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Laboratory identification of carbapenem-resistant Enterobacteriaceae (CRE) is a key step in controlling its spread. Our survey showed that most Veterans Affairs laboratories follow VA guidelines for initial CRE identification, whereas 55.0% use PCR to confirm carbapenemase production. Most respondents were knowledgeable about CRE guidelines. Barriers included staffing, training, and financial resources.
Optimising short- and long-term outcomes for children and patients with CHD depends on continued scientific discovery and translation to clinical improvements in a coordinated effort by multiple stakeholders. Several challenges remain for clinicians, researchers, administrators, patients, and families seeking continuous scientific and clinical advancements in the field. We describe a new integrated research and improvement network – Cardiac Networks United – that seeks to build upon the experience and success achieved to-date to create a new infrastructure for research and quality improvement that will serve the needs of the paediatric and congenital heart community in the future. Existing gaps in data integration and barriers to improvement are described, along with the mission and vision, organisational structure, and early objectives of Cardiac Networks United. Finally, representatives of key stakeholder groups – heart centre executives, research leaders, learning health system experts, and parent advocates – offer their perspectives on the need for this new collaborative effort.
Findings as to whether individuals’ experiences of physical maltreatment from their parents in childhood predict their own perpetration of physical maltreatment toward their children in adulthood are mixed. Whether the maltreatment experienced is severe versus moderate or mild may relate to the strength of intergenerational associations. Furthermore, understanding of the roles of possible mediators (intervening mechanisms linking these behaviors) and moderators of the intervening mechanisms (factors associated with stronger or weaker mediated associations) is still relatively limited. These issues were examined in the present study. Mediating mechanisms based on a social learning model included antisocial behavior as assessed by criminal behaviors and substance use (alcohol and drug use), and the extent to which parental angry temperament moderated any indirect effects of antisocial behavior was also examined. To address these issues, data were used from Generations 2 and 3 of a prospective three-generational study, which is an extension of the Oregon Youth Study. Findings indicated modest intergenerational associations for severe physical maltreatment. There was a significant association of maltreatment history, particularly severe maltreatment with mothers’ and fathers’ delinquency. However, neither delinquency nor substance use showed significant mediational effects, and parental anger as a moderator of mediation did not reach significance.
Few studies have investigated the patterns of posttraumatic stress disorder (PTSD) symptom change in prolonged exposure (PE) therapy. In this study, we aimed to understand the patterns of PTSD symptom change in both PE and present-centered therapy (PCT).
Participants were active duty military personnel (N = 326, 89.3% male, 61.2% white, 32.5 years old) randomized to spaced-PE (S-PE; 10 sessions over 8 weeks), PCT (10 sessions over 8 weeks), or massed-PE (M-PE; 10 sessions over 2 weeks). Using latent profile analysis, we determined the optimal number of PTSD symptom change classes over time and analyzed whether baseline and follow-up variables were associated with class membership.
Five classes, namely rapid responder (7–17%), steep linear responder (14–22%), gradual responder (30–34%), non-responder (27–33%), and symptom exacerbation (7–13%) classes, characterized each treatment. No baseline clinical characteristics predicted class membership for S-PE and M-PE; in PCT, more negative baseline trauma cognitions predicted membership in the non-responder v. gradual responder class. Class membership was robustly associated with PTSD, trauma cognitions, and depression up to 6 months after treatment for both S-PE and M-PE but not for PCT.
Distinct profiles of treatment response emerged that were similar across interventions. By and large, no baseline variables predicted responder class. Responder status was a strong predictor of future symptom severity for PE, whereas response to PCT was not as strongly associated with future symptoms.
Latest Sandbian to early Katian sequences across Laurentia's epicontinental sea exhibit a transition from lithologies characterized as ‘warm-water’ carbonates to those characterized as ‘cool-water'carbonates. This shift occurs across the regionally recognized M4/M5 sequence stratigraphic boundary and has been attributed to climatic cooling and glaciation, basin reorganization and upwelling of open ocean water, and/or increased water turbidity and terrigenous input associated with the Taconic tectophase. Documentation of oxygen isotopic trends across the M4/M5 and through bracketing strata provides a potential means of distinguishing among these alternative scenarios; however, oxygen isotopic records generated to date have failed to settle the debate. This lack of resolution is because δ18O records are open to multiple interpretations and potentially confounding factors related to local environmental conditions have not been tested by examining the critical interval in multiple areas and different depositional settings. To begin to address this shortcoming, we present new species-specific and mixed assemblage conodont δ18O values in samples spanning the M4/M5 boundary from the Upper Mississippi Valley, Alabama, and Virginia. The new results are combined with previous studies, providing a record of δ18O variability across SE Laurentia. The combined dataset allows us to test for regional trends at a resolution not previously available. Our results document a ~1.5‰ decrease in values across Laurentia instead of increasing δ18O values across the M4/M5 as predicted in various ‘cool-water’ scenarios. In short, these results do not support a shift to ‘cool-water’ conditions as an explanation for changes in early Katian carbonates across the M4/M5.
Poor effortful control is a key temperamental factor underlying behavioral problems. The bidirectional association of child effortful control with both positive parenting and negative discipline was examined from ages approximately 3 to 13–14 years, involving five time points, and using data from parents and children in the Oregon Youth Study—Three Generational Study (N = 318 children from 150 families). Based on a dynamic developmental systems approach, it was hypothesized that there would be concurrent associations between parenting and child effortful control and bidirectional effects across time from each aspect of parenting to effortful control and from effortful control to each aspect of parenting. It was also hypothesized that associations would be more robust in early childhood, from ages 3 to 7 years, and would diminish as indicated by significantly weaker effects at the older ages, 11–12 to 13–14 years. Longitudinal feedback or mediated effects were also tested. The findings supported (a) stability in each construct over multiple developmental periods; (b) concurrent associations, which were significantly weaker at the older ages; (c) bidirectional effects, consistent with the interpretation that at younger ages children's effortful control influenced parenting, whereas at older child ages, parenting influenced effortful control; and (d) a transactional effect, such that maternal parenting in late childhood was a mechanism explaining children's development of effortful control from middle childhood to early adolescence.
The ability to strongly attach biomolecules such as enzymes and antibodies to surfaces underpins a host of technologies that are rapidly growing in utility and importance. Such technologies include biosensors for medical and environmental applications and protein or antibody diagnostic arrays for early disease detection. Emerging new applications include continuous flow reactors for enzymatic chemical, textile or biofuels processing and implantable biomaterials that interact with their host via an interfacial layer of active biomolecules. In many of these applications it is desirable to maintain physical properties of an underlying material whilst engineering a surface suitable for attachment of proteins or peptide constructs. Nanoscale polymeric interlayers are attractive for this purpose.
We have developed interlayers that form the basis of a new biomolecule binding technology with significant advantages over other currently available methods. The interlayers, created by the ion implantation of polymer like surfaces, achieve covalent immobilization on immersion of the surface in protein solution. The interlayers can be created on any underlying material and ion stitched into its surface. The covalent immobilization of biomolecules from solution is achieved through the action of highly reactive free radicals in the interlayer.
In this paper, we present characterisation of the structure and properties of the interlayers and describe a detailed kinetic model for the covalent attachment of protein molecules directly from solution.
A bed on Jbel Issoumour, near Alnif in southeastern Morocco, contains numerous complete trilobites. The bed is located stratigraphically at the base of the El Otfal Formation, immediately above a cliff-forming resistant unit known to local trilobite miners as the ‘grand calcaire’, and is latest Emsian or early Eifelian in age. The fauna exhibits an alpha trilobite diversity of at least eight species, including Erbenochile issoumourensis n. sp., Acanthopyge (Lobopyge) bassei n. sp., and Walliserops lindoei n. sp. The absence of lateral palpebral extensions in E. issoumourensis but their presence in the type species of Erbenochile, E. erbeni, when considered with other differences in the exceptionally large eyes of both species, supports the hypothesis that these palpebral structures functioned as eyeshades in E. erbeni but not in E. issoumourensis. Walliserops lindoei has a short, stout haft at the base of the trident anterior cephalic projection, which is the most characteristic feature of Walliserops. This projection in Walliserops primarily functioned as a deterrent to predators.
On January 12, 2010, a major earthquake in Haiti resulted in approximately 212 000 deaths, 300 000 injuries, and more than 1.2 million internally displaced people, making it the most devastating disaster in Haiti's recorded history. Six academic medical centers from the city of Chicago established an interinstitutional collaborative initiative, the Chicago Medical Response, in partnership with nongovernmental organizations (NGOs) in Haiti that provided a sustainable response, sending medical teams to Haiti on a weekly basis for several months. More than 475 medical volunteers were identified, of whom 158 were deployed to Haiti by April 1, 2010. This article presents the shared experiences, observations, and lessons learned by all of the participating institutions. Specifically, it describes the factors that provided the framework for the collaborative initiative, the communication networks that contributed to the ongoing response, the operational aspects of deploying successive medical teams, and the benefits to the institutions as well as to the NGOs and Haitian medical system, along with the challenges facing those institutions individually and collectively. Academic medical institutions can provide a major reservoir of highly qualified volunteer medical personnel that complement the needs of NGOs in disasters for a sustainable medical response. Support of such collaborative initiatives is required to ensure generalizability and sustainability.
(Disaster Med Public Health Preparedness. 2010;4:169-173)
Although research has been conducted on the course, consequences, and correlates of borderline personality disorder (BPD), little is known about its emergence in childhood, and no studies have examined the extent to which theoretical models of the pathogenesis of BPD in adults are applicable to the correlates of borderline personality symptoms in children. The goal of this study was to examine the interrelationships between two BPD-relevant personality traits (affective dysfunction and disinhibition), self- and emotion-regulation deficits, and childhood borderline personality symptoms among 263 children aged 9 to 13. We predicted that affective dysfunction, disinhibition, and their interaction would be associated with childhood borderline personality symptoms, and that self- and emotion-regulation deficits would mediate these relationships. Results provided support for the roles of both affective dysfunction and disinhibition (in the form of sensation seeking) in childhood borderline personality symptoms, as well as their hypothesized interaction. Further, both self- and emotion-regulation deficits partially mediated the relationship between affective dysfunction and childhood borderline personality symptoms. Finally, results provided evidence of different gender-based pathways to childhood borderline personality symptoms, suggesting that models of BPD among adults are more relevant to understanding the factors associated with borderline personality symptoms among girls than boys.
The Earth rotates in the gravity fields of the Moon and Sun, causing cyclic variations in the gravitational potential. The most obvious consequence is the marine tide but there are also tidal deformations of the solid Earth. These take the form of prolate ellipsoidal extensions, aligned with the Moon or Sun, and the observed tides are caused by the rotation of the Earth in the deformed ‘envelope’. This phenomenon occurs in all rotating astronomical bodies that are not very remote from the gravitational influences of their neighbours. It would merit little more than a footnote in a text of this kind were it not for one crucial effect: tides are dissipative. The dissipation of rotational energy is slight in gaseous bodies, but it strongly influences the behaviour and orbital evolution of solid planets and satellites and in the Earth it is strongest in the oceans.
We present an analysis of tidal potential and deformation as the starting point for a discussion of tidal friction. This has had a major effect on the Earth–Moon system and we suggest also on Venus and Mercury. It may not be important to Mars but it has interesting effects on some of the solid bodies of the outer Solar System. The vigorous volcanism of Jupiter's satellite Io is attributed to heating by tidal dissipation. In this case it is a radial tide, that is, a variation in the amplitude of a tide of constant orientation, because Io has stopped rotating relative to Jupiter.
A thermal history of the mantle can be calculated almost independently of the core. The logic for this is that core heat is carried up through the mantle by narrow, buoyant plumes that have only a weak interaction with the plate tectonic convection process that cools the mantle. The converse is not true. The core is cooled by loss of heat into a thermal boundary layer at the base of the mantle and so depends on the temperature difference between the core and the deep mantle, 100 to 200 km above the boundary, as well as on mantle rheology. The boundary layer must have developed, that is, the mantle must have cooled substantially, before significant core cooling could occur.
Mantle rheology also controls the cooling of the mantle itself, but it is a mutual control. Tozer (1972) drew attention to the fact that the strong dependence of viscosity on temperature (Eq. (10.27)) has a stabilizing effect on both. If the mantle were to become too cool and viscous to convect at the ‘normal’ rate, convection would slow until radioactive heating caught up. But this does not mean that the heat loss is in equilibrium with the heat source, because the source is not constant. With diminishing radiogenic heat, convection slows down and this means that the mantle is cooling, as is most convincingly demonstrated by a consideration of the heat balance equation (Eq. (23.14)).