SummaryBackgroundSince the 1918 influenza pandemic, non-randomised studies and small clinical trials have suggested that convalescent plasma or anti-influenza hyperimmune intravenous immunoglobulin (hIVIG) might have clinical benefit for patients with influenza infection, but definitive data do not exist. We aimed to evaluate the safety and efficacy of hIVIG in a randomised controlled trial.MethodsThis randomised, double-blind, placebo-controlled trial was planned for 45 hospitals in Argentina, Australia, Denmark, Greece, Mexico, Spain, Thailand, UK, and the USA over five influenza seasons from 2013–14 to 2017–18. Adults (≥18 years of age) were admitted for hospital treatment with laboratory-confirmed influenza A or B infection and were randomly assigned (1:1) to receive standard care plus either a single 500-mL infusion of high-titre hIVIG (0·25 g/kg bodyweight, 24·75 g maximum; hIVIG group) or saline placebo (placebo group). Eligible patients had a National Early Warning score of 2 points or greater at the time of screening and their symptoms began no more than 7 days before randomisation. Pregnant and breastfeeding women were excluded, as well as any patients for whom the treatment would present a health risk. Separate randomisation schedules were generated for each participating clinical site using permuted block randomisation. Treatment assignments were obtained using a web-based application by the site pharmacist who then masked the solution for infusion. Patients and investigators were masked to study treatment. The primary endpoint was a six-category ordinal outcome of clinical status at day 7, ranging in severity from death to resumption of normal activities after discharge. The choice of day 7 was based on haemagglutination inhibition titres from a pilot study. It was analysed with a proportional odds model, using all six categories to estimate a common odds ratio (OR). An OR greater than 1 indicated that, for a given category, patients in the hIVIG group were more likely to be in a better category than those in the placebo group. Prespecified primary analyses for safety and efficacy were based on patients who received an infusion and for whom eligibility could be confirmed. This trial is registered with ClinicalTrials.gov, NCT02287467.Findings313 patients were enrolled in 34 sites between Dec 11, 2014, and May 28, 2018. We also used data from 16 patients enrolled at seven of the 34 sites during the pilot study between Jan 15, 2014, and April 10, 2014. 168 patients were randomly assigned to the hIVIG group and 161 to the placebo group. 21 patients were excluded (12 from the hIVIG group and 9 from the placebo group) because they did not receive an infusion or their eligibility could not be confirmed. Thus, 308 were included in the primary analysis. hIVIG treatment produced a robust rise in haemagglutination inhibition titres against influenza A and smaller rises in influenza B titres. Based on the proportional odds model, the OR on day 7 was 1·25 (95% CI 0·79–1·97; p=0·33). In subgroup analyses for the pr...

This study investigated factors related to successful and unsuccessful collaborations, studied the specific problems that are part of the collaboration process, and identified solutions to minimize their occurrence. Thirty-three stakeholders from nine state departments and three private social services agencies in Ohio were categorized into two groups: program chiefs and program specialists. Participants were interviewed as to their opinions on successes, problems, and solutions related to interagency collaboration. Interviews were transcribed and data were analyzed using content analysis. Significant differences were found in two areas: factors that jeopardized interagency collaboration and areas each group would change in future collaborative efforts. Based on the outcomes of this study, seven factors related to successful interagency collaboration were delineated.

A route to explain water anomalies from results on an aqueous solution of salt Salt effects on the surface tensions of dilute electrolyte solutions: The influence of nonzero relative solubility of the salt between the coexisting phases J. Chem. Phys. 80, 6225 (1984); 10.1063/1.446725The solubility of some sparingly soluble lead salts: An evaluation of the solubility in water and aqueous electrolyte solutionThe literature on the solubility of mercury and of the sparingly soluble salts of mercury-(I) and mercury (II) in water and in aqueous electrolyte solutions has been reviewed. The solubility data have been compiled and evaluated. Recommended and tentative values of Jh_e solul?Aiti es are preseI.1t¢ when warranted. AuxiliafY'thermodynamic data and crystallographic data useful in the interpretation of solubility data are given. An annotated bibliography on the solubility of some of the less common inorganic mercury compounds, with emphasis on the solubility literature published since 1950, is given.

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This investigation compared how hindlimb unweighting (HU) affected the contractile function of single soleus muscle fibers from 12- and 30-mo-old Fischer 344 Brown Norway F1 Hybrid rats. After 1 wk of HU, functional properties of single permeabilized fibers were studied, and, subsequently, the fiber type was established by myosin heavy chain (MHC) analysis. After HU, the relative mass of soleus declined by 12 and 19% and the relative mass of the gastrocnemius declined by 15 and 13% in 12- and 30-mo-old animals, respectively. In 12-mo-old animals, the peak active force (5.0 +/- 0.2 x10(-4) vs. 3.8 +/- 0.2 x10(-4) N) and the peak specific tension (92 +/- 4 vs. 78 +/- 3 kN/m2) were significantly reduced in the MHC type I fibers by 24 and 15%, respectively. In 30-mo-old animals, the peak active force declined by 40% (4.7 +/- 0.2 x10(-4) vs. 2.8 +/- 0. 3 x10(-4) N) and the peak specific tension declined by 30% (79 +/- 5 vs. 55 +/- 4 kN/m2). The maximal unloaded shortening velocity of the MHC type I fibers increased in 12-mo-old animals (from 1.65 +/- 0.12 to 2.59 +/- 0.26 fiber lengths/s) and in 30-mo-old animals (from 0.90 +/- 0. 09 to 1.50 +/- 0.10 fiber lengths/s) after HU. Collectively, these data suggest that the effects of HU on single soleus skeletal muscle fiber function occur in both age groups; however, the single MHC type I fibers from the older animals show greater changes than do single MHC type I fibers from younger animals.