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To develop a pediatric research agenda focused on pediatric healthcare-associated infections and antimicrobial stewardship topics that will yield the highest impact on child health.
The study included 26 geographically diverse adult and pediatric infectious diseases clinicians with expertise in healthcare-associated infection prevention and/or antimicrobial stewardship (topic identification and ranking of priorities), as well as members of the Division of Healthcare Quality and Promotion at the Centers for Disease Control and Prevention (topic identification).
Using a modified Delphi approach, expert recommendations were generated through an iterative process for identifying pediatric research priorities in healthcare associated infection prevention and antimicrobial stewardship. The multistep, 7-month process included a literature review, interactive teleconferences, web-based surveys, and 2 in-person meetings.
A final list of 12 high-priority research topics were generated in the 2 domains. High-priority healthcare-associated infection topics included judicious testing for Clostridioides difficile infection, chlorhexidine (CHG) bathing, measuring and preventing hospital-onset bloodstream infection rates, surgical site infection prevention, surveillance and prevention of multidrug resistant gram-negative rod infections. Antimicrobial stewardship topics included β-lactam allergy de-labeling, judicious use of perioperative antibiotics, intravenous to oral conversion of antimicrobial therapy, developing a patient-level “harm index” for antibiotic exposure, and benchmarking and or peer comparison of antibiotic use for common inpatient conditions.
We identified 6 healthcare-associated infection topics and 6 antimicrobial stewardship topics as potentially high-impact targets for pediatric research.
Determination of antibodies against ToRCH antigens at the beginning of pregnancy allows assessment of both the maternal immune status and the risks to an adverse pregnancy outcome. Age-standardised seroprevalences were determined in sera from 1009 women of childbearing age residing in Mexico, Brazil, Germany, Poland, Turkey or China using a multiparametric immunoblot containing antigen substrates for antibodies against Toxoplasma gondii, rubella virus, cytomegalovirus (CMV), herpes simplex viruses (HSV-1, HSV-2), Bordetella pertussis, Chlamydia trachomatis, parvovirus B19, Treponema pallidum and varicella zoster virus (VZV). Seroprevalences for antibodies against HSV-1 were >90% in samples from Brazil and Turkey, whereas the other four countries showed lower mean age-adjusted seroprevalences (range: 62.5–87.9%). Samples from Brazilian women showed elevated seroprevalences of antibodies against HSV-2 (40.1%), C. trachomatis (46.8%) and B. pertussis (56.6%) compared to the other five countries. Seroprevalences of anti-T. gondii antibodies (0.5%) and anti-parvovirus B19 antibodies (7.5%) were low in samples from Chinese women, compared to the other five countries. Samples from German women revealed a low age-standardised seroprevalence of anti-CMV antibodies (28.8%) compared to the other five countries. These global differences in immune status of women in childbearing age advocate country-specific prophylaxis strategies to avoid infection with ToRCH pathogens.
Previous genetic association studies have failed to identify loci robustly associated with sepsis, and there have been no published genetic association studies or polygenic risk score analyses of patients with septic shock, despite evidence suggesting genetic factors may be involved. We systematically collected genotype and clinical outcome data in the context of a randomized controlled trial from patients with septic shock to enrich the presence of disease-associated genetic variants. We performed genomewide association studies of susceptibility and mortality in septic shock using 493 patients with septic shock and 2442 population controls, and polygenic risk score analysis to assess genetic overlap between septic shock risk/mortality with clinically relevant traits. One variant, rs9489328, located in AL589740.1 noncoding RNA, was significantly associated with septic shock (p = 1.05 × 10–10); however, it is likely a false-positive. We were unable to replicate variants previously reported to be associated (p < 1.00 × 10–6 in previous scans) with susceptibility to and mortality from sepsis. Polygenic risk scores for hematocrit and granulocyte count were negatively associated with 28-day mortality (p = 3.04 × 10–3; p = 2.29 × 10–3), and scores for C-reactive protein levels were positively associated with susceptibility to septic shock (p = 1.44 × 10–3). Results suggest that common variants of large effect do not influence septic shock susceptibility, mortality and resolution; however, genetic predispositions to clinically relevant traits are significantly associated with increased susceptibility and mortality in septic individuals.
Existing research has suggested children of caregivers with histories of exposure to trauma are at heightened risk for victimization, but few studies have explored potential mechanisms that explain this intergenerational transmission of risk. With data from peri-urban households in Lima, Peru (N = 402), this study analyzes parenting behaviors in the relation between caregivers’ trauma history and child victimization for children aged 4–17. Results indicated caregivers’ trauma history and negative parenting behaviors related to child victimization, and negative parenting behaviors mediated this relation. Positive parenting behaviors did not have significant direct effects and were not mediators of risk transmission. Parenting behaviors did not moderate the relation between caregiver and child victimization, suggesting parenting behaviors may not buffer or exacerbate intergenerational transmission. Post-hoc analyses revealed family type (e.g., single, cohabitating/married) exerted significant direct and moderating effects on child risk, interacting with positive parenting. Families with married/cohabitating caregivers reported overall lower levels of child victimization; however, the relation between positive parenting and victimization was slightly stronger for children in single-parent families. Results highlight potential pathways of the intergenerational cycle of victimization and suggest high-risk families in Peru may benefit from parenting supports, especially pertaining to remediation of negative parenting behaviors.
It is known that pigs can acquire flavour preferences by brief social interactions with conspecifics that previously consumed a flavoured solid feed. However, there is no information about whether a flavoured solution could support flavour preferences through social transmission. Ninety-six pigs (49 days old) were housed in 12 pens (8 pigs/pen). Four animals per pen were randomly selected to act as observers and four as demonstrators. Demonstrator animals were temporarily moved to an empty pen where a protein solution was offered (porcine digestive peptides (PDPs), 4% weight/volume) with the addition of 0.075% aniseed (six pens) or garlic (six pens) powdered artificial flavours for 30 min. Afterwards, demonstrators were returned to interact with observer animals for 30 min. A choice test (30 min) between aniseed and garlic PDP was performed for each observer group after the interaction. Observers showed a higher intake of solutions previously consumed by their demonstrator conspecifics (648 v. 468 ml; SEM 61.36, P < 0.05). As with flavoured solid feeds, protein solutions containing artificial flavours can create preferences in pigs for those flavours through social transmission from conspecifics.
Many Spanish chroniclers detail violent cultural practices of the indigenous populations they encountered in the Isthmo-Colombian Area; however, lack of physical evidence of interpersonal violence from archaeological contexts has made uncertain the veracity of these claims. At the precolumbian site of Playa Venado in Panama, these accounts of violent mortuary rituals may have influenced the interpretation of the burials encountered in excavations, leading to claims of mutilations and sacrifice, with little or no supporting evidence. This paper considers the physical evidence for interpersonal violence and sacrificial death at Playa Venado based on the burial positioning, demographic composition, and trauma present on the human remains recovered from the site. Analysis of field notes, excavation photos, and the 77 individuals available for study from the site yielded no evidence of perimortem trauma nor abnormal body positioning unexplained by taphonomy. The demography at the site tracked with normal patterns of natural age-at-death at the non-elite site of Cerro Juan Díaz rather than the abnormal patterns seen at the large ceremonial sites of Sitio Conte and El Caño. Therefore, we propose an alternative interpretation of the site as a non-elite cemetery containing evidence of re-use and secondary burial practices associated with ancestor veneration rituals.
Social workers all around the world work with families and family complexity in their everyday practice. In this article, we present findings from a cross-national study exploring how social workers in child welfare conceptualise ‘family’, and how they relate to ‘family’ in their practice. Data presented is taken from focus groups with twenty-eight social workers from Chile, Mexico and Norway. The findings reveal that in Chilean, Mexican, and Norwegian social work, the conceptualisation of family has expanded over time, acknowledging various family forms and displays, and an increased orientation towards networks regardless of biological ties. However, differences were found, particularly in the way professionals view extended family, perspectives on family intervention, and the position of children in the family. Practical implications will be discussed.
Habits are behavioral routines that are automatic and frequent, relatively independent of any desired outcome, and have potent antecedent cues. Among individuals with anorexia nervosa (AN), behaviors that promote the starved state appear habitual, and this is the foundation of a recent neurobiological model of AN. In this proof-of-concept study, we tested the habit model of AN by examining the impact of an intervention focused on antecedent cues for eating disorder routines.
The primary intervention target was habit strength; we also measured clinical impact via eating disorder psychopathology and actual eating. Twenty-two hospitalized patients with AN were randomly assigned to 12 sessions of either Supportive Psychotherapy or a behavioral intervention aimed at cues for maladaptive behavioral routines, Regulating Emotions and Changing Habits (REaCH).
Covarying for baseline, REaCH was associated with a significantly lower Self-Report Habit Index (SRHI) score and significantly lower Eating Disorder Examination-Questionnaire (EDE-Q) global score at the end-of-treatment. The end-of-treatment effect size for SRHI was d = 1.28, for EDE-Q was d = 0.81, and for caloric intake was d = 1.16.
REaCH changed habit strength of maladaptive routines more than an active control therapy, and targeting habit strength yielded improvement in clinically meaningful measures. These findings support a habit-based model of AN, and suggest habit strength as a mechanism-based target for intervention.
We describe the performance of the Boolardy Engineering Test Array, the prototype for the Australian Square Kilometre Array Pathfinder telescope. Boolardy Engineering Test Array is the first aperture synthesis radio telescope to use phased array feed technology, giving it the ability to electronically form up to nine dual-polarisation beams. We report the methods developed for forming and measuring the beams, and the adaptations that have been made to the traditional calibration and imaging procedures in order to allow BETA to function as a multi-beam aperture synthesis telescope. We describe the commissioning of the instrument and present details of Boolardy Engineering Test Array’s performance: sensitivity, beam characteristics, polarimetric properties, and image quality. We summarise the astronomical science that it has produced and draw lessons from operating Boolardy Engineering Test Array that will be relevant to the commissioning and operation of the final Australian Square Kilometre Array Path telescope.
The Millimetre Astronomy Legacy Team 90 GHz survey aims to characterise the physical and chemical evolution of high-mass clumps. Recently completed, it mapped 90 GHz line emission towards 3 246 high-mass clumps identified from the ATLASGAL 870 μm Galactic plane survey. By utilising the broad frequency coverage of the Mopra telescope’s spectrometer, maps in 16 different emission lines were simultaneously obtained. Here, we describe the first catalogue of the detected line emission, generated by Gaussian profile fitting to spectra extracted towards each clumps’ 870 μm dust continuum peak. Synthetic spectra show that the catalogue has a completeness of > 95%, a probability of a false-positive detection of < 0.3%, and a relative uncertainty in the measured quantities of < 20% over the range of detection criteria. The detection rates are highest for the (1–0) transitions of HCO+, HNC, N2H+, and HCN (~77–89%). Almost all clumps (~95%) are detected in at least one of the molecular transitions, just over half of the clumps (~53%) are detected in four or more of the transitions, while only one clump is detected in 13 transitions. We find several striking trends in the ensemble of properties for the different molecular transitions when plotted as a function of the clumps’ evolutionary state as estimated from Spitzer mid-IR images, including (1) HNC is relatively brighter in colder, less evolved clumps than those that show active star formation, (2) N2H+ is relatively brighter in the earlier stages, (3) that the observed optical depth decreases as the clumps evolve, and (4) the optically thickest HCO+ emission shows a ‘blue-red asymmetry’ indicating overall collapse that monotonically decreases as the clumps evolve. This catalogue represents the largest compiled database of line emission towards high-mass clumps and is a valuable data set for detailed studies of these objects.
Energy reserve, estimated as body condition score (BCS), is the major determinant of the re-initiation of ovarian activity in postpartum cows. Leptin, IGF-I and insulin are positively related to BCS and are putative mediators between BCS and reproductive function. However, when BCS and body composition dissociates, concentrations of these metabolic hormones are altered. We hypothesized that increasing lean muscle tissue, but not fat tissue, would diminish the reproductive response to oestrus induction treatments. Thirty lactating beef cows with BCS of 3.10±1.21 and 75.94±12 days postpartum were divided in two groups. Control cows (n=15) were supplemented with 10.20 kg of concentrate daily for 60 days. Treated cows (n=15) were supplemented equally, and received a β-adrenergic receptor agonist (β-AA; 0.15 mg/kg BW) to achieve accretion of lean tissue mass and not fat tissue mass. Twelve days after ending concentrate supplementation/β-AA treatment, cows received a progestin implant to induce oestrus. Cows displaying oestrus were inseminated during the following 60 days, and maintained with a fertile bull for a further 21 days. Cows in both groups gained weight during the supplementation period (Daily weight gain: Control=0.75 kg v. β-AA=0.89 kg). Cows treated with β-AA had a larger increase in BCS (i.e. change in BCS: control=1 point (score 4.13) v. β-AA=2 points (score 5.06; P<0.05), as a result of muscle accretion (i.e. change in muscle depth: control 0.21 cm v. β-AA 0.97 cm; P<0.05) but not adipose tissue (i.e. change in back fat depth; control 0.13 cm v. β-AA −0.06 cm; P<0.05). The changes in body composition in β-AA cows were associated with a reduction in serum concentrations of IGF-I (25.4%) and leptin (27.9%), without observed changes in insulin. Ovulation and pregnancy to 1st service (P>0.05) did not differ between groups. However, the number of cows displaying oestrus (control 13/15 v. β-AA 8/15; P<0.05) and the percentage cycling (control 6/8 v. β-AA 3/10; P=0.07) after progestin treatment and the pregnancy percentage at the end of the breeding period (control 13/15 v. β-AA 8/15; P<0.05) were lower in β-AA than control cows. In summary, the increase BCS through muscle tissue accretion, but not through fat tissue accretion, resulted in a lower response to oestrus induction, lower percentage of cycling animals and lower pregnancy percentage after progestin treatment; which was associated with a decrease in serum concentrations of leptin and IGF-I.
I deficiency is still a worldwide public health problem, with children being especially vulnerable. No nationwide study had been conducted to assess the I status of Spanish children, and thus an observational, multicentre and cross-sectional study was conducted in Spain to assess the I status and thyroid function in schoolchildren aged 6–7 years. The median urinary I (UI) and thyroid-stimulating hormone (TSH) levels in whole blood were used to assess the I status and thyroid function, respectively. A FFQ was used to determine the consumption of I-rich foods. A total of 1981 schoolchildren (52 % male) were included. The median UI was 173 μg/l, and 17·9 % of children showed UI<100 μg/l. The median UI was higher in males (180·8 v. 153·6 μg/l; P<0·001). Iodised salt (IS) intake at home was 69·8 %. IS consumption and intakes of ≥2 glasses of milk or 1 cup of yogurt/d were associated with significantly higher median UI. Median TSH was 0·90 mU/l and was higher in females (0·98 v. 0·83; P<0·001). In total, 0·5 % of children had known hypothyroidism (derived from the questionnaire) and 7·6 % had TSH levels above reference values. Median TSH was higher in schoolchildren with family history of hypothyroidism. I intake was adequate in Spanish schoolchildren. However, no correlation was found between TSH and median UI in any geographical area. The prevalence of TSH above reference values was high and its association with thyroid autoimmunity should be determined. Further assessment of thyroid autoimmunity in Spanish schoolchildren is desirable.
Predisposition to offspring metabolic dysfunction due to poor maternal nutrition differs with the developmental stage at exposure. Post-weaning nutrition also influences offspring phenotype in either adverse or beneficial ways. We studied a well-established rat maternal protein-restriction model to determine whether post-weaning dietary intervention improves adverse outcomes produced by a deficient maternal nutritional environment in pregnancy. Pregnant rats were fed a controlled diet (C, 20% casein) during pregnancy and lactation (CC) or were fed a restricted diet (R, 10% casein isocaloric diet) during pregnancy and C diet during lactation (RC). After weaning, the offspring were fed the C diet. At postnatal day (PND) 70 (young adulthood), female offspring either continued with the C diet (CCC and RCC) or were fed commercial Chow Purina 5001 (I) to further divide the animals into dietary intervention groups CCI and RCI. Another group of mothers and offspring were fed I throughout (III). Offspring food intake was averaged between PND 95–110 and 235–250 and carcass and liver compositions were measured at PND 25 and 250. Leptin (PND 110 and 250) and serum glucose, triglycerides and cholesterol (PND 250) levels were measured. Statistical analysis was carried out using ANOVA. At PND 25, body and liver weights were similar between groups; however, CCC and RCC carcass protein:fat ratios were lower compared with III diet. At PND 110 and 250, offspring CCC and RCC had higher body weight, food intake and serum leptin compared with CCI and RCI. CCI had lower carcass fat and increased protein compared with CCC and improved fasting glucose and triglycerides. Adult dietary intervention partially overcomes adverse effects of programming. Further studies are needed to determine the mechanisms involved.
This paper describes the system architecture of a newly constructed radio telescope – the Boolardy engineering test array, which is a prototype of the Australian square kilometre array pathfinder telescope. Phased array feed technology is used to form multiple simultaneous beams per antenna, providing astronomers with unprecedented survey speed. The test array described here is a six-antenna interferometer, fitted with prototype signal processing hardware capable of forming at least nine dual-polarisation beams simultaneously, allowing several square degrees to be imaged in a single pointed observation. The main purpose of the test array is to develop beamforming and wide-field calibration methods for use with the full telescope, but it will also be capable of limited early science demonstrations.
An experimental investigation was conducted to study the dynamical behaviour of a model valve in a pulsatile flow. The valve is modelled as a pair of curved, rectangular, flexible leaflets that open and close under a time-periodic flow. Using image analysis, the range of flow parameters for which a valve (of a particular geometry and material properties of the leaflets) works correctly were identified. A correct performance was considered to be when the valve opened in one direction but blocked the flow in the reversed direction. A model is proposed to predict the performance of the valves. Furthermore, an analysis of fluid strains is conducted for valves that operate correctly to identify the influence of the valve’s design on fluid stresses. The main purpose of this investigation is to gain insight for the design of future prosthetic heart valves.
The ferroic phase transition in LaEr(MoO4)3 has been analyzed for the first time. It has been confirmed that this compound undergoes a phase transition from a tetragonal system (paraelectric-paraelastic phase), with space group P-421m [β-Gd2(MoO4)3 averaged phase] to an orthorhombic system (ferroelectric-ferroelastic phase), with space group Pba2 [β'-Gd2(MoO4)3 phase] in a reversible process. This phenomenon, together with the observed demixing at high temperature has been studied using different techniques. LaEr(MoO4)3 samples have been obtained by the conventional solid-state synthesis. The thermal dependence of the crystal structure was studied by powder X-ray and neutron diffraction, following a new refining procedure in which the symmetry modes of atomic displacements from the paraelectric-paraelastic structure were analyzed. Dielectric spectroscopy measurements have confirmed the structural results, showing a very smooth phase transition. Finally, calculations within the framework of Density Functional Theory show a behavior of the lattice parameters similar to that observed in our experiments.
Two polymorphs of Holmium molybdate, known as β'-phase and γ-phase, were prepared by solid state reaction with different thermal treatments. These polycrystalline samples have been studied for the first time by X-ray thermodiffractometry from room temperature up to 1300 K. We found that the initial β'-phase undergoes a transition to a β-phase and then to a γ-phase. The γ (hydrated)-phase, turns to the γ (dehydrated)-phase and then to the β-phase. Each sequence involves a reversible and an irreversible phase transition for Ho2(MoO4)3. Both polymorphs have remarkable physical properties like nonlinear optics, ferroelectricity and negative thermal expansion. We have calculated the linear expansion coefficients of both phases. We have obtained a positive coefficient for the β'-phase and a negative one for the γ-phase. Moreover, we have made a comparison of the obtained coefficients with previous results for other rare earth molybdates.
Ultra-high molecular weight polyethylene/graphite nanocomposites were prepared by high-energy cryogenic milling followed by syntering. Microstructure changes shows that graphite was reduced to graphite nanoplatelets by high-energy cryomilling and partial exfoliation of graphite to few layered graphene nanoplatelets occurred in a small extent. The resulting nanocomposites revealed high electrical conductivity and good mechanical performance. Thermal characterization of the nanocomposites was also carried out by differential scanning calorimetry.