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Introduction: Acute non-variceal upper gastrointestinal bleeding (NVUGIB) is a common presentation to the Emergency Department (ED) associated with significant mortality and morbidity. Recent evidence suggests that overt-transfusion is associated with poor patient outcomes and that stable patients above a hemoglobin (hgb) above 70 g/L should be transfused judiciously. This retrospective health records review aims to determine the proportion of NVUGIB patients with hemoglobin greater than 70 g/L who were still appropriately transfused based on clinical parameters. Methods: A retrospective review was conducted on randomly selected patients that presented to one of two major tertiary hospitals with a primary diagnosis of NVUGIB who received blood products, despite a presenting hemoglobin >70 g/L. Standardized case report forms were developed through chart abstraction using a pilot-tested template. The appropriateness of transfusion was then adjudicated separately by a trained medical student and an emergency physician; discrepancies were resolved by discussion. Results: Following independent review of the charts, agreement was met on 94% (45/48) of the charts and after collective discussion 100% consensus was reached and all 48 patients’ transfusion appropriateness and categorized into one of three groups: Appropriate, Potentially avoidable, and clearly avoidable. Only in 22.9% (11/48) of the cases was transfusion deemed to be clearly avoidable while emergency physicians appropriately transfused 45.8% (22/48) of patients based on clinical status and other factors. In 31.3% (15/48) of the cases, transfusion was potentially avoidable in favor of other management options. We calculated the mean GBS for the appropriate, potentially avoidable, and clearly avoidable categories yielding 12.8, 12.7, and 10.2 respectively. Mortality occurred in 2 of the 48 cases (4%). Conclusion: In most instances, emergency physicians are effectively integrating hemoglobin thresholds and clinical status to determine if a patients with NVUGIB and hgb >70 require blood products.
To investigate the use of community-supported agriculture (CSA) as an employer-based health promotion intervention.
Quasi-experimental study using a convenience sample of employees at three employers.
Participants and controls from three Minnesota employers completed baseline and follow-up health assessments and surveys about their experiences with CSA.
A total of 324 participants purchased a CSA share and were eligible for study inclusion. Study participants were matched by age, sex, employer and occupation to a non-randomized control group of individuals who did not purchase a CSA share but completed health assessments during the same time frame as the study participants.
The majority of participants were female, white, middle-aged and highly educated. The most common reason for purchasing a CSA share was a desire for fresh food, and the majority of participants were satisfied with their experience. Participants reported a significant increase in the number of vegetables present in the household and the frequency of family meals. The frequency of eating out decreased significantly, especially at fast-food restaurants. Participants also reported an increase in the amount and variety of produce consumed. However, health assessment data did not show significant changes in dietary intake, health status or BMI.
CSA participation was associated with improvement in some aspects of the household environment and dietary behaviours. Further research is needed to determine whether employer-based CSA interventions may also lead to improvements in dietary intake and health.
The Consideration of Future Consequences Scale (CFC-S) is a measure of the extent to which individuals reflect and are influenced by the immediate as well as by the distant outcomes of current behavior. It´s composed by 12 items, grouped into two subscales (future and immediate). This study aims to explore the factor structure, psychometric properties and construct validity of the Portuguese version of the CFC-S in 5 samples, composed by 527 participants with ages between 13 and 71. A 2 factor structure has been found through Confirmatory Factor Analysis among several tested models. Item 5 has been eliminated in order to achieve better fit indices (χ2df = 3.88, CFI = .90, GFI = .95, RMSEA = .07) and improve internal consistency. Both CFC subscales presented strong correlations with several psychological phenomena (Sensation Seeking, Self-Esteem, Temporal Extension and Time Perspective) and main effects among groups of age and criminal record (for CFC-I, p < .001, for CFC-F, p < .001). These results allow us to support CFC as an efficient psychological evaluation instrument and as an important metric for individual differences in the study of temporal orientation.
In this work, we have studied five different GRBs detected by Swift: GRB 071010B (z = 0.94), GRB 080411 (z = 1.03), GRB 080413B (z = 1.10), GRB 091208B (z = 1.06) and GRB 110715A (z = 0.82); Those GRBs, with similar z and have well defined pulses. To obtain spectral lag, we fit the light curves with a model having exponential rise and decay parts. In addition, we performed spectral analysis using three spectral models for different GRBs' regions: power law, cutoff power law and band model. Additionaly, we releated spectral parameters such as photon index and luminosity with spectral lag. The analysis suggests that there are two types of pulses associated to specific radiation mechanisms which would reveal the radiation process of long gamma-ray bursts.
We introduce the Hausdorff measure for definable sets in an o-minimal structure, and prove the Cauchy–Crofton and co-area formulae for the o-minimal Hausdorff measure. We also prove that every definable set can be partitioned into “basic rectifiable sets”, and that the Whitney arc property holds for basic rectifiable sets.
The infrared fluorescence decay and the dispersed emission spectrum are presented for
gaseous benzene following 193 nm laser excitation. They were measured with FIREFLY
(Fluorescence in the InfraRed from Excited FLYing molecules), a new home-made
spectrometer. Redshift and redtail in the CH stretch emission spectra (3.3
μm region) demonstrate that anharmonicity plays a key role when dealing
with high internal energies, as it is the case in the interstellar medium.
Twin and sibling studies have identified specific cognitive phenotypes that may mediate the association between genes and the clinical symptoms of attention deficit hyperactivity disorder (ADHD). ADHD is also associated with lower IQ scores. We aimed to investigate whether the familial association between measures of cognitive performance and the clinical diagnosis of ADHD is mediated through shared familial influences with IQ.
Multivariate familial models were run on data from 1265 individuals aged 6–18 years, comprising 920 participants from ADHD sibling pairs and 345 control participants. Cognitive assessments included a four-choice reaction time (RT) task, a go/no-go task, a choice–delay task and an IQ assessment. The analyses focused on the cognitive variables of mean RT (MRT), RT variability (RTV), commission errors (CE), omission errors (OE) and choice impulsivity (CI).
Significant familial association (rF) was confirmed between cognitive performance and both ADHD (rF=0.41–0.71) and IQ (rF=−0.25 to −0.49). The association between ADHD and cognitive performance was largely independent (80–87%) of any contribution from etiological factors shared with IQ. The exception was for CI, where 49% of the overlap could be accounted for by the familial variance underlying IQ.
The aetiological factors underlying lower IQ in ADHD seem to be distinct from those between ADHD and RT/error measures. This suggests that lower IQ does not account for the key cognitive impairments observed in ADHD. The results have implications for molecular genetic studies designed to identify genes involved in ADHD.
Avian Plasmodium and Haemoproteus parasites are easily detected by DNA analyses of infected samples but only correctly assigned to each genus by sequencing and use of a phylogenetic approach. Here, we present a restriction site to differentiate between both parasite genera avoiding the use of those analyses. Alignments of 820 sequences currently listed in GenBank encoding a particular cytochrome B region of avian Plasmodium and Haemoproteus show a shared restriction site for both genera using the endonuclease Hpy CH4III. An additional restriction site is present in Plasmodium sequences that would initially allow differentiation of both genera by differential migration of digested products on gels. Overall 9 out of 326 sequences containing both potential restriction sites do not fit to the general rule. We used this differentiation of parasite genera based on Hpy CH4III restriction sites to evaluate the efficacy of 2 sets of general primers in detecting mixed infections. To do so, we used samples from hosts infected by parasites of both genera. The use of general primers was only able to detect 25% or less of the mixed infections. Therefore, parasite DNA amplification using general primers to determine the species composition of haemosporidian infections in individual hosts is not recommended. Specific primers for each species and study area should be designed until a new method can efficiently discriminate both parasites.
To investigate the interaction of the massive stars with the gas and dust in the active star forming region NGC 6357, located in the Sagittarius spiral arm at a distance of 1.7-2.6 kpc (Massey et al. 2001), we analyzed the distribution of the neutral and ionized gas, and that of the dust, based on Hα, [OIII] and [SII] images obtained with the Curtis-Schmidt telescope at CTIO, radio continuum observations at 1.465 MHz obtained with the Very Large Array (NRAO) in the DnC configuration (synthesized beam = 38″), Hi data from the Parkes survey (angular resolution = 15′), CO(1-0) observations obtained with the Nanten radiotelescope at Las Campanas Observatory (angular resolution = 2.7′), and IR images in the four MSX bands (angular resolution = 18.3″).
To determine the efficacy of mupirocin ointment in reducing nasal colonization with mupirocin-susceptible, methicillin-resistant Staphylococcus aureus (MS MRSA) as well as mupirocin-resistant MRSA (MR MRSA).
Prospective evaluation in which patients colonized with MRSA were treated twice daily with 2% topical mupirocin ointment for 5 days.
James H. Quillen Veterans' Affairs Medical Center.
Forty hospitalized patients with two anterior nares cultures positive for MRSA within a 7-day period.
Treated patients had post-treatment cultures at day 3 and weeks 1,2, and 4. Isolates underwent mupirocin-susceptibility testing and DNA typing. MRSA clearance and type turnover were assessed for isolates that were mupirocin-susceptible, low-level (LL) MR MRSA and high-level (HL) MR MRSA.
Post-treatment nares cultures on day 3 were negative for 78.5%, 80%, and 27.7% of patients with MS MRSA, LL-MR MRSA, and HL-MR MRSA, respectively. Sustained culture negativity at 1 to 4 weeks was more common in the MS MRSA group (91%) than in the LL-MR MRSA group (25%) or the HL-MR MRSA group (25%). Positive post-treatment cultures usually showed the same DNA pattern relative to baseline. Plasmid curing of 18 HL-MR MRSA resulted in 15 MS MRSA and 3 LL-MR MRSA.
Mupirocin was effective in eradicating MS MRSA, but strains of MR MRSA often persisted after treatment. This appeared to reflect treatment failure rather than exogenous recolonization. MR MRSA is now more prevalent and it is appropriate to sample MRSA populations for mupirocin susceptibility prior to incorporating mupirocin into infection control programs.
To describe the clinical and molecular epidemiology of mupirocin-resistant (MR) and mupirocin-susceptible (MS) methicillin-resistant Staphylococcus aureus (MRSA) at a Veterans' Affairs hospital and to assess risk factors associated with the acquisition of MR MRSA.
All clinical MRSA isolates for the period October 1990 through March 1995 underwent susceptibility testing to mupirocin. Mupirocin resistance trends were measured, and MS MRSA and MR MRSA isolates underwent typing by pulsed-field gel electrophoresis (PFGE). A retrospective case-control study was conducted to evaluate risk factors for having MR versus MS MRSA.
The James H. Quillen Veterans' Affairs Medical Center in Mountain Home, Tennessee, included a 324-bed acute-care hospital, a 120-bed nursing home, and a 525-bed domiciliary. Colonizations and infections with MRSA were endemic, and mupirocin ointment was commonly used.
Inpatients and outpatients at the facility.
MS MRSA was recovered from 506 patients and MR MRSA from 126. Among MR MRSA isolates, 58% showed low-level mupirocin resistance (minimum inhibitory concentration [MIC] ≥4 to 256 μg/mL), and 42% showed high-level mupirocin resistance (MIC ≥512 μg/mL). A significant increase (P=.002) in the number of high-level MR isolates occurred during the 1993 to 1995 period. A case-control study showed that presence of a decubitus ulcer correlated with high-level resistant isolates (P<.05). The distribution of PFGE patterns did not differ for MR and MS MRSA.
Use of mupirocin ointment in a program aimed at managing endemic MRSA infection or colonization resulted in a significant increase in the recovery of high-level MR MRSA isolates. These isolates appeared to emerge from our existing MRSA pool. A case-control study provided few clues concerning patients likely to harbor MR MRSA We confirmed the position that the extended use of mupirocin ointment should be avoided in settings where MRSA is endemic.
Two organophosphate (OP) resistant strains of the cattle tick Boophilus microplus (Canestrini) from Mexico and Costa Rica were used to analyse the presence of esterase activity associated with resistance. The concentrations of six major proteins in both resistant strains were increased compared to the susceptible Morelos strain, both when stained with Coomassie Brilliant Blue after SDS-PAGE, and when analysed for esterase activity by the hydrolysis of naphthyl acetate esters. Esterases were named A or B in relation to the substrate preference for alpha or beta naphthyl acetate and numbered according to their position on the SDS—PAGE. The molecular weights of these proteins were: 125, 115, 108, 77, 43 and 67 Kd for Est-Bl, Est-B2, Est-B3, Est-B4, Est-B5 and Est-A respectively. Est-B3 showed cholinesterase (ChE) activity. This study strengthens the hypothesis that the mechanism associated with OP resistance found in many other insects includes an increase of esterase activity, probably as a result of gene amplification. The genes encoding these enzymes could be potentially used as molecular markers to detect resistance in the cattle tick B. microplus using a DNA probe.
CrSi2 is of technological interest because it is a silicon-based semiconductor with a small band gap. Due to the lack of success with conventional molecular beam epitaxy of CrSi2 on Si, growth on mesotaxy-produced template layers and allotaxy have been attempted. After removal of the Si capping layer, epitaxy of additional CrSi2 on template layers formed by mesotaxy was found to be possible. However, single-crystal continuous films were not obtained, due at least in part to the presence of a network of cracks in the starting template. Allotaxy of CrSi2 was found to allow the formation of large grains of CrSi2 embedded in a single-crystal Si matrix, but coalescence of these grains into a continuous layer was not achieved.
Poly-buffered local-oxidation of silicon + trench-isolation (PBLT) is a technique being explored for device isolation. In an earlier study, we had reported the presence of dislocations associated with a combination of high-dose (∼5E14 cm2) phosphorous implants and PBLT isolation. In the present study, the behavior of extended defects present in the structures is analyzed in greater detail. The origin and behavior of the defects is modelled to explore potential mechanisms to explain the observations. Implantation induced dislocation-loops interact with stress fields associated with PBLT isolation-trenches. Some of the implant loops (in the presence of a stress field) transform to dislocation sources which then create glide dislocations in the structures. Strategies for defect engineering are discussed, including reducing implant-induced damage (lowering the implant dose) or reducing stress fields (by moving the edge of the implanted region away from the trench). Defect densities can be reduced or eliminated.
Zooplankton samples were collected over a 21-month period in five floodplain lakes of the Orinoco River in order
to establish zooplankton species composition, abundance patterns, and biomass and their relationships with the patterns of inundations and lake morphometry. 60 rotifer taxa were identified. This group was generally more abundant than
copepods and cladocerans (mean : 73,4 % of total zooplankton). Common and abundant rotifer species included K. americana, K. cochlearis, B. mirus, B. gessneri, P. vulgaris and F. longiseta. Copepods were dominated by nauplii (mean : 73,8 % of total copepod stages). Cladocerans were scarce and dominated by M. minuta, C. cornuta and D. spinulosum.
Most frequent and abundant zooplankton species were euplanktonic with a dominance of filter feeders and microphagous detritivores. Mean zooplankton density in all lakes ranged from 340 ind./l to 3 486 ind./l. Biomass ranged from 71,1 µg.l (dw) to 432,8 µg/l. Rotifers accounted for 64,7 % of the total mean zooplankton biomass in three lakes while
copepods accounted for 57,8 % of the biomass in two lakes. Both density and biomass were markedly seasonal with
highest mean values at low waters. Mean density in the lakes was 100 times higher than in the Orinoco main stem. Lakes
with highest variabilities in surface area and water depths showed highest zooplankton densities. The type of connection (direct or indirect) established between the lakes and the major source of the water also seemed important to interpret the productivity of floodplain lakes.
Stomach content analyses were performed on dwarf specimens of Asplanchna sieboldi collected on different dates in a shallow floodplain lake of the Orinoco River system. The results showed that the dwarf forms of A. sieboldi were highly selective on small Brachionids (Brachionus caudatus and Keratella americana). This observation confirmed on the carnivore status of these forms of the species. Considering the aleatory character of prey capture in rotifers, the high selectivity observed in A. sieboldi may be controlled by the abundance of the favoured small-sized prey. Under the conditions of the study, Asplanchna may be considered a stenophagous predator. The prédation pattern exhibited by the dwarf A. sieboldi under our tropical conditions was similar to the pattern exhibited by larger species of Asplanchna in temperate regions. In both regions, size and abundance of prey seem to control the food preferences of this planktonic predator.
As device dimensions decrease in silicon integrated-circuits, conventional LOCOS (local-oxidation of silicon) isolation becomes inadequate to meet dimensional demands. Variations on LOCOS are therefore being explored for further miniaturization of devices. One such variation involves poly-buffered LOCOS + trench-isolation (PBLT). In this study, PBLT structures were characterized using TEM. Wright-etched cross-section SEM micrographs showed etch-pits associated with a combination of high-dose (> 5E14 cm-2) phosphorous implants and PBLT isolation. TEM characterization showed that dislocations were formed in the structures for a combination of high-dose (1E15 cm-2) phosphorous implants (followed by an anneal) and PBLT isolation. Structures exposed to lower-dose (1E14 cm-2) implants showed no defects and neither did 1E15 implanted structures prior to annealing. The results are modelled in terms of the stress configurations present in the structures, and in terms of dislocation-sources resulting from implantation-related dislocation-loops. The dislocation-sources operate in the presence of stresses associated with the isolation-trenches. Glide-loops form, which then grow in response to stresses in the structures and dislocations result on glide planes.
Zooplankton samples collected at low and high water in 14 and 21 stations respectively along some 900 km of the Orinoco and its Delta, revealed the presence of 100 rotifer and 48 cladoceran taxa. Of these, only 13 rotifer and 8 cladoceran species were frequent and numerically important, mainly Keratella americana, Lecane proiecta, Ploesoma lenticulare, Polyarthra vulgaris, Bosmina tubicen, Bosminopsis deitersi, Diaphanosoma birgei and Moina minuta. Nauplii were dominant among the copepods. At low water, rotifers were by far the most abundant group (mean 49 org./l ) followed by cladocerans (mean 2.8 org/l) and copepods (1.5 org/l). At high water, rotifer densities declined to a mean of 3,5 org/l, followed by copepods (mean 3.4 org/l) and cladocerans (1.2 org/l). Mean zooplankton densities at low water were eight times higher than at high water. At low water, longitudinal zooplankton densities seemed to be influenced by tributary river waters. At high water, densities were generally low up to the Delta where a longitudinal increase was observed. A high proportion of egg carrying cladocerans, particularly B. tubicen, B. deitersi and M. minuta, were observed at low water along the sampling sites, suggesting an ability of the species for growth and reproduction in the river.