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Non-tuberculous mycobacterium encephalitis is rare. Since 2013, a global outbreak of Mycobacterium chimaera infection has been attributed to point-source contamination of heater cooler units used in cardiac surgery. Disseminated M. chimaera infection has presented many unique challenges, including non-specific clinical presentations with delays in diagnosis, and a high mortality rate among predominantly immunocompetent adults. Here, we describe three patients with fatal disseminated Mycobacterium chimaera infection showing initially non-specific, progressively worsening neurocognitive decline, including confusion, delirium, depression and apathy. Autopsy revealed widespread granulomatous encephalitis of the cerebrum, brain stem and spinal cord, along with granulomatous chorioretinitis. Cerebral involvement and differentiation between mycobacterial granulomas and microangiopathic changes can be assessed best on MRI with contrast enhancement. The prognosis of M. chimaera encephalitis appears to be very poor, but might be improved by increased awareness of this new syndrome and timely antimicrobial treatment.
This presentation will enable the learner to:
1.Describe the clinical, radiological and neuropathological findings of Mycobacterium chimaera encephalitis
2.Be aware of this rare form of encephalitis, and explain its diagnosis, prognosis and management
We assessed the impact of an embedded electronic medical record decision-support matrix (Cerner software system) for the reduction of hospital-onset Clostridioides difficile. A critical review of 3,124 patients highlighted excessive testing frequency in an academic medical center and demonstrated the impact of decision support following a testing fidelity algorithm.
Cardiac surgery-associated acute kidney injury is common. In order to improve our understanding of acute kidney injury, we formed the multi-centre Neonatal and Pediatric Heart and Renal Outcomes Network. Our main goals are to describe neonatal kidney injury epidemiology, evaluate variability in diagnosis and management, identify risk factors, investigate the impact of fluid overload, and explore associations with outcomes.
The Neonatal and Pediatric Heart and Renal Outcomes Network collaborative includes representatives from paediatric cardiac critical care, cardiology, nephrology, and cardiac surgery. The collaborative sites and infrastructure are part of the Pediatric Cardiac Critical Care Consortium. An acute kidney injury module was developed and merged into the existing infrastructure. A total of twenty-two participating centres provided data on 100–150 consecutive neonates who underwent cardiac surgery within the first 30 post-natal days. Additional acute kidney injury variables were abstracted by chart review and merged with the corresponding record in the quality improvement database. Exclusion criteria included >1 operation in the 7-day study period, pre-operative renal replacement therapy, pre-operative serum creatinine >1.5 mg/dl, and need for extracorporeal support in the operating room or within 24 hours after the index operation.
A total of 2240 neonatal patients were enrolled across 22 centres. The incidence of acute kidney injury was 54% (stage 1 = 31%, stage 2 = 13%, and stage 3 = 9%).
Neonatal and Pediatric Heart and Renal Outcomes Network represents the largest multi-centre study of neonatal kidney injury. This new network will enhance our understanding of kidney injury and its complications.
In their focal article, Chernyak-Hai and Rabenu (2018) argue that social exchange theory (SET) needs an update, and in this they are aligned with Cropanzano, Anthony, Daniels, and Hall's (2017) recent critical review of SET. Drawing on Chernyak-Hai and Rabenu's research, we explore two issues in more depth: first, that work relationships are becoming more complex than can be represented by simple dyadic reciprocity; and second, that the context of work is changing rapidly, with implications for workplace relationships. In exploring the ideas put forward by Chernyak-Hai and Rabenu, we draw on Cropanzano et al.’s two-dimensional model of social exchange, with the first dimension being desirable (positive) resources contrasted with undesirable (negative) ones, and the additional dimension being active (exhibit) behavior versus passive (withdraw) behavior. The first valence-oriented dimension fits clearly with the four foci of Chernyak-Hai and Rabenu's research, which cover both positive constructs, namely leader–member exchange (LMX), perceived organizational support and loyalty, and organizational citizenship behaviors (OCB), as well as negative constructs of perceived organizational politics and counterproductive work behaviors (CWB). The second, behavioral dimension proposed by Cropanzano et al. adds useful theoretical specificity that may address Chernyak-Hai and Rabenu's contention that SET needs updating to account for changes in how employees work and how organizations function.
Brandãoite, [BeAl2(PO4)2(OH)2(H2O)4](H2O), is a new Be–Al phosphate mineral from the João Firmino mine, Pomarolli farm region, Divino das Laranjeiras County, Minas Gerais State, Brazil, where it occurs in an albite pocket with other secondary phosphates, including beryllonite, atencioite and zanazziite, in a granitic pegmatite. It occurs as colourless acicular crystals <10 µm wide and <100 µm long that form compact radiating spherical aggregates up to 1.0–1.5 mm across. It is colourless and transparent in single crystals and white in aggregates, has a white streak and a vitreous lustre, is brittle and has conchoidal fracture. Mohs hardness is 6, and the calculated density is 2.353 g/cm3. Brandãoite is biaxial (+), α = 1.544, β = 1.552 and γ = 1.568, all ± 0.002; 2Vobs = 69.7(10)° and 2Vcalc = 71.2°. No pleochroism was observed. Brandãoite is triclinic, space group P
, a = 6.100(4), b = 8.616(4), c = 10.261(5) Å, α = 93.191(11), β = 95.120(11), γ = 96.863(11)°, V = 532.1(8) Å3 and Z = 2. Chemical analysis of a 4 µm wide needle-shaped crystal by electron microprobe and secondary-ion mass spectrometry gave P2O5 = 28.42, Al2O3 = 20.15, BeO = 4.85, H2O = 21.47 and sum = 74.89 wt.%. The empirical formula, normalised on the basis of 15 anions pfu with (OH) = 2 and (H2O) = 5 apfu (from the crystal structure) is Be0.98Al1.99P2.02H12O15. The crystal structure was solved by direct methods and refined to an R1 index of 7.0%. There are two P sites occupied by P5+, two Al sites occupied by octahedrally coordinated Al3+, and one Be site occupied by tetrahedrally coordinated Be2+. There are fifteen anions, two of which are (OH) groups and five of which are (H2O) groups. The simplified ideal formula is thus [BeAl2(PO4)2(OH)2(H2O)4](H2O) with Z = 2. Beryllium and P tetrahedra share corners to form a four-membered ring. Aluminium octahedra share a common vertex to form an [Al2φ11] dimer, and these dimers are cross-linked by P tetrahedra to form a complex slab of polyhedra parallel to (001). These slabs are cross-linked by BeO2(OH)(H2O) tetrahedra, with interstitial (H2O) groups in channels that extend along .
Norwood palliation for patients with single ventricle heart disease is associated with a significant risk for acute kidney injury, which portends a worse prognosis. We sought to investigate the impact of hybrid stage I palliation (Hybrid) on acute kidney injury risk.
This study is a single-centre prospective case–control study of seven consecutive neonates with single ventricle undergoing Hybrid palliation. Levels of serum creatinine and four novel urinary biomarkers, namely neutrophil gelatinase-associated lipocalin, interleukin-18, liver fatty acid-binding protein, and kidney injury molecule-1, were obtained before and after palliation. Acute kidney injury was defined as a ⩾50% increase in serum creatinine within 48 hours after the procedure. Data were compared with a contemporary cohort of 12 neonates with single ventricle who underwent Norwood palliation.
Patients who underwent Hybrid were more likely to be high-risk candidates (86 versus 25%, p=0.01) compared with those who underwent Norwood. Despite similar preoperative serum creatinine levels, there was a trend towards higher levels of postoperative peak serum creatinine (0.7 [0.63, 0.94] versus 0.56 [0.47, 0.74], p=0.06) and rate of acute kidney injury (67 versus 29%, p=0.17) in the Norwood cohort. Preoperative neutrophil gelatinase-associated lipocalin (58.4 [11, 86.3] versus 6.3 [5, 16.2], p=0.07) and interleukin-18 (30.6 [9.6, 167.2] versus 6.3 [6.3, 16.4], p=0.03) levels were higher in the Hybrid cohort. Nevertheless, longitudinal mixed-effect models demonstrated Hybrid palliation to be a protective factor against increased postoperative levels of neutrophil gelatinase-associated lipocalin (estimate −1.8 [−3.0, −9.0], p<0.001) and liver fatty acid-binding protein (−49.3 [−89.7, −8.8], p=0.018).
In this single-centre case–control study, postoperative acute kidney injury risk did not differ significantly by single ventricle stage I treatment strategy; however, postoperative elevation in novel urinary biomarkers, consistent with subclinical kidney injury, was encountered in the Norwood cohort but not in the Hybrid cohort.
Today's youth face unprecedented global challenges to their well-being and cognitive development. Many live in poverty without access to proper nutrition, health care, or education. This chapter describes challenges associated with the assessment of children's mental health and functioning, and identifies risk and protective factors, best practices for prevention, and promising interventions that can be utilized in resource-poor settings. The development of mental health disorders in youth is multifactorial; risk and protective factors for mental health cross biological, psychological, and social domains. Substantive research and resources have been dedicated to understanding and ameliorating mental health service provision among children and adolescents in high-income countries, and thus effective evidence-based treatments for most mental health disorders exist. The tenets of the interventions framework of SAFE (Safety and security, Access to health care, Family and others support, and Education) have useful application to all children facing adverse and difficult life situations.
Vapor movement of synthetic auxin herbicides can injure desirable plants outside the treatment zone. Vapor movement of the synthetic auxin herbicides aminocyclopyrachlor and aminocyclopyrachlor methyl was compared with that of the relatively volatile herbicide dicamba and the low volatile herbicide aminopyralid with a soybean bioassay under greenhouse and field conditions. Soybean is very sensitive to these active ingredients. Under greenhouse conditions, 82 (61 to 104) mg ae ha−1 of aminocyclopyrachlor, 26 (18 to 33) mg ae ha−1 of aminocyclopyrachlor methyl, 82 (69 to 95) mg ae ha−1 of aminopyralid, and 61 (47 to 75) mg ae ha−1 of dicamba produced an estimated 25% visual soybean phytotoxicity response when soybean was treated POST at the V3 growth stage (GR25 [95% confidence interval]). In field studies, aminocyclopyrachlor, aminocyclopyrachlor methyl, and aminopyralid were applied at 70 g ae ha−1 and dicamba was applied at 560 g ae ha−1 (labeled application rates) to soybean at the V3 growth stage. All herbicides were applied within an enclosed chamber (3 m by 3 m by 1 m) to mitigate movement of spray droplets. The enclosures were removed shortly after spray application and soybean response immediately surrounding the treated area was recorded in each of eight directions approximately 10 d after treatment. On the basis of bioassay responses, relative amount of vapor movement was dicamba > aminocyclopyrachlor methyl > aminopyralid ≈ aminocyclopyrachlor. Vapor movement of aminocyclopyrachlor was very low indicating that the risk of phytotoxic response of sensitive plants due to volatility of aminocyclopyrachlor is negligible.
Official suicide statistics for England are based on deaths given suicide verdicts and most cases given an open verdict following a coroner's inquest. Previous research indicates that some deaths given accidental verdicts are considered to be suicides by clinicians. Changes in coroners' use of different verdicts may bias suicide trend estimates. We investigated whether suicide trends may be over- or underestimated when they are based on deaths given suicide and open verdicts.
Possible suicides assessed by 12 English coroners in 1990/91, 1998 and 2005 and assigned open, accident/misadventure or narrative verdicts were rated by three experienced suicide researchers according to the likelihood that they were suicides. Details of all suicide verdicts given by these coroners were also recorded.
In 1990/91, 72.0% of researcher-defined suicides received a suicide verdict from the coroner, this decreased to 65.4% in 2005 (ptrend < 0.01); equivalent figures for combined suicide and open verdicts were 95.4% (1990/91) and 86.7% (2005). Researcher-defined suicides with a verdict of accident/misadventure doubled over that period, from 4.6% to 9.1% (p < 0.01). Narrative verdict cases rose from zero in 1990/91 to 25 in 2005 (4.2% of researcher-defined suicides that year). In 1998 and 2005, 50.0% of the medicine poisoning deaths given accidental/misadventure verdicts were rated as suicide by the researchers.
Between 1990/91 and 2005, the proportion of researcher-defined suicides given a suicide verdict by coroners decreased, largely due to an increased use of accident/misadventure verdicts, particularly for deaths involving poisoning. Consideration should be given to the inclusion of ‘accidental’ deaths by poisoning with medicines in the statistics available for monitoring suicides rates.
We studied the optical nonlinearities of modified 3,3′-diethylthiadicarbocyanine iodides (X-DTDCI) in dimethyl sulfoxide (DMSO) solutions (X = H, Cl, Br at meso position) by a pump-probe technique with crossed polarized chirped laser pulses at room temperature. Reverse-saturable-absorption (RSA) with monoexponential lifetimes is observed at 532 nm in all the samples studied. We determined the effective excited-state absorption cross-sections and their lifetimes for all the samples investigated and found that they clearly correlate to the substituent X at the meso position. Empowered by the chirped pulses, a much faster nonlinearity with a decay time of ˜3.1 ps that is much shorter than the laser pulses used, is unveiled in Cl-DTDCI. We expressed both the absorptive and the refractive part of this fast nonlinearity as the equivalent molecular hyperpolarizability γ1212 and found γ1212 = (8.1 + i9.8) × 10−32erg−1.