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This study aimed to examine the predictors of cognitive performance in patients with pediatric mild traumatic brain injury (pmTBI) and to determine whether group differences in cognitive performance on a computerized test battery could be observed between pmTBI patients and healthy controls (HC) in the sub-acute (SA) and the early chronic (EC) phases of injury.
203 pmTBI patients recruited from emergency settings and 159 age- and sex-matched HC aged 8–18 rated their ongoing post-concussive symptoms (PCS) on the Post-Concussion Symptom Inventory and completed the Cogstate brief battery in the SA (1–11 days) phase of injury. A subset (156 pmTBI patients; 144 HC) completed testing in the EC (∼4 months) phase.
Within the SA phase, a group difference was only observed for the visual learning task (One-Card Learning), with pmTBI patients being less accurate relative to HC. Follow-up analyses indicated higher ongoing PCS and higher 5P clinical risk scores were significant predictors of lower One-Card Learning accuracy within SA phase, while premorbid variables (estimates of intellectual functioning, parental education, and presence of learning disabilities or attention-deficit/hyperactivity disorder) were not.
The absence of group differences at EC phase is supportive of cognitive recovery by 4 months post-injury. While the severity of ongoing PCS and the 5P score were better overall predictors of cognitive performance on the Cogstate at SA relative to premorbid variables, the full regression model explained only 4.1% of the variance, highlighting the need for future work on predictors of cognitive outcomes.
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.
Fluoroquinolones (FQs) and extended-spectrum cephalosporins (ESCs) are associated with higher risk of Clostridioides difficile infection (CDI). Decreasing the unnecessary use of FQs and ESCs is a goal of antimicrobial stewardship. Understanding how prescribers perceive the risks and benefits of FQs and ESCs is needed.
We conducted interviews with clinicians from 4 hospitals. Interviews elicited respondent perceptions about the risk of ESCs, FQs, and CDI. Interviews were audio recorded, transcribed, and analyzed using a flexible coding approach.
Interviews were conducted with 64 respondents (38 physicians, 7 nurses, 6 advance practice providers, and 13 pharmacists). ESCs and FQs were perceived to have many benefits, including infrequent dosing, breadth of coverage, and greater patient adherence after hospital discharge. Prescribers stated that it was easy to make decisions about these drugs, so they were especially appealing to use in the context of time pressures. They described having difficulty discontinuing these drugs when prescribed by others due to inertia and fear. Prescribers were skeptical about targeting specific drugs as a stewardship approach and felt that the risk of a negative outcome from under treatment of a suspected bacterial infection was a higher priority than the prevention of CDI.
Prescribers in this study perceived many advantages to using ESCs and FQs, especially under conditions of time pressure and uncertainty. In making decisions about these drugs, prescribers balance risk and benefit, and they believed that the risk of CDI was acceptable in compared with the risk of undertreatment.
To study the natural course of vestibular schwannomas 15 to 31 mm in diameter.
A retrospective study of 45 patients conservatively managed with interval scanning was performed. Outcome measures were: changes in tumour size, clinical features and hearing. A tumour was considered to be growing if it increased in size by more than 2 mm.
Initial tumour sizes ranged from 15 to 31 mm, with a mean (± standard deviation) diameter of 20.1 ± 4.3 mm. The duration of follow up ranged from 6 months to 14 years (median, 3 years). Tumours grew in 11 cases (24.4 per cent), remained stable in 30 cases (66.7 per cent) and regressed in 4 cases (8.9 per cent). The overall mean tumour growth rate was 0.9 ± 2.2 mm per year; in growing tumours, it was 3.6 ± 2.9 mm per year.
Outcomes were similar to those reported for smaller tumours. These findings suggest that patients with medium or moderately large tumours can be safely offered an initial period of conservative management before intervention is considered.
The Dawn spacecraft orbited Asteroid (4) Vesta for a year, and returned disk-resolved images and spectra covering visible and near-infrared wavelengths at scales as high as 20 m/pix. The visible geometric albedo of Vesta is ~ 0.36. The disk-integrated phase function of Vesta in the visible wavelengths derived from Dawn approach data, previous ground-based observations, and Rosetta OSIRIS observations is consistent with an IAU H-G phase law with H=3.2 mag and G=0.28. Hapke's modeling yields a disk-averaged single-scattering albedo of 0.50, an asymmetry factor of -0.25, and a roughness parameter of ~20 deg at 700 nm wavelength. Vesta's surface displays the largest albedo variations observed so far on asteroids, ranging from ~0.10 to ~0.76 in geometric albedo in the visible wavelengths. The phase function of Vesta displays obvious systematic variations with respect to wavelength, with steeper slopes within the 1- and 2-micron pyroxene bands, consistent with previous ground-based observations and laboratory measurement of HED meteorites showing deeper bands at higher phase angles. The relatively high albedo of Vesta suggests significant contribution of multiple scattering. The non-linear effect of multiple scattering and the possible systematic variations of phase function with albedo across the surface of Vesta may invalidate the traditional algorithm of applying photometric correction on airless planetary surfaces.
We describe a new technique of helix advancement meatoplasty. This technique is useful in both mastoid surgery and some cases of otitis externa. The technique is designed to avoid the problems of (1) inferior positioning of the meatoplasty at the time of surgery, and (2) later inferior migration of the pinna (as can occur when the suspensory ligaments of the pinna have been cut or weakened). Such outcomes can result in a mastoid cavity which is difficult to clean as the approach to it is awkward; in such cases, it is common to have to look up into the cavity rather than directly into it. Helix advancement meatoplasty improves post-operative visualisation and aeration. It eases cleaning of the cavity by creating a more superiorly placed meatoplasty, which is supported by the tragus and is therefore less likely to drop.
The Rank Forum on Vitamin D was held on 2nd and 3rd July 2009 at the University of Surrey, Guildford, UK. The workshop consisted of a series of scene-setting presentations to address the current issues and challenges concerning vitamin D and health, and included an open discussion focusing on the identification of the concentrations of serum 25-hydroxyvitamin D (25(OH)D) (a marker of vitamin D status) that may be regarded as optimal, and the implications this process may have in the setting of future dietary reference values for vitamin D in the UK. The Forum was in agreement with the fact that it is desirable for all of the population to have a serum 25(OH)D concentration above 25 nmol/l, but it discussed some uncertainty about the strength of evidence for the need to aim for substantially higher concentrations (25(OH)D concentrations>75 nmol/l). Any discussion of ‘optimal’ concentration of serum 25(OH)D needs to define ‘optimal’ with care since it is important to consider the normal distribution of requirements and the vitamin D needs for a wide range of outcomes. Current UK reference values concentrate on the requirements of particular subgroups of the population; this differs from the approaches used in other European countries where a wider range of age groups tend to be covered. With the re-emergence of rickets and the public health burden of low vitamin D status being already apparent, there is a need for urgent action from policy makers and risk managers. The Forum highlighted concerns regarding the failure of implementation of existing strategies in the UK for achieving current vitamin D recommendations.
Electron backscatter diffraction (EBSD) analysis of monazite requires a comparison of empirically collected electron backscatter patterns (EBSPs) with theoretical diffraction data, or ‘match units’, derived from known crystallographic parameters. Published crystallographic data derived from compositionally varying natural and synthetic monazite are used to calculate ten different match units for monazite. These match units are used to systematically index EBSPs obtained from four natural monazite samples with different compositions. Analyses of EBSD data, derived from the indexing of five and six diffraction bands using each of the ten match units for 10,000 EBSPs from each of the four samples, indicate a large variation in the ability of the different match units to correctly index the different natural samples. However, the use of match units derived from either synthetic Gd or Eu monazite crystallographic data yield good results for three of the four analysed monazites. Comparison of sample composition with published monazite compositions indicates that these match units are likely to yield good results for the EBSD analysis of metamorphic monazite. The results provide a clear strategy for optimizing the acquisition and analysis of EBSD data from monazite but also indicate the need for the collection of new crystallographic structure data and the subsequent generation of more appropriate match units for natural monazite.
B. E. Reddy, Indian Institute of Astrophysics, Bangalore, India,
D. L. Lambert, McDonald Observatory and Department of Astronomy, University of Texas, Austin, TX, USA,
C. Allende Prieto, McDonald Observatory and Department of Astronomy, University of Texas, Austin, TX, USA
We present the results of our recent abundance survey of the Galactic thick disk. We selected from the Hipparcos catalog 176 sample stars satisfying the following criteria: they are nearby (d ≤ 150 pc) subgiants and dwarfs, of spectral types F and G, and with thick-disk kinematics (VLSR ≤ −40 kms−1, │WLSR│ ≤ 30 kms−1). Assuming that the velocity distribution of each stellar population is Gaussian, we assigned stars with a probability P ≤ 70% to one of the three components. This resulted in 95 thick-disk stars, 17 thin-disk stars, and 24 halo stars. The remaining 40 objects cannot be unambiguously assigned to one of the three components.
We derived abundances for 23 elements from C to Eu. The thick-disk abundance patterns are compared with earlier results from the thin-disk survey of Reddy et al. (2003). The levels of α-elements (O, Mg, Si, Ca, and Ti), thought to be produced dominantly in Type-ii supernovae, are enhanced in thick-disk stars relative to the values found for thin-disk members in the range −0.3 > [Fe/H] > −1.2. The scatter in the abundance ratios [X/Fe] at a given [Fe/H] for thick-disk stars is consistent with the predicted dispersion due to measurement errors, as is the case for the thin disk, suggesting a lack of “cosmic” scatter. The observed compositions seem consistent with a model of galaxy formation by mergers in a ∧ CDM universe.
Spray carrier pH affects the solubility of sulfonylurea herbicides and, therefore, could affect absorption and subsequent translocation of these compounds in weeds. Trifloxysulfuron is a sulfonylurea herbicide developed for POST weed control in cotton, sugarcane, and turfgrass with a pKa of 4.81. The objective of this study was to evaluate the absorption and translocation of foliar-applied 14C-trifloxysulfuron in Palmer amaranth and Texasweed at pH 5, 7, and 9 over a period of 4 to 72 h after treatment (HAT). For absorption, effects of time, species, and pH were significant. Absorption averaged over species and pH increased logarithmically from 4 to 72 HAT. Absorption was greater for Palmer amaranth (88%) than for Texasweed (29%) when averaged over time and pH. Absorption averaged over species and time increased in the order of pH 5 (52%) < pH 9 (60%) = pH 7 (61%). Consequently, this translated into greater translocation of 14C-trifloxysulfuron in Texasweed when sprayed with the higher pH spray solutions. These data indicate that absorption and translocation of trifloxysulfuron in some weed species may be enhanced by increasing the pH of the spray solution by 2 pH units above the pKa.
Sol-gel derived Nb2O5 thin films were intercalated with Mg2+,using the non-aqueous solution of Mg(ClO4)2 in propylene carbonate (pc) as the electrolyte. 2% and 4% ( volume %) water was added to the electrolyte to study the effect of water on the electrochromic properties of Nb2O5. This paper presents the changes in optical and structural properties of the intercalated films with and without water in the electrolyte. The ratio (x) of the Mg2+ and Nb atoms has been controlled by optimizing the intercalation duration under a constant current density. The fall in transmittance on intercalation (for x= 0.8) increased by 15% with 4% water in the electrolyte, compared to the film intercalated without water. FTIR studies show that water is incorporated in the films on intercalation and small quantities of Mg(OH)2 and Nb-OH are formed along with Mg-O-Nb bonds. The presence of water in electrolyte decreases water content in the films and enhances the formation of Mg(OH)2, Mg-O-Nb and Nb-OH bonds. The recovery of Mg2+ on deintercalation is slightly reduced in presence of water in the electrolyte. The cyclic stability of the films intercalated without water is more than that of the films intercalated in presence of water.
Paragangliomas are uncommon and those arising from the vagal trunk are rarer. Pigmented extra-adrenal paragangliomas are still rarer and reported sites of occurrence are the uterus, spine, retroperitoneum, bladder, mediastinum and orbit. The presence of abundant pigment in a cervical paraganglion has not been reported previously. We report one such unusual case of pigmented vagal paraganglioma that arose from the vagal trunk below the nodose ganglion, had massive central necrosis and showed hypovascularity on angiography. The unusual features and difficulties in the diagnosis of such cases are discussed.
Bilateral extracranial internal carotid aneurysms are very rare, though well documented. We report a case of bilateral extracranial internal carotid aneurysms presenting with vocal fold paralysis, which we believe to be the first.
This paper describes an attempt to develop and evaluate agricultural extension materials that support farmers' use of flexible management strategies. On the basis of experiment station and on-farm research results relating to millet and cowpea intercropping in Niger, a series of recommendations was developed, taking the form of a decision tree. The process of testing this format at the level of field extension agents and the implications of this experience for both research and extension workers are described.
Submicron high density devices require multilevel interconnections. In multilevel interconnections, issues relating to planarity, stress voiding of metals and stress cracking of the dielectric(s) play an dominant role.As the levels of interconnect go up so does the stress level. A high stress level in the intermediate dielectric can cause cracks which ultimately lead to device failure. In this paper we present a novel method to detect stress cracking using focussed ion beam. This method is correlated with wet chemical etch process and RIE.The phenomenum of cracking of dielectric(s) is studied and different technology aspects are considered. Using the focussed ion beam a robust dielectric is developed.
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