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Clostridioides difficile infection (CDI) is prevalent in pediatric oncology patients, but the transmission risk to peers is unknown. In 224 children with CDI, multilocus sequence typing (MLST) identified only 7 alleged transmission events (18%) originating from children <3 years old. None of these events were corroborated by WGS.
This chapter, provides an overview for caudal and penile blocks and their application in pediatric anesthesia practice. The authors discuss the indication for caudal blocks as well as anatomic considerations, dosing, conformation of placement and safety. The alternative penile block is presented.
Frascati international research criteria for HIV-associated neurocognitive disorders (HAND) are controversial; some investigators have argued that Frascati criteria are too liberal, resulting in a high false positive rate. Meyer et al. recommended more conservative revisions to HAND criteria, including exploring other commonly used methodologies for neurocognitive impairment (NCI) in HIV including the global deficit score (GDS). This study compares NCI classifications by Frascati, Meyer, and GDS methods, in relation to neuroimaging markers of brain integrity in HIV.
Two hundred forty-one people living with HIV (PLWH) without current substance use disorder or severe (confounding) comorbid conditions underwent comprehensive neurocognitive testing and brain structural magnetic resonance imaging and magnetic resonance spectroscopy. Participants were classified using Frascati criteria versus Meyer criteria: concordant unimpaired [Frascati(Un)/Meyer(Un)], concordant impaired [Frascati(Imp)/Meyer(Imp)], or discordant [Frascati(Imp)/Meyer(Un)] which were impaired via Frascati criteria but unimpaired via Meyer criteria. To investigate the GDS versus Meyer criteria, the same groupings were utilized using GDS criteria instead of Frascati criteria.
When examining Frascati versus Meyer criteria, discordant Frascati(Imp)/Meyer(Un) individuals had less cortical gray matter, greater sulcal cerebrospinal fluid volume, and greater evidence of neuroinflammation (i.e., choline) than concordant Frascati(Un)/Meyer(Un) individuals. GDS versus Meyer comparisons indicated that discordant GDS(Imp)/Meyer(Un) individuals had less cortical gray matter and lower levels of energy metabolism (i.e., creatine) than concordant GDS(Un)/Meyer(Un) individuals. In both sets of analyses, the discordant group did not differ from the concordant impaired group on any neuroimaging measure.
The Meyer criteria failed to capture a substantial portion of PLWH with brain abnormalities. These findings support continued use of Frascati or GDS criteria to detect HIV-associated CNS dysfunction.
To determine the effectiveness of ultraviolet (UV) environmental disinfection system on rates of hospital-acquired vancomycin-resistant enterococcus (VRE) and Clostridium difficile.
Using active surveillance and an interrupted time-series design, hospital-acquired acquisition of VRE and C. difficile on a bone marrow transplant (BMT) unit were examined before and after implementation of terminal disinfection with UV on all rooms regardless of isolation status of patients. The main outcomes were hospital-based acquisition measured through (1) active surveillance: admission, weekly, and discharge screening for VRE and toxigenic C. difficile (TCD) and (2) clinical surveillance: incidence of VRE and CDI on the unit.
Bone marrow transplant unit at a tertiary-care cancer center.
Stem cell transplant (SCT) recipients.
Terminal disinfection of all rooms with UV regardless of isolation status of patients.
During the 20-month study period, 579 patients had 704 admissions to the BMT unit, and 2,160 surveillance tests were performed. No change in level or trend in the incidence of VRE (trend incidence rate ratio [IRR], 0.96; 95% confidence interval [CI], 0.81–1.14; level IRR, 1.34; 95% CI, 0.37–1.18) or C. difficile (trend IRR, 1.08; 95% CI, 0.89–1.31; level IRR, 0.51; 95% CI, 0.13–2.11) was observed after the intervention.
Utilization of UV disinfection to supplement routine terminal cleaning of rooms was not effective in reducing hospital-acquired VRE and C. difficile among SCT recipients.
Background: Patients suffering from traumatic brain injury (TBI) are at increased risk of venous thromboembolism (VTE). However, initiation of pharmacological venous thromboprophylaxis (VTEp) may cause further intracranial hemorrhage. We reviewed the literature to determine the postinjury time interval at which VTEp can be administered without risk of TBI evolution and hematoma expansion. Methods: MEDLINE and EMBASE databases were searched. Inclusion criteria were studies investigating timing and safety of VTEp in TBI patients not previously on oral anticoagulation. Two investigators extracted data and graded the papers’ levels of evidence. Randomized controlled trials were assessed for bias according to the Cochrane Collaboration Tool and Cohort studies were evaluated for bias using the Newcastle-Ottawa Scale. We performed univariate meta-regression analysis in an attempt to identify a relationship between VTEp timing and hemorrhagic progression and assess study heterogeneity using an I2 statistic. Results: Twenty-one studies were included in the systematic review. Eighteen total studies demonstrated that VTEp postinjury in patients with stable head computed tomography scan does not lead to TBI progression. Fourteen studies demonstrated that VTEp administration 24 to 72 hours postinjury is safe in patients with stable injury. Four studies suggested that administering VTEp within 24 hours of injury in patients with stable TBI does not lead to progressive intracranial hemorrhage. Overall, meta-regression analysis demonstrated that there was no relationship between rate of hemorrhagic progression and VTEp timing. Conclusions: Literature suggests that administering VTEp 24 to 48 hours postinjury may be safe for patients with low-hemorrhagic-risk TBIs and stable injury on repeat imaging.
The most extremely osmotolerant microbial isolates are fungi from high-sugar environments that tolerate the lowest water activity (0.61) for growth yet reported. Studies of osmotolerant bacteria have focused on halotolerance rather than sucretolerance (ability to grow in high sugar concentrations). A collection of salinotolerant (≥10% NaCl or ≥50% MgSO4) bacterial isolates from the Great Salt Plains of Oklahoma and Hot Lake in Washington were screened for sucretolerance in medium supplemented with ≥50% fructose, glucose or sucrose. Tolerances significantly differed between solutes, even though water activities for saline media (0.92 and 0.85 for 10 and 20% NaCl Salt Plains media, respectively) were comparable or lower than water activities for high-sugar media (0.93 and 0.90 for 50 and 70% sucrose artificial nectar media, respectively). These specific solute effects were differentially expressed among individual isolates. Extrapolating the results of earlier food science studies with yeasts at high sugar concentrations to bacteria in salty environments with low water activity should be done with caution. Furthermore, the discussion of habitable Special Regions on Mars and the icy worlds should reflect an understanding of specific solute effects.
Savage et al. (1977) found that the radio source PKS 1448-232 coincided with a stellar object of about magnitude 16.4 having an ultraviolet excess. A low resolution spectrum obtained with the Anglo-Australian Telescope (AAT) confirmed this object as a QSO with zem = 2.22 and revealed many absorption lines short-ward of the La emission. Consequently this object was included in a programme of spectroscopy at intermediate resolution with the AAT to investigate QSO absorption lines. Savage et al. have given a finding chart with an optical position of 14h48m09s.3, −23°17′10″ (1950.0). The radio fluxes are 0.40 Jy at 2.7 GHz and 0.31 Jy at 5.0 GHz.
Magnetic resonance imaging studies of maltreated children with posttraumatic stress disorder (PTSD) suggest that maltreatment-related PTSD is associated with adverse brain development. Maltreated youth resilient to chronic PTSD were not previously investigated and may elucidate neuromechanisms of the stress diathesis that leads to resilience to chronic PTSD. In this cross-sectional study, anatomical volumetric and corpus callosum diffusion tensor imaging measures were examined using magnetic resonance imaging in maltreated youth with chronic PTSD (N = 38), without PTSD (N = 35), and nonmaltreated participants (n = 59). Groups were sociodemographically similar. Participants underwent assessments for strict inclusion/exclusion criteria and psychopathology. Maltreated youth with PTSD were psychobiologically different from maltreated youth without PTSD and nonmaltreated controls. Maltreated youth with PTSD had smaller posterior cerebral and cerebellar gray matter volumes than did maltreated youth without PTSD and nonmaltreated participants. Cerebral and cerebellar gray matter volumes inversely correlated with PTSD symptoms. Posterior corpus callosum microstructure in pediatric maltreatment-related PTSD differed compared to maltreated youth without PTSD and controls. The group differences remained significant when controlling for psychopathology, numbers of Axis I disorders, and trauma load. Alterations of these posterior brain structures may result from a shared trauma-related mechanism or an inherent vulnerability that mediates the pathway from chronic PTSD to comorbidity.
Commission 25 (C25) deals with the techniques and issues involved with the measurement of optical and infrared radiation intensities and polarization from astronomical sources. As such, in recent years attention has focused on photometric standard stars, atmospheric extinction, photometric passbands, transformation between systems, nomenclature, and observing and reduction techniques. At the start of the trimester C25 changed its name from Stellar Photometry and Polarization to Astronomical Photometry and Polarization so as to explicitly include in its mandate particular issues arising from the measurement of resolved sources, given the importance of photometric redshifts of distant galaxies for many of the large photometric surveys now underway. We begin by summarizing commission activities over the 2012-2014 period, follow with a report on Polarimetry, continue with Photometry topics that have been of interest to C25 members, and conclude with a Vision for the Future.
The aim of the present study was to investigate the mechanistic basis of protein deficiency during pregnancy in mother that is transduced to offspring. To this end, timed-pregnant Sprague–Dawley rats were fed either a control (20 % of energy from protein) or low-protein (LP, 8 % of energy from protein) diet during gestation. Tissues were collected after delivery from rat dams, and skeletal muscle was collected at postnatal day 38 from the offspring. Quantitative RT-PCR and Western blot analyses were performed to determine mRNA and protein levels. Histological analysis was performed to evaluate myofibre size. LP dams gained significantly less weight during pregnancy, developed muscle atrophy, and had significantly lower circulating threonine and histidine levels than control dams. The mRNA expression of the well-known amino acid response (AAR) pathway-related target genes was increased only in the skeletal muscle of LP dams, as well as the protein expression levels of activating transcription factor 4 (ATF4) and phosphorylated eukaryotic translation initiation factor 2α (p-eIF2α). The mRNA expression of autophagy-related genes was significantly increased in the skeletal muscle of LP dams. Moreover, the mRNA expression of genes involved in both AAR and autophagy pathways remained elevated and was memorised in the muscle of LP offspring that consumed a post-weaning control diet. Additionally, the LP diet increased an autophagy marker, microtubule-associated proteins 1A/1B light chain 3B (LC3B) protein expression in the skeletal muscle of rat dams, consistent with the initiation of autophagy. The LP diet further increased ATF4 binding at the predicted regions of AAR and autophagy pathway-related genes. Increased binding of ATF4 unveils the crucial role of ATF4 in the activation of autophagy in response to protein restriction. Our data suggest that molecular changes in maternal muscle are memorised in the offspring long after gestational protein restriction, reinforcing the role of maternal signalling in programming offspring health.
A series of laser pump, x-ray probe experiments show that above band gap photoexcitation can generate a large out-of-plane strain in multiferroic BiFeO3 thin films. The strain decays in a time scale that is the same as the photo-induced carriers measured in an optical transient absorption spectroscopy experiment. We attribute the strain to the piezoelectric effect due to screening of the depolarization field by laser induced carriers. A strong film thickness dependence of strain and carrier relaxation is also observed, revealing the role of the carrier transport in determining the structural and carrier dynamics in complex oxide thin films.
The challenges associated with meeting 20nm technology requirements for better Cu CMP process uniformity and lower defectivity have been studied. Required improvements in uniformity were obtained through platen process optimization along with evaluation & selection of specific Cu slurries and pads and their performance reported. The principal factors influencing defect formation, including Cu barrier metallurgy, interconnect pattern density and process queue times were studied. Specific new post CMP clean chemistries were evaluated to assess their capability to suppress defect formation and their performance reported. The trade off between uniformity and defect suppression as a function slurry, pad and post Cu CMP clean chemistry is described.
Tight networks of interwoven carbon nanotube bundles are formed in our highly conductive composite. The composite possesses properties suggesting a two-dimensional percolative network rather than other reported dispersions displaying three-dimensional networks. Binding nanotubes into large but tight bundles dramatically alters the morphology and electronic transport dynamics of the composite. This enables it to carry higher levels of charge in the macroscale leading to conductivities as high as 1600 S/cm. We now discuss in further detail, the electronic and physical properties of the nanotube composites through Raman spectroscopy and transmission electron microscopy analysis. When controlled and used appropriately, the interesting properties of these composites reveal their potential for practical device applications. For instance, we used this composite to fabricate coatings, which improve the properties of an electromagnetic antenna/amplifier transducer. The resulting transducer possesses a broadband range up to GHz frequencies. A strain gauge transducer was also fabricated using changes in conductivity to monitor structural deformations in the composite coatings.
A systematic approach was taken to identify methods to prevent post CMP corrosion of copper in 22nm interconnect structures. Line to line current leakage measurements (at various times post CMP) were used as a means to quantify the extent and time-dependence of copper corrosion. Interruption of the corrosion mechanism by the use of passivating agents in post-CMP clean chemistries is explored. A broad-based screening was conducted to identify aqueous formulations of passivating agents for protection of copper which do not have deleterious effects on line resistance and overall defectivity. A formulation was identified which was effective in preventing corrosion when applied during post CMP brush clean.
Three new dynamic tensor thermal diffusivity subgrid-scale (SGS) heat flux (HF) models are proposed for large-eddy simulation of thermal convection. The constitutive relations for the proposed modelling approaches represent the most general explicit algebraic formulations possible for the family of SGS HF models constructed using the resolved temperature gradient and SGS stress tensor. As a result, these three new models include a number of previously proposed dynamic SGS HF models as special cases. In contrast to the classical dynamic eddy thermal diffusivity SGS HF model, which strictly requires the SGS heat flux be aligned with the negative of the resolved temperature gradient, the three new models proposed here admit more degrees of freedom, and consequently provide a more realistic geometrical and physical representation of the SGS HF vector. To validate the proposed models, numerical simulations have been performed based on two benchmark test cases of neutrally and unstably stratified horizontal channel flows.