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There are some unique considerations when caring for the airway in infants and small children. They have relatively larger oropharyngeal structures (tongue, tonsils, and adenoids), and a large and floppy epiglottis, which can predispose to upper airway obstruction. A larger occiput may increase the neck flexion observed while in supine position as compared with adults, which can also lead to airway obstruction. The shorter and narrower trachea may increase the risk for tracheal tube malposition after intubation, and has a greater risk for secretions, edema, or foreign body to produce disproportionate negative effects in airflow resistance. Children run the highest risk of problems from stridor and glottic edema because of their smaller diameter airways. Post-extubation stridor incidence ranges from 2% in children having elective surgical procedures to 40% in pediatric trauma and burn victims. Additionally, infants have less physical space in the oropharynx and within the tracheal tube for an advanced bridging technique such as SGA devices and/or airway exchange catheter.
The molybdenum disulfide (MoS2) and indium tin oxide (ITO) interface were studied by atom probe tomography (APT). Raman spectroscopy, scanning electron microscopy, and grazing-incidence x-ray diffraction measurements were performed as complementary characterization. Results confirm that nanowires plated shape with the 〈110〉-orientation are aligned perpendicular to the ITO film with principal reflections at (002), (100), (101), (201), and Raman spectroscopy vibrational modes at E12g at 378 cm−1 and A1g at 407 cm−1 correspond to 2H-MoS2. APT reveals MoS+2, MoS+3 as predominant evaporated molecular ions on the sample, indicating no significant diffusion/segregation of Mo or S species within the ITO layer.
The present work describes a simple method to produce zinc oxide nanoparticles supported in nitrogen-doped reduced graphene oxide, ZnO/N-rGO. The rGO structures were nitrogen-doped using hydrazine as nitrogen source (N-rGO) with the purpose of enhancing the rGO capability to promote the electrons transport along their surface. Thus, ZnO/N-rGO catalytic systems were tested as photocatalyst to degrade methylene blue and lignin molecules under ultraviolet (UV) and visible (Vis) light irradiation. N-doping of rGO was confirmed by X-ray photoelectron spectroscopy (XPS). Photocatalytic degradation studies confirm better performance of the ZnO/N-rGO in comparison to ZnO. The percentage of lignin degradation for the ZnO/N-rGO compound under UV was 59%, while using visible energy it was achieved 46%, in a time of 70 min.
Echinococcosis is a zoonotic parasitic illness that can cause significant disabilities, and even death for sick people. The disease is caused by the larval stage of cestodes belonging to the Echinococcus genus. In this study, multiple hydatid cysts were excised from an infected porcine liver. The identification of the parasitic species was made by the morphometric assessment of rostellar hooks and molecular detection of ribosomal DNA extant in protoscoleces of the hydatid sand. Rostellar hooks presented an average length of 27.4 µm by optical microscopy. Parasite DNA were detected in samples of hydatid sediment and positive controls by polymerase chain reaction. In conclusion, Echinococcus granulosus was recognized in samples of porcine hydatid cysts by microscopic observation, and the E. granulosus sensu lato strain E. canadensis G6/G7 was identified by molecular assay.
The present research was aimed to study the degradation of 2-Chlorophenol through the use of bismuth molybdate (γ-Bi2MoO6) structures supported on graphene oxide (GO) which is intended to control the recombination of charge carriers. γ-Bi2MoO6/GO systems were doped with nitrogen via chemical reaction, to reduce their energy gap, improving their photocatalytic activity. Structural and physicochemical characterization of the resulting catalysts were performed using X-ray diffraction (XRD), scanning electron microscopy (SEM), X-ray photoelectron spectroscopy (XPS), and UV-Vis. The obtained compounds show good photo catalytic performance when using visible energy to degrade 2-Chlorophenol, obtaining 80% of degradation in 65 min.
The Pennsylvania Longitudinal Study of Parents and Children Twin Registry was developed to capture a representative sample of multiple births and their parents in the state of Pennsylvania. The registry has two main efforts. The first began in 2012 through recruitment of adolescents in Pennsylvania schools. The second effort began in January 2019 in partnership with the Pennsylvania Department of Health to capture the birth cohort of twins born from 2007 to 2017. Study recruitment, sample demographics, focus and measures are provided, as well as future directions.
The present work aims to explore the tribological behavior of the laser texturing process with different patterns on a Co based alloy using a pulsed Nd: YAG laser. Different parameters such as peak power, speed and spot diameter of the laser were explored for the experimental setting. The microstructural analysis was performed using scanning electron microscopy (SEM) with energy dispersive spectroscopy (EDS), X-ray diffraction (XRD), and nanoindentation tests. The influence of the different textured patterns of the tribological performance tested with a pin-on-disc tribometer under lubricated sliding condition was evaluated. The results showed that typical interdendritic structures in the as-cast CoCr alloy condition were refined due to the heat input and fast cooling rate during the laser treatment. The refined microstructure showed less volumetric loss resulting in a increment of wear resistance and a better tribological performance than as-cast alloy. The correlation among laser parameters, microstructural effect and their influence in wear resistance is discussed.
To reduce surgical site infection (SSI) incidence in plastic surgery and hand surgery.
Uncontrolled before-and-after study.
Department of plastic surgery and hand surgery of a tertiary-care teaching hospital.
Patients undergoing surgery between January 2016 and April 2018.
A comprehensive unit-based safety program (CUSP) consisting of a bundle of evidence-based SSI prevention strategies and a change in safety culture was fully implemented after a 14-month baseline surveillance and implementation period. SSI surveillance was performed over an intervention period of another 14 months, and differences in SSI rates between the 2 periods were calculated. Adherence with bundle components and risk factors for SSI were further evaluated in a case-cohort analysis.
Of 3,321 patients, 63 (1.9%) developed an SSI, 38 of 1,722 (2.2%) in the baseline group and 25 of 1,599 (1.6%) in the intervention group (P = .20). The CUSP was associated with an adjusted relative SSI risk reduction of 41% (95% confidence interval [CI], 0.4%–65%; P = .048) in multivariable analysis, whereas the need for revision surgery increased SSI risk (odds ratio [OR], 2.63; 95% CI, 1.31–5.30; P = .007). During the intervention period, the proportion of checklists completed was 62.4%, and no difference in adherence with bundle components between patients with and without SSI was observed.
This CUSP helped reduce SSI in a surgical specialty with a low baseline SSI incidence, even though adherence with checklist completion was moderate and the main modifiable risk factors remained unchanged over time. Programs that include safety culture change may more effectively promote SSI reduction than prevention bundles alone.
Tubular pottery comprises certain peculiar artifacts that were produced by late Holocene complex hunter-gatherer societies in southeastern South America for unknown purposes. Some authors have related them to mortuary behaviour which has also been suggested by historical sources, while others have considered domestic use. In this paper, the technical, compositional and functional properties of these artifacts are explored in order to contrast both hypotheses, given an example of how technical analysis allows the identification of special pottery within archeological contexts. This analysis includes a study of the fabrics involved using low and high magnification, thin sections, Scanning Electron Microscopy, Energy Dispersive X-ray Spectroscopy, Mössbauer Spectroscopy, Laser Induced Breakdown Spectroscopy and fatty acid profiles. The results show that these tubular artifacts are not fit structurally for utilitarian purposes and show no evidence of domestic use. Based on these results and on historical data, it can be postulated that they were used as part of mortuary rituals, thus becoming part of the select global group of pottery manufactured exclusively for mortuary purposes.
The aim of the current study was to evaluate energy intake misreporting prevalence, its associated factors and its effects on nutrient intake, in the Portuguese population aged from 18 to 84 years.
Adults participants from the National Food, Nutrition and Physical Activity Survey, IAN-AF, 2015–2016, who provided two complete 24 h dietary recall and complete covariate information.
Under, plausible and over-reporters were identified according to the Goldberg method. Total misreporting prevalence was 29·9 %, being 28·5 % of under-reporting and 1·4 % of over-reporting. The current study found higher odds of being classified as an under-reporter especially in participants with higher BMI and in those who self-reported health perception status as non-favourable. Energy intake estimation increases by 853.5 kJ/d (204 kcal/d) when misreporters are excluded, and the same tendency is observed for macro and micronutrients. It is worth mentioning that the prevalence of inadequacy for protein intake decreases by about 5 % when considering plausible reporters.
The exclusion of misreporters has a small impact on the crude energy and nutrient estimates as well as on assessing the contribution of nutrients to total energy intake. However, a moderate impact was observed in the estimation of nutrient inadequacy prevalence.
Bovine babesiosis is the most important protozoan disease transmitted by ticks. In Plasmodium falciparum, another Apicomplexa protozoan, the interaction of rhoptry neck protein 2 (RON2) with apical membrane antigen-1 (AMA-1) has been described to have a key role in the invasion process. To date, RON2 has not been described in Babesia bigemina, the causal agent of bovine babesiosis in the Americas. In this work, we found a ron2 gene in the B. bigemina genome. RON2 encodes a protein that is 1351 amino acids long, has an identity of 64% (98% coverage) with RON2 of B. bovis and contains the CLAG domain, a conserved domain in Apicomplexa. B. bigemina ron2 is a single copy gene and it is transcribed and expressed in blood stages as determined by RT-PCR, Western blot, and confocal microscopy. Serum samples from B. bigemina-infected bovines were screened for the presence of RON2-specific antibodies, showing the recognition of conserved B-cell epitopes. Importantly, in vitro neutralization assays showed an inhibitory effect of RON2-specific antibodies on the red blood cell invasion by B. bigemina. Therefore, RON2 is a novel antigen in B. bigemina and contains conserved B-cell epitopes, which induce antibodies that inhibit merozoite invasion.
To assess total sugar (TS), added sugar (AS) and free sugar (FS) intakes, dietary sources, adherence to recommendations and determinants of consumption, in a Portuguese national sample.
Cross-sectional study. Dietary assessment was obtained by two food diaries in children aged <10 years and two non-consecutive 24 h recalls for other age groups. TS, AS and FS intakes were estimated by using SPADE software. TS content in food was estimated at the ingredient level. AS content in food was assessed through a systematic methodology and FS was based on the WHO definition.
National Food, Nutrition and Physical Activity Survey (IAN-AF 2015–2016), Portugal.
Representative sample from the Portuguese population, aged from 3 months to 84 years (n 5811).
Mean daily intake and contribution to total energy intake (E%) were 84·3 g/d (18·5 E%) for TS, 32·1 g/d (6·8 E%) for AS and 35·3 g/d (7·5 E%) for FS. Of the population, 76 % adhered to the FS recommendation (FS < 10 E%). The lowest adherence was in children (51·6 %) and adolescents (51·3 %). The main dietary source of TS was fruit across all ages, except in adolescents which was soft drinks. In children, the main dietary sources of FS were yoghurts and sweets, soft drinks in adolescents and table sugar in adults/elderly. FS intake was lower in children with more educated parents and in adults who practised physical activity regularly, and higher among smokers.
Interventions ought to be planned towards decreasing intakes of added and free sugars considering population-specific characteristics.
Tick-borne diseases (TBDs) can sometimes cause severe symptoms and lead to hospitalisation, but they often go unnoticed in the Emergency Department (ED). The aim of this study was twofold: (i) to describe the profile of patients hospitalised by TBDs; and (ii) to evaluate the data collected in the medical records from the ED in order to analyse their potential clinical consequences. A total of 84 cases that included all TBD diagnoses registered in the ED records were identified and analysed. These corresponded to all the hospitalisations by TBDs in the last 10 years (2009–2019) in two tertiary hospitals in Granada, Spain. Statistical analyses were made using RStudio. Coinciding with the absence of patient's report of exposure to ticks, 64.3% of TBDs were not suspected in the ED. Intensive care unit admission was required in 8.3% of cases, and the mortality rate was 2.4%. Non-suspected cases showed longer hospital stay (P < 0.001), treatment duration (P = 0.02) and delay in the initiation of antibiotic treatment (P < 0.001). Our findings indicate that symptoms associated with TBDs are highly non-specific. In the absence of explicit information related to potential tick exposure, TBDs are not initially suspected. As a consequence, elective treatment administration is delayed and hospitalisation time is prolonged. In conclusion, our results highlight the importance of addressing potential exposure to ticks during the ED contact with patients presenting with febrile syndrome.
Meteorological and even human-made disasters are increasing every year in frequency and magnitude. The passage of a disaster affects a society without distinction, but groups with social vulnerability (low socioeconomic status, chronic medical, or psychological conditions, limited access to resources) face the most significant impact. As a result, psychological and behavioral symptoms (eg, depression and anxiety) can ensue, making the immediate response of mental health services crucial. Secondary data from a database of a temporary healthcare unit were analyzed. A total of 54 records were reviewed to collect information; univariate and bivariate analyses were done. The purpose of this article is to present our experience regarding the incorporation of a mental health services model, with its respective benefits and challenges, into a temporary healthcare unit, after Hurricane Maria in 2017.
The aim of this work was to use X-ray diffraction to identify substances used for adulteration of raw milk and to determine if crystallographic analysis can detect extraneous substances in milk. Two unknown substances were sent anonymously by employers linked to the dairy chain, who claimed that they were added directly in milk prior to water addition by truck drivers. The samples were analyzed by X-ray diffraction and submitted to physicochemical analysis. The first substance was identified by X-ray diffraction as sodium citrate, complying with its physicochemical attributes, such as the powerful ability to decrease the freezing point. The second substance was identified by X-ray diffraction as sucrose and this result was also in agreement with its ability to increase the density, decrease the freezing point and finally, to be positive for sucrose in the resorcinol qualitative test. To evaluate if X-ray diffraction can detect extraneous substances already mixed in milk, fresh raw milk samples tampered with urea, sodium hydroxide, sodium citrate and sucrose were freeze dried and analyzed by X-ray diffraction, with no detection of any extraneous substances at any percentage. This is the first report of attempted diagnosis of extraneous substances in milk by X-ray diffraction. However, this technique can be useful only when applied to identify substances used for adulteration prior to its dilution in milk, since the amorphous nature of milk seems to be a limitation for the accurate detection of extraneous substances.
The Van Kampen normal-mode method is applied in a comprehensive study of the linear wave perturbations of a homogeneous, magnetized and finite-temperature plasma, described by the collisionless Vlasov–Maxwell system in its non-relativistic version. The analysis considers a stable, Maxwellian background, but is otherwise completely general in that it allows for arbitrary wave propagation direction relative to the equilibrium magnetic field, multiple plasma species and general polarization states of the perturbed electromagnetic fields. A convenient formulation is introduced whereby the generator of the time advance is a Hermitian operator, analogous to the Hamiltonian in the Schrödinger equation of quantum mechanics. This guarantees a real frequency spectrum and complete bases of normal modes. Expansions in these normal-mode bases yield immediately the solutions of initial-value problems for general initial conditions. With standard initial conditions and propagation direction parallel to the equilibrium magnetic field, all the familiar results obtained following Landau’s Laplace transform approach are recovered. Considering such parallel propagation, the present work shows also explicitly and provides an example of how to construct special initial conditions that result in different, damped but otherwise arbitrarily prescribed time variations of the macroscopic variables. The known dispersion relations for perpendicular propagation are also recovered.