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Culture-based studies, which focus on individual organisms, have implicated stethoscopes as potential vectors of nosocomial bacterial transmission. However, the full bacterial communities that contaminate in-use stethoscopes have not been investigated.
We used bacterial 16S rRNA gene deep-sequencing, analysis, and quantification to profile entire bacterial populations on stethoscopes in use in an intensive care unit (ICU), including practitioner stethoscopes, individual-use patient-room stethoscopes, and clean unused individual-use stethoscopes. Two additional sets of practitioner stethoscopes were sampled before and after cleaning using standardized or practitioner-preferred methods.
Bacterial contamination levels were highest on practitioner stethoscopes, followed by patient-room stethoscopes, whereas clean stethoscopes were indistinguishable from background controls. Bacterial communities on stethoscopes were complex, and community analysis by weighted UniFrac showed that physician and patient-room stethoscopes were indistinguishable and significantly different from clean stethoscopes and background controls. Genera relevant to healthcare-associated infections (HAIs) were common on practitioner stethoscopes, among which Staphylococcus was ubiquitous and had the highest relative abundance (6.8%–14% of contaminating bacterial sequences). Other HAI-related genera were also widespread although lower in abundance. Cleaning of practitioner stethoscopes resulted in a significant reduction in bacterial contamination levels, but these levels reached those of clean stethoscopes in only a few cases with either standardized or practitioner-preferred methods, and bacterial community composition did not significantly change.
Stethoscopes used in an ICU carry bacterial DNA reflecting complex microbial communities that include nosocomially important taxa. Commonly used cleaning practices reduce contamination but are only partially successful at modifying or eliminating these communities.
A transannular patch is often used in the contemporary surgical repair of tetralogy of Fallot. This can lead to significant pulmonary insufficiency and increased right ventricular volumes and ultimately pulmonary valve replacement. Cardiopulmonary exercise testing is used to assess exercise capacity in tetralogy of Fallot patients before pulmonary valve replacement. There is only few published literatures on how lung function affects functional capacity in tetralogy of Fallot patients repaired with a transannular patch.
A retrospective chart review was done from 2015 to 2017 on patients with tetralogy of Fallot who underwent maximal effort cardiopulmonary exercise testing with cycle ergometry and with concurrent pulmonary function testing. Tetralogy of Fallot patients repaired with a transannular patch without pulmonary valve replacement were compared with age, gender, and size-matched normal controls.
In the tetralogy of Fallot group, 24 out of 57 patients underwent primary repair with a transannular patch. When compared to the normal controls, they demonstrated abnormal predicted forced expiratory volume in one second (79 ± 23.1% versus 90.7 ± 14.1%, p<0.05), predicted maximal voluntary ventilation (74 ± 18% versus 90.5 ± 16.2%, p<0.05) while having low-normal predicted forced vital capacity (80.5 ± 17.2% versus 90.2 ± 12.4%, p<0.05) and normal breathing reserve percentage (50.3 ± 11.3% versus 47.5 ± 17.3%, p = 0.52). Cardiopulmonary exercise testing abnormalities included significantly lower percent predicted oxygen consumption (63.2 ± 12.2% versus 87 ± 12.1%, p<0.05), maximal heart rate (171.8 ± 18.9 versus 184.6 ± 13.6, p<0.05), and percent predicted maximum workload (61.7 ± 15.9% versus 88.3 ± 21.5%, p<0.05).
Tetralogy of Fallot patients repaired with a transannular patch can have abnormal pulmonary function testing with poor exercise capacity in addition to chronotropic incompetence and impaired muscular power.
This article presents the results of a program of radiocarbon dating and Bayesian modeling from the precontact Yup'ik site of Nunalleq (GDN-248) in subarctic southwestern Alaska. Nunalleq is deeply stratified, presenting a robust relative chronological framework of well-defined individual house floors abundant in ecofacts suitable for radiocarbon dating. Capitalizing on this potential, we present the results of one of the first applications of Bayesian statistical modeling of radiocarbon data from an archaeological site in the North American Arctic. Using these methods, we demonstrate that it is possible to generate robust, high-resolution chronological models from Arctic archaeology. Radiocarbon dates, procured prior to the program of dating and modeling presented here, suggested an approximately three-century duration of occupation at the site. The results of Bayesian modeling nuance this interpretation. While it is possible that there may have been activity for almost three centuries (beginning in the late fourteenth century), occupation of the dwelling complex, which dominates the site, was more likely to have endured for no more than a century. The results presented here suggest that the occupation of Nunalleq likely encompassed three generations beginning cal AD 1570–1630 before being curtailed by conflict around cal AD 1645–1675.
The objective of the present study was to evaluate the growth and tolerance in healthy, term infants consuming a synbiotic formula with daily weight gain as the primary outcome. In a randomised, controlled, double-blind, multicentre, intervention study infants were assigned to an extensively hydrolysed formula containing a specific combination of Bifidobacterium breve M-16V and a prebiotic mixture (short-chain galacto-oligosaccharides and long-chain fructo-oligosaccharides in a 9:1 ratio; scGOS/lcFOS; synbiotic group), or the same formula without this synbiotic concept for 13 weeks (control group). Anthropometry, formula intake, tolerance, stool characteristics, blood parameters, faecal microbiota and metabolic faecal profile were assessed. Medically confirmed adverse events were recorded throughout the study. Equivalence in daily weight gain was demonstrated for the intention-to-treat (ITT) population (n 211). In the per-protocol (PP) population (n 102), the 90 % CI of the difference in daily weight gain slightly crossed the lower equivalence margin. During the intervention period, the mean weight-for-age and length-for-age values were close to the median of the WHO growth standards in both groups, indicating adequate growth. The number of adverse events was not different between both groups. No relevant differences were observed in blood parameters indicative for liver and renal function. At 13 weeks, an increased percentage of faecal bifidobacteria (60 v. 48 %) and a reduced percentage of Clostridium lituseburense/C. histolyticum (0·2 v. 2·6 %) were observed in the synbiotic group (n 19) compared with the control group (n 27). In conclusion, this study demonstrates that an extensively hydrolysed formula with B. breve M-16V and the prebiotic mixture scGOS/lcFOS (9:1) supports an adequate infant growth.
Boars have a decisive impact on the progress in pig production, however, there is no recent information about the optimal growth parameters during the rearing period for modern breed later used in artificial insemination (AI) stations. Therefore, the objective of the research was to conduct semen parameter and conception rate analyses on the basis of growth rate and meat content assessments made during the rearing of AI boars of different genotypes. The study was carried out between 2010 and 2014 and included 184 boars in five breed combinations: 46 Polish Large White, 50 Polish Landrace, 27 Pietrain, 36 Duroc×Pietrain and 25 Hampshire×Pietrain. Boars were qualified by daily gains and meat content assessment (between 170 and 210 days of life). A total number of 38 272 ejaculates were examined (semen volume (ml), spermatozoa concentration (×106 ml−1), total number of spermatozoa (×109) and number of insemination doses from one ejaculate (n)). The fertility was determined by the conception rate (%). Semen volume, spermatozoa concentration and conception rate (P<0.01), followed by the total number of spermatozoa and insemination doses (P<0.05) were characterized by the highest variability in relation to breed of boars. The effect of daily gains was reported for spermatozoa concentration, number of insemination doses, conception rate (all P<0.01) and total number of spermatozoa (P<0.05). The peak of growth for spermatozoa concentration, total number of spermatozoa, insemination doses and conception rate was achieved for 800 to 850 g gains. Meat content affected semen volume, number of insemination doses and conception rate (P<0.05). Rearing boars while maintaining daily gains at the 800 to 850 g level and 62.5% to 65% meat content helps AI stations to increase the efficiency and economic profitability, and the number of insemination doses to increase by up to 300 doses/boar within a year. The analyses of growth parameters may help increase the efficiency and economic viability of AI stations.
This note studies the addendum to the Arctic Council (AC)'s 2013 Observer Manual adopted at the Senior Arctic Officials’ (SAO) meeting in Anchorage, Alaska, in October 2015. The amendment means another essential step to systematise further and improve the council's working relations with currently 32 entities that hold observer status in the forum. Compared to the initial manual that sketched out the role observers should play in the council's subsidiary bodies, the latest revisions delineate a framework for enhancing observer participation and commitment in working group, task force and expert group meetings. After reviewing the content and practical implications of the addendum in the context of larger reform efforts to adapt the council to the age of a global(ising) Arctic, the article further discusses a number of signals the Anchorage decision sends to observers. These comprise the council's willingness and ability to quick, unified and purposeful action towards institutional adaptation and procedural reform as considered necessary to address organisational deficiencies, strengthened top-down steering of the reform processes by SAOs as related to the work conducted in subsidiary bodies and the overall functioning of the council, and higher expectations on observers to contribute to the AC system and deliver on the new provisions.
Bellies derived from the commercial population of pig carcasses are diverse in terms of tissue composition. Knowledge of the factors influencing it and the expected results, permits quick and easy evaluation of raw material. The study was designed to determine the factors affecting the tissues composition of pork bellies and to estimate their lean meat content. The research population (n=140 pig carcasses) was divided into groups according to sex (gilts, barrows), half-carcass mass (<40, 40 to 43.9, 44 to 46.9, ⩾47 kg) and lean meat content class: S (⩾60%), E (55% to 60%), U (50% to 55%), R (<50%). Bellies were subjected to a detailed dissection. Half-carcass mass affected the levels of all the analysed parameters. The only exception was the mass of the fat with the skin in the 40 to 43.9 kg group, for which the value did not differ statistically between the two groups <40 and 44 to 46.9 kg. Decrease in lean meat content affected the growth of the fat and skin mass in a linear way. No differences were observed between class S and E in terms of belly muscle mass. A 0.37% higher share of belly in the half-carcass was found for barrows (P<0.001), although bellies issued from barrows were characterized by a higher proportion of fat with skin compared with gilts (P=0.02). Interactions were observed between sex and half-carcass mass, so the sex of heavy half-carcasses becomes an important determinant for conditioning the muscle content. Equations were calculated and allow a fast and highly accurate determination of the lean meat content in bellies, suggesting they may be used directly in the production line.
We present and compare two evolutionary algorithm based methods for rectangular architectural layout generation: dense packing and subdivision algorithms. We analyze the characteristics of the two methods on the basis of three floor plan scenarios. Our analyses include the speed with which solutions are generated, the reliability with which optimal solutions can be found, and the number of different solutions that can be found overall. In a following step, we discuss the methods with respect to their different user interaction capabilities. In addition, we show that each method has the capability to generate more complex L-shaped layouts. Finally, we conclude that neither of the methods is superior but that each of them is suitable for use in distinct application scenarios because of its different properties.
Results are reported on several new glass and glass-ceramic waste
formulations for plutonium disposition. The approach proposed involves
employing existing calcined high level waste (HLW) present at the Idaho
Chemical Processing Plant (ICPP) as an additive to: 1) aid in the formation
of a durable waste form and 2) decrease the attractiveness level of the
plutonium from a proliferation viewpoint. The plutonium, PuO2,
loadings employed were 15 wt% (glass) and 17 wt% (glass-ceramic). Results in
the form of x-ray diffraction patterns, microstructure and durability tests
are presented on cerium surrogate and plutonium loaded waste forms using
simulated calcined HLW and demonstrate that durable phases, zirconia and
zirconolite, contain essentially all the plutonium.
A genetically modified M13 bacteriophage template was used to biomineralize ZnO. A peptide, EAHVMHKVAPRP , with a known affinity for ZnO was genetically displayed on each of five copies of the pIII protein located at one tip of the M13 virus. Site-directed assembly using this pIII peptide fusion was studied using a variety of precursor concentrations, incubation times, and phage concentrations. For comparision, free ZnO-binding peptides were also used to biomineralize ZnO. Isolated, polydisperse, spherical ZnO nanoparticles were formed at all mineralization conditions containing the ZnO-binding M13 bacteriophage, whereas free peptide mineralization resulted in smaller, more irregularly shaped particles which agglomerated at longer incubation times. These studies are preliminary experiments in the investigation of ZnO biomineralization on the various structural proteins of the M13 bacteriophage and cooperative effects which occur between neighboring peptides.
Why do states go through the trouble of seeking authorization from multilateral institutions to use military force when they are not required to do so? How do states choose the international organization through which to work? Why do citizens sometimes demand a multilateral response to an international crisis, yet at other times seem content when their leaders act unilaterally? Terrence Chapman takes up these questions in his persuasive and important book Securing Approval. The answer, he says, is domestic politics. Using a game-theoretic approach supported by a wealth of empirical evidence, Chapman shows that international organizations (IOs) provide important information to domestic publics. This information can affect public opinion and, by extension, foreign policy. A short review does not do justice to this nuanced and smart book. Nevertheless, I will outline the author's central argument before discussing the book's contribution to the literature. I conclude by raising three issues that might serve as avenues for future research.
I want to thank Terrence Chapman for his insightful comments. The core of our respective arguments is similar: We both find that public opinion can shape international affairs in important, and perhaps unexpected, ways. Nevertheless, he offers some constructive criticism that has prompted me to think more deeply about my work.
This article examines the extent to which service-learning courses affect students' attitudes and opinions. Elsewhere, we used a pre/postsurvey field experiment to demonstrate that volunteering with a homeless person tends to erode the stereotypes held by the domiciled—a confirmation of the venerable contact hypothesis. Here we use the same research design to assess whether students in service-learning courses exhibit a similar type of opinion change after spending a day with a homeless person. We find that even with limited contact a significant number of service-learning students came away from their time with homeless individuals holding fewer stereotypes and with a more nuanced perspective on the causes and consequences of homelessness. Nevertheless, working with a homeless person did have a negative effect on some students and contact generally failed to change students' views on public policy.