Understanding the Context for Long-Term Care Planning.

Evolving family structure and economic conditions may affect individuals' ability and willingness to plan for future long-term care (LTC) needs. We applied life course constructs to analyze focus group data from a study of family decision making about LTC insurance. Participants described how past exposure to caregiving motivated them to engage in LTC planning; in contrast, child rearing discouraged LTC planning. Perceived institutional and economic instability drove individuals to regard financial LTC planning as either a wise precaution or another risk. Perceived economic instability also shaped opinions that adult children are ill-equipped to support parents' LTC. Despite concerns about viability of social insurance programs, some participants described strategies to maximize gains from them. Changing norms around aging and family roles also affected expectations of an active older age, innovative LTC options, and limitations to adult children's involvement. Understanding life course context can inform policy efforts to encourage LTC planning.

Ventricular conduction and long-term heart failure outcomes and mortality in African Americans: insights from the Jackson Heart Study.

BACKGROUND: QRS prolongation is associated with adverse outcomes in mostly white populations, but its clinical significance is not well established for other groups. We investigated the association between QRS duration and mortality in African Americans. METHODS AND RESULTS: We analyzed data from 5146 African Americans in the Jackson Heart Study stratified by QRS duration on baseline 12-lead ECG. We defined QRS prolongation as QRS≥100 ms. We assessed the association between QRS duration and all-cause mortality using Cox proportional hazards models and reported the cumulative incidence of heart failure hospitalization. We identified factors associated with the development of QRS prolongation in patients with normal baseline QRS. At baseline, 30% (n=1528) of participants had QRS prolongation. The cumulative incidences of mortality and heart failure hospitalization were greater with versus without baseline QRS prolongation: 12.6% (95% confidence interval [CI], 11.0-14.4) versus 7.1% (95% CI, 6.3-8.0) and 8.2% (95% CI, 6.9-9.7) versus 4.4% (95% CI, 3.7-5.1), respectively. After risk adjustment, QRS prolongation was associated with increased mortality (hazard ratio, 1.27; 95% CI, 1.03-1.56; P=0.02). There was a linear relationship between QRS duration and mortality (hazard ratio per 10 ms increase, 1.06; 95% CI, 1.01-1.12). Older age, male sex, prior myocardial infarction, lower ejection fraction, left ventricular hypertrophy, and left ventricular dilatation were associated with the development of QRS prolongation. CONCLUSIONS: QRS prolongation in African Americans was associated with increased mortality and heart failure hospitalization. Factors associated with developing QRS prolongation included age, male sex, prior myocardial infarction, and left ventricular structural abnormalities.

Modulation of the infant immune responses by the first pertussis vaccination

info:eu-repo/semantics/nonPublished

Modulation of the infant immune responses by the first pertussis vaccination

info:eu-repo/semantics/nonPublished

Modulation of the infant immune responses by the firts pertussis vaccine administrations

info:eu-repo/semantics/nonPublished

Identification of pertussis-specific effector memory T cells in preschool children

Whooping cough remains a problem despite vaccination, and worldwide resurgence of pertussis is evident. Since cellular immunity plays a role in long-term protection against pertussis, we studied pertussis-specific T-cell responses. Around the time of the preschool acellular pertussis (aP) booster dose at 4 years of age, T-cell memory responses were compared in children who were primed during infancy with either a whole-cell pertussis (wP) or an aP vaccine. Peripheral blood mononuclear cells (PBMCs) were isolated and stimulated with pertussis vaccine antigens for 5 days. T cells were characterized by flow-based analysis of carboxyfluorescein succinimidyl ester (CFSE) dilution and CD4, CD3, CD45RA, CCR7, gamma interferon (IFN-γ), and tumor necrosis factor alpha (TNF-α) expression. Before the aP preschool booster vaccination, both the proliferated pertussis toxin (PT)-specific CD4⁺ and CD8⁺ T-cell fractions (CFSE^dim) were higher in aP-than in wP-primed children. Post-booster vaccination, more pertussis-specific CD4⁺ effector memory cells (CD45RA^- CCR7^-) were induced in aP-primed children than in those primed with wP. The booster vaccination did not appear to significantly affect the T-cell memory subsets and functionality in aP-primed or wP-primed children. Although the percentages of Th1 cytokine-producing cells were alike in aP- and wP-primed children pre-booster vaccination, aP-primed children produced more Th1 cytokines due to higher numbers of proliferated pertussis-specific effector memory cells. At present, infant vaccinations with four aP vaccines in the first year of life result in pertussis-specific CD4⁺ and CD8⁺ effector memory T-cell responses that persist in children until 4 years of age and are higher than those in wP-primed children. The booster at 4 years of age is therefore questionable; this may be postponed to 6 years of age.

Cellular immune responses of preterm infants after vaccination with whole-cell or acellular pertussis vaccines.

Based on studies reporting specific antibody titers, it is recommended to vaccinate preterm infants against Bordetella pertussis according to their chronological age. However, as specific T-cell responses also are involved in the protection against B. pertussis, we have determined whether highly preterm infants (<31 weeks) are able to mount these immune responses during vaccination. Forty-eight premature infants were vaccinated at 2, 3, and 4 months of their chronological age with an acellular (Pa; n = 24) or a whole-cell (Pw; n = 24) tetravalent diphtheria-tetanus-pertussis-polio vaccine, and blood samples were collected at 2, 3, and 6 months of age. Most of the Pa- and Pw-vaccinated infants developed at 3 or 6 months of age a gamma interferon (IFN-gamma) response to the B. pertussis antigens, accompanied by an interleukin-5 (IL-5) and IL-13 secretion for the Pa-vaccinated infants. No association was found between a very low infant birth weight, the occurrence of severe infections, and corticosteroid treatment or the administration of gammaglobulins with a low level of antigen-induced IFN-gamma secretion. We conclude that like full-term infants, most preterm infants are able to mount a specific cellular immune response to the administration of the first doses of an acellular or a whole-cell pertussis vaccine.

Revisiting the carrier-phase source-term formulation in mixed Lagrangian-Eulerian particle models

The formulation of the carrier-phase momentum and enthalpy source terms in mixed Lagrangian-Eulerian models of particle-laden flows is frequently reported inaccurately. Under certain circumstances, this can lead to erroneous implementations, which violate physical laws. A particle- rather than carrier-based approach is suggested for a consistent treatment of these terms.

Temporal modelling of short-term rainfall using Cox processes

We study two marked point process models based on the Cox process. These models are used to describe the probabilistic structure of the rainfall intensity process. Mathematical formulation of the models is described and some second-moment characteristics of the rainfall depth, and aggregated processes are considered. The derived second-order properties of the accumulated rainfall amounts at different levels of aggregation are used in order to examine the model fit. A brief data analysis is presented. Copyright © 1998 John Wiley & Sons, Ltd.

Effect of long-term aging on the rheological characteristics and printing performance of lead-free solder pastes used for flip-chip assembly

Stencil printing of solder pastes is a critical stage in the SMT assembly process as a high proportion of the solder-related defects can be attributed to this stage. As the trend towards product miniaturization continues, there is a greater need for better understanding of the rheological behaviour and printing performance of new paste formulations. This fundamental understanding is crucial for achieving the repeatable solder paste deposits from board-to-board and pad-to-pad required for more reliable solder interconnections. The paper concerns a study on the effect of ageing on the rheological characteristics and printing performance of new lead-free solder pastes formulations used for flip-chip assembly applications. The objective is to correlate the rheological characteristics of aged paste samples to their printing performance. The methodology developed can be used for bench-marking new lead-free paste formulations in terms of shelf life, the potential deterioration in rheological characteristics and their printing performance.

Heavy metals in the Fal estuary, Cornwall: A study of long term contamination by mining waste and its effects on estuarine organisms. Occasional Publication of the Marine Biological Association 2

The Fal Estuary System in West Cornwall has, over many centuries, received inputs of heavy metals from various mining activities. In this context its most important tributary is the Carnon River. Analyses of organisms from the Fal Estuary have shown that some species contain abnormally high concentrations of Cu, Zn and As, especially those living in Restronguet Creek.

Long-term and regional variability of phytoplankton biomass in the Northeast Atlantic (1960-1995)

Long-term regional changes in phytoplankton biomass in the Northeast Atlantic and North Sea are investigated using data from the Continuous Plankton Recorder survey. During the last decade there have been large changes in the long-term variation in phytoplankton biomass in the Northeast Atlantic and North Sea. Most regions, particularly in the North Sea, have shown a considerable increase in phytoplankton biomass while the opposite pattern was seen in the northern oceanic region of the Northeast Atlantic. These different spatial responses show similar patterns of change to the decadal variability in sea surface temperature influenced by the North Atlantic Oscillation index. Two rare oceanographic events and their relationship to the interannual changes in phytoplankton biomass are discussed. The results highlight the importance of maintaining long-term biological monitoring programmes to assess the biological responses to slow oceanic/atmospheric processes and to rare or episodic physical events.