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Approximately, 1.7 million individuals in the United States have been infected with SARS-CoV-2, the virus responsible for the novel coronavirus disease-2019 (COVID-19). This has disproportionately impacted adults, but many children have been infected and hospitalised as well. To date, there is not much information published addressing the cardiac workup and monitoring of children with COVID-19. Here, we share the approach to the cardiac workup and monitoring utilised at a large congenital heart centre in New York City, the epicentre of the COVID-19 pandemic in the United States.
There is an extensive literature describing the detrimental effects of adverse childhood experiences (ACE; e.g., abuse, neglect, and household dysfunction) on physical and mental health. However, few large-scale studies have explored these associations longitudinally in urban minority cohorts or assessed links to broader measures of well-being such as educational attainment, occupation, and crime. Although adversity and resilience have long been of interest in developmental psychology, protective and promotive factors have been understudied in the ACE literature. This paper investigates the psychosocial processes through which ACEs contribute to outcomes, in addition to exploring ways to promote resilience to ACEs in vulnerable populations. Follow-up data were analyzed for 87% of the original 1,539 participants in the Chicago Longitudinal Study (N = 1,341), a prospective investigation of the impact of an Early Childhood Education program and early experiences on life-course well-being. Findings suggest that ACEs impact well-being in low-socioeconomic status participants above and beyond the effects of demographic risk and poverty, and point to possible mechanisms of transmission of ACE effects. Results also identify key areas across the ecological system that may promote resilience to ACEs, and speak to the need to continue to support underserved communities in active ways.
Norovirus, a major cause of gastroenteritis in people of all ages worldwide, was first reported in South Korea in 1999. The most common causal agents of pediatric acute gastroenteritis are norovirus and rotavirus. While vaccination has reduced the pediatric rotavirus infection rate, norovirus vaccines have not been developed. Therefore, prediction and prevention of norovirus are very important. Norovirus is divided into genogroups GI–GVII, with GII.4 being the most prevalent. However, in 2012–2013, GII.17 showed a higher incidence than GII.4 and a novel variant, GII.P17-GII.17, appeared. In this study, 204 stool samples collected in 2013–2014 were screened by reverse transcriptase-polymerase chain reaction; 11 GI (5.39%) and 45 GII (22.06%) noroviruses were identified. GI.4, GI.5, GII.4, GII.6 and GII.17 were detected. The whole genomes of the three norovirus GII.17 were sequenced. The whole genome of GII.17 consists of three open reading frames of 5109, 1623 and 780 bp. Compared with 20 GII.17 strains isolated in other countries, we observed numerous changes in the protruding P2 domain of VP1 in the Korean GII.17 viruses. Our study provided genome information that might aid in epidemic prevention, epidemiology studies and vaccine development.
Introduction: Current guideline recommendations for optimal management of non-purulent skin and soft tissue infections (SSTIs) are based on expert consensus. There is currently a lack of evidence to guide emergency physicians on when to select oral versus intravenous antibiotic therapy. The primary objective was to identify risk factors associated with oral antibiotic treatment failure. A secondary objective was to describe the epidemiology of adult emergency department (ED) patients with non-purulent SSTIs. Methods: We performed a health records review of adults (age 18 years) with non-purulent SSTIs treated at two tertiary care EDs. Patients were excluded if they had a purulent infection or infected ulcers without surrounding cellulitis. Treatment failure was defined any of the following after a minimum of 48 hours of oral therapy: (i) hospitalization for SSTI; (ii) change in class of oral antibiotic owing to infection progression; or (iii) change to intravenous therapy owing to infection progression. Multivariable logistic regression was used to identify predictors independently associated with the primary outcome of oral antibiotic treatment failure after a minimum of 48 hours of oral therapy. Results: We enrolled 500 patients (mean age 64 years, 279 male (55.8%) and 126 (25.2%) with diabetes) and the hospital admission rate was 29.6%. The majority of patients (70.8%) received at least one intravenous antibiotic dose in the ED. Of 288 patients who had received a minimum of 48 hours of oral antibiotics, there were 85 oral antibiotic treatment failures (29.5%). Tachypnea at triage (odds ratio [OR]=6.31, 95% CI=1.80 to 22.08), chronic ulcers (OR=4.90, 95% CI=1.68 to 14.27), history of MRSA colonization or infection (OR=4.83, 95% CI=1.51 to 15.44), and cellulitis in the past 12 months (OR=2.23, 95% CI=1.01 to 4.96) were independently associated with oral antibiotic treatment failure. Conclusion: This is the first study to evaluate potential predictors of oral antibiotic treatment failure for non-purulent SSTIs in the ED. We observed a high rate of treatment failure and hospitalization. Tachypnea at triage, chronic ulcers, history of MRSA colonization or infection and cellulitis within the past year were independently associated with oral antibiotic treatment failure. Emergency physicians should consider these risk factors when deciding on oral versus intravenous antimicrobial therapy for non-purulent SSTIs being managed as outpatients.
Transcatheter pulmonary valve insertion is the most important advance in congenital interventional cardiology since atrial septal defect devices became commonly available 15 years ago. It has changed the way we look at a number of diverse diagnoses and changes how we plan, diagnose, operate, and follow-up patients. It has changed how we counsel families expecting a child that may benefit from it. Expanded use of the Melody® valve, outside its United States Food and Drug Administration approved indications, has helped numerous additional patients. The use of transcatheter pulmonary valve insertion in selected patients following surgical Gore-tex® bileaflet in valve right ventricular outflow tract reconstruction and those with a history of prior small homograft conduits will be discussed.
Epidemiological studies have reported that higher education (HE) is associated with a reduced risk of incident Alzheimer's disease (AD). However, after the clinical onset of AD, patients with HE levels show more rapid cognitive decline than patients with lower education (LE) levels. Although education level and cognition have been linked, there have been few longitudinal studies investigating the relationship between education level and cortical decline in patients with AD. The aim of this study was to compare the topography of cortical atrophy longitudinally between AD patients with HE (HE-AD) and AD patients with LE (LE-AD).
We prospectively recruited 36 patients with early-stage AD and 14 normal controls. The patients were classified into two groups according to educational level, 23 HE-AD (>9 years) and 13 LE-AD (≤9 years).
As AD progressed over the 5-year longitudinal follow-ups, the HE-AD showed a significant group-by-time interaction in the right dorsolateral frontal and precuneus, and the left parahippocampal regions compared to the LE-AD.
Our study reveals that the preliminary longitudinal effect of HE accelerates cortical atrophy in AD patients over time, which underlines the importance of education level for predicting prognosis.
Increase of fat cells (FCs) in adipose tissue is attributed to proliferation of preadipocytes or immature adipocytes in the early stage, as well as adipogenic differentiation in the later stage of adipose development. Although both events are involved in the FC increase, they are contrary to each other, because the former requires cell cycle activity, whereas the latter requires cell cycle withdrawal. Therefore, appropriate regulation of cell cycle inhibition is critical to adipogenesis. In order to explore the important cell cycle inhibitors and study their expression in adipogenesis, we adopted a strategy combining the Gene Expression Omnibus (GEO) database available on the NCBI website and the results of quantitative real-time PCR (qPCR) data in porcine adipose tissue. Three cell cycle inhibitors – cyclin G2 (CCNG2), cyclin-dependent kinase inhibitor 2C (CDKN2C) and peripheral myelin protein (PMP22) – were selected for study because they are relatively highly expressed in adipose tissue compared with muscle, heart, lung, liver and kidney in humans and mice based on two GEO DataSets (GDS596 and GDS3142). In the latter analysis, they were found to be more highly expressed in differentiating/ed preadipocytes than in undifferentiated preadipocytes in human and mice as shown respectively by GDS2366 and GDS2743. In addition, GDS2659 also suggested increasing expression of the three cell cycle inhibitors during differentiation of 3T3-L1 cells. Further study with qPCR in Landrace pigs did not confirm the high expression of these genes in adipose tissue compared with other tissues in market-age pigs, but confirmed higher expression of these genes in FCs than in the stromal vascular fraction, as well as increasing expression of these genes during in vitro adipogenic differentiation and in vivo development of adipose tissue. Moreover, the relatively high expression of CCNG2 in adipose tissue of market-age pigs and increasing expression during development of adipose tissue was also confirmed at the protein level by western blot analysis. Based on the analysis of the GEO DataSets and results of qPCR and Western blotting we conclude that all three cell cycle inhibitors may inhibit adipocyte proliferation, but promote adipocyte differentiation and hold a differentiated state by inducing and maintaining cell cycle inhibition. Therefore, their expression in adipose tissue is positively correlated with age and mature FC number. By regulating the expression of these genes, we may be able to control FC number, and, thus, reduce excessive fat tissue in animals and humans.
Transcatheter pulmonary valve replacement with the Melody® valve is an accepted alternative to surgical replacement of the pulmonary valve for some patients and therefore a complementary strategy in the long-term management of several groups of patients with congenital heart disease. It allows at least extending the time between sternotomies and possibly improving late outcomes. With a combined surgical and percutaneous approach, late morbidity for some of these patients will likely be diminished. This manuscript will review the current expanded applications for this technology, demonstrate several examples of its use and discuss future directions for this evolving equipment.
The Ultra-Fast Flash Observatory (UFFO), which will be launched onboard the
Lomonosov spacecraft, contains two crucial instruments: UFFO Burst
Alert & Trigger Telescope (UBAT) for detection and localization of Gamma-Ray Bursts
(GRBs) and the fast-response Slewing Mirror Telescope (SMT) designed for the observation
of the prompt optical/UV counterparts. Here we discuss the in-space calibrations of the
UBAT detector and SMT telescope. After the launch, the observations of the standard X-ray
sources such as pulsar in Crab nebula will provide data for necessary calibrations of
UBAT. Several standard stars will be used for the photometric calibration of SMT. The
celestial X-ray sources, e.g. X-ray binaries with bright optical sources
in their close angular vicinity will serve for the cross-calibration of UBAT and SMT.
The Ultra-Fast Flash Observatory (UFFO) Pathfinder for Gamma-Ray Bursts (GRBs) consists
of two telescopes. The UFFO Burst Alert & Trigger Telescope (UBAT) handles the
detection and localization of GRBs, and the Slewing Mirror Telescope (SMT) conducts the
measurement of the UV/optical afterglow. UBAT is equipped with an X-ray detector, analog
and digital signal readout electronics that detects X-rays from GRBs and determines the
location. SMT is equipped with a stepping motor and the associated electronics to rotate
the slewing mirror targeting the GRBs identified by UBAT. First the slewing mirror points
to a GRB, then SMT obtains the optical image of the GRB using the intensified CCD and its
readout electronics. The UFFO Data Acquisition system (UDAQ) is responsible for the
overall function and operation of the observatory and the communication with the satellite
main processor. In this paper we present the design and implementation of the electronics
of UBAT and SMT as well as the architecture and implementation of UDAQ.
The Slewing Mirror Telescope (SMT) is the UV/optical telescope of UFFO-pathfinder. The
SMT optical system is a Ritchey-Chrétien (RC) telescope of 100 mm diameter pointed by
means of a gimbal-mounted flat mirror in front of the telescope. The RC telescope has a
17 × 17arcmin2 in Field of View and 4.3 arcsec resolution (full width half
maximum of the point spread function) The beam-steering mirror enables the SMT to access a
35 × 35degree region and point and settle within 1 sec. All mirrors were fabricated to
about 0.02 wavelengths RMS in wave front error (WFE) and 84.7% average reflectivity over
200 nm ~ 650 nm. The RC telescope was aligned to 0.05 wavelengths RMS in WFE (test
wavelength 632.8 nm). In this paper, the technical details of the RC telescope and slewing
mirror system assembly, integration, and testing are given shortly, and performance tests
of the full SMT optical system are reported.
The UFFO (Ultra-Fast Flash Observatory) is a GRB detector on board the Lomonosov
satellite, to be launched in 2013. The GRB trigger is provided by an X-ray detector,
called UBAT (UFFO Burst Alarm & Trigger Telescope), which detects X-rays from the GRB
and then triggers to determine the direction of the GRB and then alerts the Slewing Mirror
Telescope (SMT) to turn in the direction of the GRB and record the optical photon fluxes.
This report details the calibration of the two components: the MAPMTs and the YSO crystals
and simulations of the UBAT. The results shows that this design can observe a GRB within a
field of view of ±35° and can trigger in a time scale as short as 0.2 – 1.0 s
after the appearance of a GRB X-ray spike.
The Ultra-Fast Flash Observatory (UFFO) is a space observatory for optical follow-ups of
gamma ray bursts (GRBs), aiming to explore the first 60 seconds of GRBs optical emission.
UFFO is utilized to catch early optical emissions from GRBs within few sec after trigger
using a Gimbal mirror which redirects the optical path rather than slewing entire
spacecraft. We have developed a 15 cm two-axis Gimbal mirror stage for the UFFO-Pathfinder
which is going to be on board the Lomonosov satellite which is to be launched in 2013. The
stage is designed for fast and accurate motion with given budgets of 3 kg of mass and 3
Watt of power. By employing stepping motors, the slewing mirror can rotate faster than 15
deg/sec so that objects in the UFFO coverage (60 deg × 60 deg) can be targeted in
~1 sec. The obtained targeting resolution is better 2 arcmin using a close-loop
control with high precision rotary encoder. In this presentation, we will discuss details
of design, manufacturing, space qualification tests, as well as performance tests.
The Ultra-Fast Flash Observatory (UFFO) aims to detect the earliest moment of Gamma-Ray
Bursts (GRBs) which is not well known, resulting into the enhancement of GRB mechanism
understanding. The pathfinder mission was proposed to be a scaled-down version of UFFO,
and only contains the UFFO Burst Alert & Trigger Telescope (UBAT) measuring the
X-ray/gamma-ray with the wide-field of view and the Slewing Mirror Telescope (SMT) with a
rapid-response for the UV/optical photons. Once the UBAT detects a GRB candidate with the
position accuracy of 10 arcmin, the SMT steers the UV/optical photons from the candidate
to the telescope by the fast rotatable mirror and provides the early UV/optical photons
measurements with 4 arcsec accuracy. The SMT has a modified Ritchey-Chrètien telescope
with the aperture size of 10 cm diameter including the rotatable mirror and the image
readout by the intensified charge-coupled device. There is a key board called the UFFO
Data Acquisition system (UDAQ) that manages the communication of each telescope and also
of the satellite and the UFFO overall operation. This pathfinder is designed and built
within the limited size and weight of ~20 kg and the low power consumption up to
~30 W. We will discuss the design and performance of the UFFO-pathfinder, and its
integration to the Lomonosov satellite.
One of the key aspects of the upcoming Ultra-Fast Flash Observatory (UFFO) pathfinder for
Gamma Ray Bursts (GRBs) identification is the UFFO Burst Alert & Trigger Telescope
(UBAT). The scientific propose of UBAT is to detect and locate as fast as possible the
GRBs in the sky. This is achieved by using a coded mask aperture camera scheme with a wide
field of view (FOV) and selecting a X-ray detector of high quantum efficiency and large
detection area. This X-ray detector of high quantum efficiency and large detection area is
called the UBAT detector. The UBAT detector consists of 48 × 48 Yttrium Oxyorthosilicate
(YSO) scintillator crystal arrays and Multi Anode Photomultiplier Tubes (MAPMTs), analog
electronics equipped with ASIC chips, digital electronics equipped with Field Programmable
Gate Array (FPGA) chips, and a mechanical structure that supports all components of the
UBAT detector. The total number of the pixels in the UBAT detector is 2304, and the total
effective detection area is 191 cm2. We will present the design and
construction, and performance of the UBAT detector including the responses of the UBAT
detector to X-ray sources.
Transcatheter pulmonary valve replacement is fast becoming an accepted alternative to repeat surgical pulmonary valve replacement for selected patients and therefore a complementary strategy in the long-term management of those requiring surgical pulmonary valve replacement. With a combined surgical and percutaneous approach, late morbidity for some of these patients may be diminished. This manuscript will review the current indications for this procedure, its limitations, and its benefits.
Cardiac catheterisation continues to play an important role in the long-term management of patients with common arterial trunk and transposition of the great arteries. Although non-invasive imaging has largely eliminated the need for diagnostic catheterisation in newborns with these congenital cardiac lesions, cardiac catheterisation is an important tool for the diagnosis of a variety of problems encountered after surgical intervention, and allows interventions to be performed when feasible. We review the indications for cardiac catheterisation and describe the specifics for various interventional procedures for these patients in this manuscript.
A total of 245 patients with confirmed 2009 H1N1 influenza were admitted to the intensive-care units of 28 hospitals (South Korea). Their mean age was 55·3 years with 68·6% aged >50 years, and 54·7% male. Nine were obese and three were pregnant. One or more comorbidities were present in 83·7%, and nosocomial acquisition occurred in 14·3%. In total, 107 (43·7%) patients received corticosteroids and 66·1% required mechanical ventilation. Eighty (32·7%) patients died within 30 days after onset of symptoms and 99 (40·4%) within 90 days. Multivariate logistic regression analysis showed that the clinician's decision to prescribe corticosteroids, older age, Sequential Organ Failure Assessment score and nosocomial bacterial pneumonia were independent risk factors for 90-day mortality. In contrast with Western countries, critical illness in Korea in relation to 2009 H1N1 was most common in older patients with chronic comorbidities; nosocomial acquisition occurred occasionally but disease in obese or pregnant patients was uncommon.
Three types of Ganium Nitride (GaN) transistors were studied in this work. The devices were fabricated and exhibited unique characteristics over on-state current and off-state blocking performances. We also compared the performance differences of devices fabricated by multiepitaxial GaN/AlGaN layers on different substrates (Sapphire and Si) and evaluated the correlations among starting substrate, device variation, and manufacturing uniformity. The first device is a normally-on device with Sapphire substrate which shows good drain saturation current (Idsat) and breakdown characteristics, but the gate leakage current is quite large. The second device is a normally-off GaN transistor named metal-insulate-semiconductor (MIS) heterojunction field-effect transistor (MIS-HFET) which exhibits good performance with threshold voltage (Vth) of 3V and breakdown voltage (Vbd) of over 1800V. However the third device is a normally-off GaN metal-oxide-semiconductor field-elect transistor (MOSFET) structure which is rather difficult to exhibit good blocking characteristic due to inadequate doping process control of the reduce-surface-field (RESURF) region.