatric EDs (PEDs) for MH concerns. Our study sought to explore the characteristics of MH patients with repeat PED visits and determine predictors of return visits, of earlier repeat visits, and of more frequent repeat visits. METHODS: We examined data collected prospectively in a clinical database looking at MH presentations to a crisis intervention program housed within a PED from October 2006 to December 2011. Predictive models based on demographic and clinical variables were constructed using logistic, Cox, and negative binomial regression. RESULTS: A total of 4,080 presentations to the PED were made by the 2,900 children and youth. Repeat visits accounted for almost half (45.8%) of all presentations. Multivariable analysis identified five variables that independently predicted greater odds of having repeat presentations, greater risk of earlier repeat presentations, and greater risk of frequent repeat presentations. The five variables were: female, living in the metropolitan community close to the PED, being in the care of child protective services, taking psychotropic medications, and presenting with an actionable need in the area of mood disturbances. CONCLUSIONS: Repeat visits account for a large portion of all MH presentations to the PED. Furthermore, several patient characteristics are significant predictors of repeat PED use and of repeating use sooner and more frequently. Further research is needed to examine interventions targeting this patient group to ensure appropriate MH patient management.

Improving mental health care transitions for children and youth: a protocol to implement and evaluate an emergency department clinical pathway.

BACKGROUND: While the emergency department (ED) is often a first point of entry for children and youth with mental health (MH) concerns, there is a limited capacity to respond to MH needs in this setting. Child MH systems are typically fragmented among multiple ministries, organizations, and providers. Communication among these groups is often poor, resulting in gaps, particularly in transitions of care, for this vulnerable population. The evidence-based Emergency Department Mental Health Clinical Pathway (EDMHCP) was created with two main goals: (1) to guide risk assessment and disposition decision-making for children and youth presenting to the ED with MH concerns and (2) to provide a streamlined transition to follow-up services with community MH agencies (CMHAs) and other providers. The purpose of this paper is to describe our study protocol to implement and evaluate the EDMHCP. METHODS/DESIGN: This mixed methods health services research project will involve implementation and evaluation of the EDMHCP in four exemplar ED-CMHA dyads. The Theoretical Domains Framework will be used to develop a tailored intervention strategy to implement the EDMHCP. A multiple baseline study design and interrupted time-series analysis will be used to determine if the EDMHCP has improved health care utilization, medical management of the MH problems, and health sector coordination. The primary process outcome will be the proportion of patients with MH-specific recommendations documented in the health record. The primary service outcome will be the proportion of patients receiving the EDMHCP-recommended follow-up at 24-h or at 7 days. Data sources will include qualitative interviews, health record audits, administrative databases, and patient surveys. A concurrent process evaluation will be conducted to assess the degree of variability and fidelity in implementation across the sites. DISCUSSION: This paper presents a novel model for measuring the effects of the EDMHCP. Our development process will identify how the EDMHCP is best implemented among partner organizations to deliver evidence-based risk management of children and youth presenting with MH concerns. More broadly, it will contribute to the body of evidence supporting clinical pathway implementation within novel partnerships. TRIAL REGISTRATION: ClinicalTrials.gov ( NCT02590302 ).

Incidence of Type 1 Diabetes among Children and Adolescents in Italy between 2009 and 2013: The Role of a Regional Childhood Diabetes Registry.

BACKGROUND: Surveillance represents a key strategy to control type 1 diabetes mellitus (T1DM). In Italy, national data are missing. This study aimed at evaluating the incidence of T1DM in subjects <18 year olds in Apulia (a large southeastern region, about 4,000,000 inhabitants) and assessing the sensitivity of the regional Registry of Childhood-Onset Diabetes (RCOD) in the 2009-2013 period. METHODS: We performed a retrospective study matching records from regional Hospital Discharge Registry (HDR), User Fee Exempt Registry (UFER), and Drugs Prescription Registry (DPR) and calculated T1DM incidence; completeness of each data source was also estimated. In order to assess the RCOD sensitivity we compared cases from the registry to those extracted from HDR-UFER-DPR matching. RESULTS: During 2009-2013, a total of 917 cases (about 184/year) in at least one of the three sources and an annual incidence of 25.2 per 100,000 were recorded, lower in infant, increasing with age and peaked in 5- to 9-year-olds. The completeness of DPR was 78.7%, higher than that of UFER (64.3%) and of HDR (59.6%). The RCOD's sensitivity was 39.05% (360/922; 95% CI: 34.01%-44.09%). CONCLUSIONS: Apulia appeared as a high-incidence region. A full, active involvement of physicians working in paediatric diabetes clinics would be desirable to improve the RCOD performance.

Transitioning Youth into Adult Mental Health and Addiction Services: An Outcomes Evaluation of the Youth Transition Project.

The Youth Transition Project was designed to provide youth with mental health and addiction issues with individualized transitional care plans as they transition from Child and Adolescent Mental Health Services (CAMHS) to Adult Mental Health Services (AMHS). Over an 18-month period, a total of 127 (59.1%) youth were transitioned and seen by an AMHS provider, 41 (19.1%) remained on a waitlist for services and 47 (21.8%) canceled services. The average time to transition was 110 days (SD = 100). Youth exhibited a wide range of diagnoses; 100% of the population was identified as having serious psychiatric problems. Findings demonstrate that the Youth Transition Project has been successful in promoting continuity of care by transitioning youth seamlessly from youth to adult services. Inconsistencies in wait times and service delivery suggest that further model development is needed to enhance the long-term sustainability of the Youth Transition Project.

Proceedings of the Consensus Day Meeting: Implications for Rotavirus Vaccination in the 2014 Apulian Lifetime Immunization Schedule. Foggia, 17 April 2015.

Recommendations for vaccination against rotavirus (RV) were issued in Apulia in 2006; the vaccine was free of charge to children who entered day care or nursery school by 1 year of age or those affected by chronic diseases for which diarrhea caused by rotavirus can increase the risk of complications and hospitalization. In 2014, vaccination became available to all healthy children with only a copayment. However, there has not been a significant increase in vaccination coverage. On April 17, 2015, Apulian public health physicians and paediatricians met to share strategies to promote the RV vaccine indications provided in the regional immunization schedule. During the meeting, presentation of data reports were interspersed with discussions that were led with a "bottom-up" approach. The discussants responded to pre-planned questions raised by the participants and encouraged by the discussion.

A seroprevalence survey on varicella among adults in the vaccination era in Apulia (Italy).

In 2006, the Apulia Region (Italy) introduced universal routine vaccination (URV) against varicella disease. The coverage for one dose of varicella vaccine at 24 month of age reached 91.1% in 2010 birth-cohort. Vaccination coverage for the second dose at 5-6 years was 64.8% for the cohort 2005, and 28.8% for adolescents born in 1997. The aim of the present study is to evaluate the pattern of immunity/susceptibility to varicella in Apulian adults by a seroprevalence survey carried out 6 years after the introduction of URV. The study was carried out from May 2011 to June 2012 among blood donors of the Department of Transfusion Medicine of Policlinico General Hospital in Bari. Subjects were enrolled by a convenience sample. For each enrolled patient we collected a sample of serum of 5 ml. Anti-VZV IgG in collected sera were analyzed by chemiluminescence (CLIA). We enrolled 1769 subject; 1365 (77.2%) were male with a mean age of 38.4 ± 11.7 years. 93% (95% CI=91.7-94.1) of enrolled subject presented a titre of anti-VZV IgG >164 mIU/mL. GMT of anti-VZV IgG titre was 1063.4 mIU/ml and no difference was observed between different age group. According to our data, URV did not seem to have any impact on susceptibility among adults and in particular we did not note any cluster of susceptible subjects among young adults. Also in the vaccination era, we did not note that the average age of infection shifts among adults and then we could exclude an increase of case of complicated varicella related to the URV.

Addressing the anti-vaccination movement and the role of HCWs.

Over the last two decades, growing numbers of parents in the industrialized world are choosing not to have their children vaccinated. Trying to explain why this is occurring, public health commentators refer to the activities of an anti-vaccination movement. The aim of this paper is to review the literature about the anti-vaccination movements and to highlight the knowledge and the skills needed for HCWs to fight against their ideas. The main theoretical structures of anti-vaccination ideology in the 19th and 20th centuries are: vaccines cause idiopathic illness; opponents against vaccines accused vaccine partisans to be afraid of the "search after truth," they fear unveiling errors; the vaccination law not only insults every subject of the realm, but also it insults every human being; vaccine immunity is temporary; an alternative healthy lifestyle, personal hygiene and diet stop diseases. Proponents against vaccination now have additional means to communicate their positions to the general public, the Internet in particular. Doctors and HCWs constantly have to face parents and patients who search information about vaccination. A lot of these people have previously found data about vaccinations from a lot of sources, such as papers, media or in websites and in these sources most contents come from anti-vaccine movements. For these reasons doctors and HCWs need to have updated knowledge about the vaccinations and to know the contents proposed by vaccine sceptics. Educating the general public cannot be fully effective unless there is a corresponding provision, enthusiasm and commitment by trained HCWs.

A Thomson-type mass and energy spectrometer for characterizing ion energy distributions in a coaxial plasma gun operating in a gas-puff mode.

Measurements of ion energy distribution are performed in the accelerated plasma of a coaxial electromagnetic plasma gun operating in a gas-puff mode at relatively low discharge energy (900 J) and discharge potential (4 kV). The measurements are made using a Thomson-type mass and energy spectrometer with a gated microchannel plate and phosphor screen as the ion sensor. The parabolic ion trajectories are captured from the sensor screen with an intensified charge-coupled detector camera. The spectrometer was designed and calibrated using the Geant4 toolkit, accounting for the effects on the ion trajectories of spatial non-uniformities in the spectrometer magnetic and electric fields. Results for hydrogen gas puffs indicate the existence of a class of accelerated protons with energies well above the coaxial discharge potential (up to 24 keV). The Thomson analyzer confirms the presence of impurities of copper and iron, also of relatively high energies, which are likely erosion or sputter products from plasma-electrode interactions.

Time-synchronized continuous wave laser-induced fluorescence on an oscillatory xenon discharge.

A novel approach to time-synchronizing laser-induced fluorescence measurements to an oscillating current in a 60 Hz xenon discharge lamp using a continuous wave laser is presented. A sample-hold circuit is implemented to separate out signals at different phases along a current cycle, and is followed by a lock-in amplifier to pull out the resulting time-synchronized fluorescence trace from the large background signal. The time evolution of lower state population is derived from the changes in intensity of the fluorescence excitation line shape resulting from laser-induced fluorescence measurements of the 6s(')[1/2](1)(0)-6p(')[3/2](2) xenon atomic transition at λ = 834.68 nm. Results show that the lower state population oscillates at twice the frequency of the discharge current, 120 Hz.

[Working overseas and cardiovascular diseases: application of a screening method on Oil&Gas employees]. / Lavoro all'estero e malattie cardiovascolari: applicazione di un protocollo di screening su un gruppo di lavoratori del settore Oil&Gas.

Working overseas is a reality for decades in the Oil&Gas Industry and many noxae impact on the cardiovascular system. In fitness to work evaluation the physician should consider besides the conventional risk factors, the presence of cardiovascular diseases, and prevent their evolution. A cardiovascular screening and follow up after 2 years was carried out on 42 Oil&Gas employees, over 45 of age, during medical fitness to work. The main tests were ECG, exercise tolerance test (ETT) and echocardiocolordoppler, completed with other instrumental tests. Cardiovascular diseases causing unfitness to working overseas occurred in 7%, blood hypertension in 23%. The screening permitted to diagnose and correct acute cardiovascular diseases, that caused unfitness to work, and disease that can get worse related to occupational risk. Moreover it was fundamental for evaluation of fitness and timing of health surveillance.

Attitude and knowledge about genetics and genetic testing.

BACKGROUND: Increasing numbers of health care users may be confronted with new genetic knowledge and discoveries that offer new types of medical decision-making. How people use these new insights and make decisions about genetic risk depends, at least in part, on their knowledge and attitudes about human genetics. METHODS: A postal survey administered to 560 women who had been offered prenatal screening in Ontario measured knowledge about, and attitudes toward, genetic testing and the uses of genetic information. RESULTS: Respondents strongly supported the use of genetic information to improve disease diagnosis and to help understand disease causes; however, people also held a more critical attitude towards certain aspects of testing and genetic information. Relatively high levels of knowledge about genetics were also observed in this sample, although there were deficits in specific areas (e.g., transmission patterns). CONCLUSIONS: Despite overall positive attitudes towards genetics, participants held more critical attitudes towards certain aspects of testing and the uses of genetic information. It would be unwise for genetics policy-makers and stakeholders to assume that a better-informed public would automatically be more supportive of all genetics research and new genetic discoveries.

Identifying mental health services in clinical genetic settings.

The purpose of this study was to examine the mental health needs of individuals at risk for adult onset hereditary disorder (AOHD) from the perspective of their genetic service providers, as it is unknown to what extent psychosocial services are required and being met. A mail-out survey was sent to 281 providers on the membership lists of the Canadian Association of Genetic Counsellors and the Canadian College of Medical Geneticists. The survey assessed psychosocial issues that were most commonly observed by geneticists, genetic counsellors (GCs), and nurses as well as availability and types of psychosocial services offered. Of the 129 respondents, half of genetic service providers reported observing signs of depression and anxiety, while 44% noted patients' concerns regarding relationships with family and friends. In terms of providing counselling to patients, as the level of psychological risk increased, confidence in dealing with these issues decreased. In addition, significantly more GCs reported that further training in psychosocial issues would be most beneficial to them if resources were available. As a feature of patient care, it is recommended that gene-based predictive testing include an integrative model of psychosocial services as well as training for genetic service providers in specific areas of AOHD mental health.