Assessment of best single sample for finding chlamydia in women with and without symptoms: a diagnostic test study

Objective: to compare vulvovaginal swabs with endocervical swabs as optimal diagnostic sample for detection of Chlamydia trachomatis infection. Design: a diagnostic test study. Setting: an urban sexual health centre. Participants: 3973 women aged ≥16 years requesting testing for sexually transmitted infections. Interventions: participants took a vulvovaginal swab before routine examination, and clinicians took an endocervical swab during examination. Main outcome measure: diagnosis of chlamydia infection with samples analysed using the Aptima Combo-2 assay; positive results confirmed with the Aptima CT assay. Results: of the 3973 participants, 410 (10.3%) were infected with C trachomatis. Infected women were significantly younger (22 v 25 years, P<0.0001) and more likely to have symptoms suggestive of a bacterial sexually transmitted infection (53% v 41%, odds ratio 1.63 (95% CI 1.30 to 2.04)), be a contact of someone with a sexually transmitted infection (25% v 5%, odds ratio 6.18 (4.61 to 8.30)), clinically diagnosed with cervicitis (17% v 4%, odds ratio 4.92 (3.50 to 6.91)), and have pelvic inflammatory disease (9% v 3%, odds ratio 2.85 (1.87 to 4.33)). When women co-infected with gonorrhoea were included in the analysis, there was an association with mixed ethnicity (10% v 7%, odds ratio 1.53 (1.07 to 2.17)); but when those with gonorrhoea were removed, women of white ethnicity were significantly more likely to have chlamydia (85% v 80%, odds ratio 1.40 (1.03 to 1.91)). On analysis of complete paired results, vulvovaginal swabs were significantly more sensitive than endocervical swabs (97% (95% CI 95% to 98%) v 88% (85% to 91%), P<0.00001); corresponding specificities were 99.9% and 100%. In women with symptoms suggestive of a bacterial sexually transmitted infection, vulvovaginal swabs were significantly more sensitive than endocervical swabs (97% (93% to 98%) v 88% (83% to 92%), P=0.0008), as they were in women without symptoms (97% (94% to 99%) v 89% (84% to 93%), P=0.002). Conclusions: vulvovaginal swabs are significantly better than endocervical swabs at detecting chlamydia in women with and without symptoms suggestive of sexually transmitted infections. In those with symptoms, using endocervical samples rather than vulvovaginal swabs would have missed 9% of infections, or 1 in every 11 cases of chlamydia

The chemistry of protoplanetary fragments formed via gravitational instabilities

In this paper, we model the chemical evolution of a 0.25 M$_{\odot}$ protoplanetary disc surrounding a 1 M$_{\odot}$ star that undergoes fragmentation due to self-gravity. We use Smoothed Particle Hydrodynamics including a radiative transfer scheme, along with time-dependent chemical evolution code to follow the composition of the disc and resulting fragments over approximately 4000 yrs. Initially, four quasi-stable fragments are formed, of which two are eventually disrupted by tidal torques in the disc. From the results of our chemical modelling, we identify species that are abundant in the fragments (e.g. H$_{\rm 2}$O, H$_{\rm 2}$S, HNO, N$_{\rm 2}$, NH$_{\rm 3}$, OCS, SO), species that are abundant in the spiral shocks within the disc (e.g. CO, CH$_{\rm 4}$, CN, CS, H$_{\rm 2}$CO), and species which are abundant in the circumfragmentary material (e.g. HCO$^{\rm +}$). Our models suggest that in some fragments it is plausible for grains to sediment to the core before releasing their volatiles into the planetary envelope, leading to changes in, e.g., the C/O ratio of the gas and ice components. We would therefore predict that the atmospheric composition of planets generated by gravitational instability should not necessarily follow the bulk chemical composition of the local disc material

Holography at an Extremal De Sitter Horizon

Rotating maximal black holes in four-dimensional de Sitter space, for which the outer event horizon coincides with the cosmological horizon, have an infinite near-horizon region described by the rotating Nariai metric. We show that the asymptotic symmetry group at the spacelike future boundary of the near-horizon region contains a Virasoro algebra with a real, positive central charge. This is evidence that quantum gravity in a rotating Nariai background is dual to a two-dimensional Euclidean conformal field theory. These results are related to the Kerr/CFT correspondence for extremal black holes, but have two key differences: one of the black hole event horizons has been traded for the cosmological horizon, and the near-horizon geometry is a fiber over dS_2 rather than AdS_2.Comment: 15 page

Pre-cooling for endurance exercise performance in the heat: a systematic review.

PMCID: PMC3568721The electronic version of this article is the complete one and can be found online at: http://www.biomedcentral.com/1741-7015/10/166. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.Endurance exercise capacity diminishes under hot environmental conditions. Time to exhaustion can be increased by lowering body temperature prior to exercise (pre-cooling). This systematic literature review synthesizes the current findings of the effects of pre-cooling on endurance exercise performance, providing guidance for clinical practice and further research

A de Sitter Hoedown

Rotating black holes in de Sitter space are known to have interesting limits where the temperatures of the black hole and cosmological horizon are equal. We give a complete description of the thermal phase structure of all allowed rotating black hole configurations. Only one configuration, the rotating Nariai limit, has the black hole and cosmological horizons both in thermal and rotational equilibrium, in that both the temperatures and angular velocities of the two horizons coincide. The thermal evolution of the spacetime is shown to lead to the pure de Sitter spacetime, which is the most entropic configuration. We then provide a comprehensive study of the wave equation for a massless scalar in the rotating Nariai geometry. The absorption cross section at the black hole horizon is computed and a condition is found for when the scattering becomes superradiant. The boundary-to-boundary correlators at finite temperature are computed at future infinity. The quasinormal modes are obtained in explicit form. Finally, we obtain an expression for the expectation value of the number of particles produced at future infinity starting from a vacuum state with no incoming particles at past infinity. Some of our results are used to provide further evidence for a recent holographic proposal between the rotating Nariai geometry and a two-dimensional conformal field theory.Comment: 35 + 1 pages, 9 figures; v3: typos correcte

Deformation of Codimension-2 Surface and Horizon Thermodynamics

The deformation equation of a spacelike submanifold with an arbitrary codimension is given by a general construction without using local frames. In the case of codimension-1, this equation reduces to the evolution equation of the extrinsic curvature of a spacelike hypersurface. In the more interesting case of codimension-2, after selecting a local null frame, this deformation equation reduces to the well known (cross) focusing equations. We show how the thermodynamics of trapping horizons is related to these deformation equations in two different formalisms: with and without introducing quasilocal energy. In the formalism with the quasilocal energy, the Hawking mass in four dimension is generalized to higher dimension, and it is found that the deformation of this energy inside a marginal surface can be also decomposed into the contributions from matter fields and gravitational radiation as in the four dimension. In the formalism without the quasilocal energy, we generalize the definition of slowly evolving future outer trapping horizons proposed by Booth to past trapping horizons. The dynamics of the trapping horizons in FLRW universe is given as an example. Especially, the slowly evolving past trapping horizon in the FLRW universe has close relation to the scenario of slow-roll inflation. Up to the second order of the slowly evolving parameter in this generalization, the temperature (surface gravity) associated with the slowly evolving trapping horizon in the FLRW universe is essentially the same as the one defined by using the quasilocal energy.Comment: Latex, 61 pages, no figures; v2, type errors corrected; v3, references and comments are added, English is improved, to appear in JHE

Holography For a De Sitter-Esque Geometry

Warped dS$_3$ arises as a solution to topologically massive gravity (TMG) with positive cosmological constant $+1/\ell^2$ and Chern-Simons coefficient $1/\mu$ in the region $\mu^2 \ell^2 < 27$. It is given by a real line fibration over two-dimensional de Sitter space and is equivalent to the rotating Nariai geometry at fixed polar angle. We study the thermodynamic and asymptotic structure of a family of geometries with warped dS$_3$ asymptotics. Interestingly, these solutions have both a cosmological horizon and an internal one, and their entropy is unbounded from above unlike black holes in regular de Sitter space. The asymptotic symmetry group resides at future infinity and is given by a semi-direct product of a Virasoro algebra and a current algebra. The right moving central charge vanishes when $\mu^2 \ell^2 = 27/5$. We discuss the possible holographic interpretation of these de Sitter-esque spacetimes.Comment: 22 pages, 1 figure; v2: typos corrected, to match with published versio

Isolated and dynamical horizons and their applications

Over the past three decades, black holes have played an important role in quantum gravity, mathematical physics, numerical relativity and gravitational wave phenomenology. However, conceptual settings and mathematical models used to discuss them have varied considerably from one area to another. Over the last five years a new, quasi-local framework was introduced to analyze diverse facets of black holes in a unified manner. In this framework, evolving black holes are modeled by dynamical horizons and black holes in equilibrium by isolated horizons. We review basic properties of these horizons and summarize applications to mathematical physics, numerical relativity and quantum gravity. This paradigm has led to significant generalizations of several results in black hole physics. Specifically, it has introduced a more physical setting for black hole thermodynamics and for black hole entropy calculations in quantum gravity; suggested a phenomenological model for hairy black holes; provided novel techniques to extract physics from numerical simulations; and led to new laws governing the dynamics of black holes in exact general relativity.Comment: 77 pages, 12 figures. Typos and references correcte

Addressing Potential Conflicts of Interest Arising from the Multiple Roles of Colorado’s Community Centered Boards

This document summarizes the information we gathered, our analysis of potential conflicts of interest, and recommendations for addressing opportunities for improvement. The information we gathered is based on document review, input from stakeholders, and a review of practices in four other states

New approaches to measuring anthelminthic drug efficacy: parasitological responses of childhood schistosome infections to treatment with praziquantel

By 2020, the global health community aims to control and eliminate human helminthiases, including schistosomiasis in selected African countries, principally by preventive chemotherapy (PCT) through mass drug administration (MDA) of anthelminthics. Quantitative monitoring of anthelminthic responses is crucial for promptly detecting changes in efficacy, potentially indicative of emerging drug resistance. Statistical models offer a powerful means to delineate and compare efficacy among individuals, among groups of individuals and among populations.; We illustrate a variety of statistical frameworks that offer different levels of inference by analysing data from nine previous studies on egg counts collected from African children before and after administration of praziquantel.; We quantify responses to praziquantel as egg reduction rates (ERRs), using different frameworks to estimate ERRs among population strata, as average responses, and within strata, as individual responses. We compare our model-based average ERRs to corresponding model-free estimates, using as reference the World Health Organization (WHO) 90 % threshold of optimal efficacy. We estimate distributions of individual responses and summarize the variation among these responses as the fraction of ERRs falling below the WHO threshold.; Generic models for evaluating responses to anthelminthics deepen our understanding of variation among populations, sub-populations and individuals. We discuss the future application of statistical modelling approaches for monitoring and evaluation of PCT programmes targeting human helminthiases in the context of the WHO 2020 control and elimination goals