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The majority of paediatric Clostridioides difficile infections (CDI) are community-associated (CA), but few data exist regarding associated risk factors. We conducted a case–control study to evaluate CA-CDI risk factors in young children. Participants were enrolled from eight US sites during October 2014–February 2016. Case-patients were defined as children aged 1–5 years with a positive C. difficile specimen collected as an outpatient or ⩽3 days of hospital admission, who had no healthcare facility admission in the prior 12 weeks and no history of CDI. Each case-patient was matched to one control. Caregivers were interviewed regarding relevant exposures. Multivariable conditional logistic regression was performed. Of 68 pairs, 44.1% were female. More case-patients than controls had a comorbidity (33.3% vs. 12.1%; P = 0.01); recent higher-risk outpatient exposures (34.9% vs. 17.7%; P = 0.03); recent antibiotic use (54.4% vs. 19.4%; P < 0.0001); or recent exposure to a household member with diarrhoea (41.3% vs. 21.5%; P = 0.04). In multivariable analysis, antibiotic exposure in the preceding 12 weeks was significantly associated with CA-CDI (adjusted matched odds ratio, 6.25; 95% CI 2.18–17.96). Improved antibiotic prescribing might reduce CA-CDI in this population. Further evaluation of the potential role of outpatient healthcare and household exposures in C. difficile transmission is needed.
To describe the 5-year findings after a policy to screen for, diagnose, and isolate medical center employees with adenoviral conjunctivitis was implemented.
Observational report with a retrospective evaluation of a current quality improvement initiative.
Johns Hopkins Medicine, Baltimore, Maryland.
Johns Hopkins Medicine employees.
Data were retrieved from records maintained for this initiative, in which employees with suspected adenoviral conjunctivitis were evaluated in the Occupational Health Clinic and swabbed for polymerase chain reaction (PCR) testing for adenoviral conjunctivitis. Signs, symptoms, work area, diagnoses, and disposition of employees with eye complaints as well as PCR result and adenoviral type were recorded. Five-year data were reviewed.
From 2011 to 2016, of 10,000 full-time equivalent employees, 1,059 employees visited the Occupational Health Clinic with suspicion of adenoviral conjunctivitis. Of these, 104 (10%) were PCR positive for adenovirus. Of these PCR-positive employees, 26 (25%) had the worst clinical presentation, epidemic keratoconjunctivitis (EKC). The Outpatient Pharmacy had the highest number of adenoviral conjunctivitis cases (n=9). The proportion of red-eye employees having PCR-positive adenoviral conjunctivitis increased over 5 years (P<.005, Cochrane-Armitage test for trend) as did the proportion of employees with EKC (P<.05). The proportion of employees with EKC caused by type 37 also increased (P<.05).
Adenoviral conjunctivitis represents 10% of employee cases clinically suspected of this infection. Employees in patient-care areas should be screened even if they have no direct patient contact. Despite increases in the proportions of adenoviral conjunctivitis and of EKC over 5 years, no outbreaks occurred. This policy helps identify incipient EKC outbreaks and guides infection control efforts.
In this work we have conducted a study on the radiative and spectroscopic properties of the radiative precursor and the post-shock region from experiments with radiative shocks in xenon performed at the Orion laser facility. The study is based on post-processing of radiation-hydrodynamics simulations of the experiment. In particular, we have analyzed the thermodynamic regime of the plasma, the charge state distributions, the monochromatic opacities and emissivities, and the specific intensities for plasma conditions of both regions. The study of the intensities is a useful tool to estimate ranges of electron temperatures present in the xenon plasma in these experiments and the analysis performed of the microscopic properties commented above helps to better understand the intensity spectra. Finally, a theoretical analysis of the possibility of the onset of isobaric thermal instabilities in the post-shock has been made, concluding that the instabilities obtained in the radiative-hydrodynamic simulations could be thermal ones due to strong radiative cooling.
Background: Continuous video-EEG (cvEEG) monitoring is the standard of care for diagnosis and management of neonatal seizures. However, it is labour-intensive. We aimed to establish consistency in monitoring of newborns utilising NICU nurses. Methods: Neonatal nurses were trained to apply scalp electrodes, troubleshoot technical issues. Guidelines, checklists and visual training modules were developed. A central network system allowed remote access to the cvEEGs by the epileptologist for timely interpretation and feedback. We compared 100 infants with moderate to severe HIE before and after the training program. Results: 192 cvEEGs were performed. Of the 100 infants compared; time to initiate brain monitoring decreased by average of 31.5 hours, in electrographic seizure detection increased(20% compared to 34% a), seizure clinical misdiagnosis decreased (65% compared to 36% ), and Anti-Seizure burden decreased. Conclusions: Training experienced NICU nurses to set-up, start and monitor cvEEG can decrease the time to initiate cvEEG which may lead to better seizure diagnosis and management.
Background: Despite advances in neonatal care, neonates with moderate to severe HIE are at high risk of mortality and morbidity. we report the impact of a dedicated NNCC team on short term mortality and morbidities. Methods: A retrospective cohort study on neonates with moderate to serve HIE between July 1st 2008 and December 31st 2017. primary outcome : a composite of death and/or brain injury on MRI. Secondary outcomes: rate of cooling, length of hospital stay, anti-seizure medication burden, and use of inotropes. A regression analysis was done adjusting for gestational age, birth weight, gender, out-born status, Apgar score at 10 minutes, cord blood pH, and HIE clinical staging Results: 216 neonates were included, 109 before NNCC implementation, and 107 thereafter. NNCC program resulted in reduction in the primary outcome (AOR: 0.28, CI: 0.14-0.54, p<0.001) and brain injury (AOR: 0.28, CI: 0.14-0.55, p<0.001). It decreased average length of stay/infants by 5 days (p=0.03), improved cooling rate (73% compared to 93% , p <0.001), reduced: seizure misdiagnosis (71% compared to 23%, P <0.001), anti-seizure medication burden (P = 0.001), and inotrope use (34% compared to 53%, p=0.004) Conclusions: NNCC program decreased mortality and brain injury , shortened the length of hospital stay and improved care of neonates with significant HIE.
Blazar OJ 287 is one of the best observed extragalactic objects. It's historical light curve goes back to 1890′s. Based on the historical behaviour Sillanpää et al. (1988) showed that OJ 287 displays large periodic outbursts, with a period of 11.7 years. We have monitored OJ 287 intensively for two years, during the OJ-94 project. This project was created for monitoring OJ 287 during its predicted new outburst in 1994. In the data archive we have over 7000 observations on OJ 287, in the radio, infrared and optical bands. This data archive contains the best ever obtained light curves for any extragalactic object. The optical light curve shows continuous variability down to time scales of tens of minutes. The variability observed in OJ 287 can be broken down to (at least) four different categories:
A gas-filled cylindrical liner z-pinch configuration has been used to drive convergent radiative shock waves into different gases at velocities of 20–50 km s−1. On application of the 1.4 MA, 240 ns rise-time current pulse produced by the Magpie generator at Imperial College London, a series of cylindrically convergent shock waves are sequentially launched into the gas-fill from the inner wall of the liner. This occurs without any bulk motion of the liner wall itself. The timing and trajectories of the shocks are used as a diagnostic tool for understanding the response of the liner z-pinch wall to a large pulsed current. This analysis provides useful data on the liner resistivity, and a means to test equation of state (EOS) and material strength models within MHD simulation codes. In addition to providing information on liner response, the convergent shocks are interesting to study in their own right. The shocks are strong enough for radiation transport to influence the shock wave structure. In particular, we see evidence for both radiative preheating of material ahead of the shockwaves and radiative cooling instabilities in the shocked gas. Some preliminary results from initial gas-filled liner experiments with an applied axial magnetic field are also discussed.
The follicle destiny towards ovulation or atresia is multi-factorial in nature and involves outcries, paracrine and endocrine factors that promote cell proliferation and survival (development) or unchain apoptosis as part of the atresia process. In several types of cells, sphingosine-1-phospate (S1P) promotes cellular proliferation and survival, whereas ceramide (CER) triggers cell death, and the S1P/CER ratio may determine the fate of the cell. The aim of present study was to quantify S1P and CER concentrations and their ratio in bovine antral follicles of 8 to 17 mm classified as healthy and atretic antral follicles. Follicles were dissected from cow ovaries collected from a local abattoir. The theca cell layer, the granulosa cells and follicular fluid were separated, and 17β-estradiol (E2) and progesterone (P4) concentrations were measured in the follicular fluid by radioimmunoassay. Based on the E2/P4 ratio, the follicles were classified as healthy (2.2±0.3) or atretic (0.2±0.3). In both follicular compartments (granulosa and theca cell layer), sphingolipids were extracted and S1P and CER concentrations were quantified by HPLC (XTerra RP18; 5 µm, 3.0×150 mm column). Results showed that in both follicular compartments, S1P concentrations were higher in healthy antral follicles than in atretic antral follicles (P<0.05). The concentration of CER in the granulosa cells was higher in atretic antral follicles than in healthy antral follicles, but no differences were observed in the theca cell layer. The S1P/CER ratio in both follicular compartments was also higher in healthy antral follicles. Interestingly, in these follicles, there was a 45-fold greater concentration of S1P than CER in the granulosa cells (P<0.05), whereas in the theca cell layer, S1P had only a 14-fold greater concentration than CER when compared with atretic antral follicles. These results suggest that S1P plays a role in follicle health, increasing cellular proliferation and survival. In contrast, reduction of S1P and the S1P/CER in the antral follicle could trigger cellular death and atresia.
Hospital employees with suspected adenoviral conjunctivitis underwent evaluation and testing with real-time polymerase chain reaction. Viral conjunctivitis was suspected in 307 (59%) of 518 employees with eye complaints; adenovirus was detected in 4% (22 of 518). Four employees had genotypes consistent with epidemic keratoconjunctivitis. This algorithm minimizes productivity loss compared with clinical diagnosis.
Patella ferruginea is the most threatened macroinvertebrate in the western Mediterranean, where it is at serious risk of extinction. There is little information on the status of the various populations and most data were published more than 25 years ago. This study provides updated information on the global status of this species, and implications for management and conservation, and tests the hypothesis that population structure can be influenced by collection by people and by the type of substrate. Fifty-five localities were surveyed in Corsica, Sardinia, Tuscany and Sicily, on the islands of Egadi and Pantelleria, and on the Zembra archipelago and Tunisian coasts. The species is extinct on mainland Italy and Sicily but isolated individuals can be found on Egadi and Pantelleria. Populations on Corsica and Sardinia have declined dramatically during the last 25 years. The population in the Zembra archipelago is well preserved, although more widely on Tunisian coasts the species is highly threatened. The information provided here, combined with information from the literature, indicates a strong decline and/or extinction of many populations throughout the western Mediterranean and the presence of healthy populations only in some locations along the north African coast. The species exhibits an increase in density and mean size in areas free of human pressure but the type of substrate (natural or artificial) has no strong influence.
To analyse the association between waist-to-height ratio (WtHR) and body fat and to develop predictive adiposity equations that will simplify the diagnosis of obesity in the paediatric age group.
Cross-sectional study conducted in Spain during 2007 and 2008. Anthropometric dimensions were taken according to the International Biology Program. The children were classified as underweight, normal weight, overweight or obese according to national standards of percentage body fat (%BF). WtHR differences among nutritional status categories were evaluated using ANOVA. Correlation analysis and regression analysis were carried out using WtHR as a predictor variable for %BF. A t test was applied to the results obtained by the regression model and by the Siri equation. The degree of agreement between both methods was evaluated by estimating the intra-class correlation coefficient.
Elementary and secondary schools in Madrid (Spain).
Girls (n 1158) and boys (n 1161) from 6 to 14 years old.
WtHR differed significantly (P < 0·001) depending on nutritional status category. This index was correlated (P < 0·001) with all adiposity indicators. The mean %BF values estimated by the regression model (boys: %BF = 106·50 × WtHR – 28·36; girls: %BF = 89·73 × WtHR – 15·40) did not differ from those obtained by the Siri equation. The intra-class correlation coefficient (0·85 in boys, 0·79 in girls) showed a high degree of concordance between both methods.
WtHR proved to be an effective method for predicting relative adiposity in 6–14-year-olds. The developed equations can help to simplify the diagnosis of obesity in schoolchildren.
A series of NiW catalysts supported on SBA-15-type materials modified with Al, Ti or Zr were prepared and tested in simultaneous hydrodesulfurization (HDS) of two model compounds: dibenzothiophene (DBT) and 4,6-dimethyldibenzothiophene (4,6-DMDBT). Catalysts were prepared by incipient wetness impregnation of SBA-type materials (pure silica SBA-15, Al-SBA-15, Ti-SBA-15 or Zr-SBA-15) using Keggin-type heteropolyacid H4SiW12O40 as active phase precursor and nickel nitrate. Nominal composition of the catalysts was 19 wt.% of WO3 and 3 wt.% of NiO. The supports and catalysts were characterized by SEM-EDX, N2physisorption, small-angle and powder XRD, UV-Vis DRS, TPR and HRTEM. It was shown that a good dispersion of Al, Ti and Zr species on the SBA-15 surface was reached. The characteristic structure of the SBA-15 support was preserved in all supports and NiW catalysts. Addition of metal atoms (Al, Ti, Zr) on the SBA-15 surface prior to catalysts’ preparation improved dispersion of Ni and W oxide species in calcined catalysts. HRTEM characterization of sulfided catalysts showed that the dispersion of NiW active phase was also better on metal-containing SBA-15 supports than on the pure silica one. All NiW catalysts supported on metal-containing SBA-15 materials showed an outstanding catalytic performance in HDS of both model compounds used (DBT and 4,6-DMDBT). A good correlation was found between the dispersion of sulfided NiW active phase and catalytic activity results. The highest HDS activity was obtained with the NiW catalyst supported on Zr-containing SBA-15 molecular sieve, which makes it a promising catalytic system for ultra-deep hydrodesulfurization of diesel fuel.
The objective of this study was to investigate the genetic diversity of methicillin-resistant Staphylococcus aureus (MRSA) clonal complex (CC) 398 using pulsed-field gel electrophoresis (PFGE). Dust and pigs at five age groups were sampled in six Danish MRSA-positive pig farms. MRSA CC398 was isolated from 284 of the 391 samples tested, including 230 (74%) animal and 54 (68%) environmental samples. PFGE analysis of a subset of 48 isolates, including the six strains previously isolated from farm workers, revealed the existence of farm-specific pulsotypes. With a single exception, human, environmental and porcine isolates originating from the same farm clustered together in the PFGE cluster analysis, indicating that spread of MRSA CC398 in Danish pig farms is mainly due to clonal dissemination of farm-specific lineages that can be discriminated by PFGE. This finding has important implications for planning future epidemiological studies investigating the spread of CC398 in pig farming.
In 2010, Mexico celebrates 200 years since the beginning of the Independence war that gave rise to the independent Mexican Empire in 1821, and afterwards to the Mexican Republic. This document had two original copies; one of them was lost in a fire at the beginning of twentieth century, while the second was stolen and finally returned to Mexico in 1960, after a long history of events. This document is kept in the General Archives of Nation (AGN), Mexico.
The “Independence Act of the Mexican Empire of 1821” was written on paper using iron-gall inks. The document has two parts: a declaration and a set of 36 signatures of Iturbide and other people involved in establishing the Independence of Mexico.
The non-destructive study of this document was carried out in order to answer several questions: legitimacy, composition of the materials (paper and inks), deterioration conditions and a possible sequence of writing and the signatures. For these purposes several in situ techniques were used: optical microscopy, ultraviolet and infrared light imaging, portable X-ray Fluorescence and Raman Spectroscopy. This work presents the main results of this analytical methodology applied to the Mexican Independence Act. The results indicate that several inks were used in the manuscript and that the paper has an aging consistent with a nineteenth century document. From these results, we consider that the document examined is genuine and not a copy or facsimile of the original act.