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Background: Neonatal hypoxic ischemic encephalopathy (HIE) is a clinical phenomenon, that often results from pre or perinatal reduced cerebral blood flow and/or hypoxemia. However, in some cases, neonates present with HIE without significant risk factors or have an unusual clinical course. With the advent of advanced genetic testing, we aimed to explore if such infants had genetic risk factors predisposing them to an HIE-phenotype. Methods: We reviewed 206 charts of infants meeting local protocol criteria for moderate to severe HIE at Level III NICU’s in Calgary, Alberta. Of these, 27 patients had genetic testing such as microarray, whole exome sequencing, or gene panels. Results: Six/twenty-seven patients had genetic mutations; two CDKL5 mutations (protein kinase), one CFTR mutation (cystic fibrosis), one PDH deficiency, one CYP21A2 mutation (congenital adrenal hyperplasia), and one ISY1 (VUS; pre-mRNA splicing). Two patients had noted difficult deliveries and four had minor complications, but all were out of keeping with the severity of presumed HIE. Conclusions: This preliminary study demonstrates a possible association between genetic co-morbidities and predisposition towards HIE in the context of a relatively uneventful pre/perinatal course. Earlier identification of genetic etiology, recognized by a discrepancy between risk factors and clinical presentation, could aid in treatment decisions and outcome prognostication.
A compact planar ultra-wideband (UWB) antenna with WiMAX and WLAN notched band is presented in this paper. The presented antenna consists of a rectangular patch and slotted partial ground plane and fed by a microstrip feed line. The volumetric size of the antenna is 30 mm × 22 mm × 1.6 mm. Method of moment-based simulation technology is used to simulate and analyze the characteristics of the antenna. To generate two notch bands at WiMAX and WLAN, a pair of parasitic resonator is placed beneath the radiating patch. The presented antenna achieves an operating band (VSWR ≤2) ranging from 2.98 to 12 GHz with an average gain of 3.95 dBi along with considerable efficiency and symmetric radiation patterns. Moreover, the antenna exhibits two notch bands at 3.5 and 5.45 GHz and is able to avoid possible interference with pre-existing narrow band services. The proposed antenna is low cost and low profile and is modeled to be used as a transceiver in UWB communication applications.
Background: Therapeutic hypothermia (TH) improves the outcome in HIE but cvEEG is vital to detect any seizures that occur. Unfortunately, the costs associated with cvEEG can make it impractical. We studied outcomes in TH with the objective of optimizing the length of cvEEG required. Methods: Term infants with HIE were treated with 72 h of TH followed by 6 h of rewarming. cvEEG reports were quantified (background, sharp transients, seizures) and compared with pre and post-cooling variables to determine whether risk stratification was possible. Results: 25/78 infants had seizures during the TH, however, most seizures occurred early, with 7 infants seizing prior to cooling and 15 having their first seizure within 24h. Only 3 infants had their first seizure between 24-48h and none were recorded after. Novel seizures after 24h were brief and did not require treatment. EEG variables such as frequent sharp transients and first seizures within 24h were correlated with MRI abnormalities. Conclusions: For the majority of infants undergoing TH, 24h of cvEEG may be sufficient with few infants requiring longer than 48h. A combination of clinical variables (abnormal neurological exam) and EEG traits (frequency of discharges, seizures) can help to decide on the likelihood of seizures and length of EEG recording needed.
Background: Despite advances in neonatal care, neonates with moderate to severe HIE are at high risk of mortality and morbidity. we report the impact of a dedicated NNCC team on short term mortality and morbidities. Methods: A retrospective cohort study on neonates with moderate to serve HIE between July 1st 2008 and December 31st 2017. primary outcome : a composite of death and/or brain injury on MRI. Secondary outcomes: rate of cooling, length of hospital stay, anti-seizure medication burden, and use of inotropes. A regression analysis was done adjusting for gestational age, birth weight, gender, out-born status, Apgar score at 10 minutes, cord blood pH, and HIE clinical staging Results: 216 neonates were included, 109 before NNCC implementation, and 107 thereafter. NNCC program resulted in reduction in the primary outcome (AOR: 0.28, CI: 0.14-0.54, p<0.001) and brain injury (AOR: 0.28, CI: 0.14-0.55, p<0.001). It decreased average length of stay/infants by 5 days (p=0.03), improved cooling rate (73% compared to 93% , p <0.001), reduced: seizure misdiagnosis (71% compared to 23%, P <0.001), anti-seizure medication burden (P = 0.001), and inotrope use (34% compared to 53%, p=0.004) Conclusions: NNCC program decreased mortality and brain injury , shortened the length of hospital stay and improved care of neonates with significant HIE.
Background: Continuous video-EEG (cvEEG) monitoring is the standard of care for diagnosis and management of neonatal seizures. However, it is labour-intensive. We aimed to establish consistency in monitoring of newborns utilising NICU nurses. Methods: Neonatal nurses were trained to apply scalp electrodes, troubleshoot technical issues. Guidelines, checklists and visual training modules were developed. A central network system allowed remote access to the cvEEGs by the epileptologist for timely interpretation and feedback. We compared 100 infants with moderate to severe HIE before and after the training program. Results: 192 cvEEGs were performed. Of the 100 infants compared; time to initiate brain monitoring decreased by average of 31.5 hours, in electrographic seizure detection increased(20% compared to 34% a), seizure clinical misdiagnosis decreased (65% compared to 36% ), and Anti-Seizure burden decreased. Conclusions: Training experienced NICU nurses to set-up, start and monitor cvEEG can decrease the time to initiate cvEEG which may lead to better seizure diagnosis and management.
BACKGROUND: IGTS is a rare phenomenon of paradoxical germ cell tumor (GCT) growth during or following treatment despite normalization of tumor markers. We sought to evaluate the frequency, clinical characteristics and outcome of IGTS in patients in 21 North-American and Australian institutions. METHODS: Patients with IGTS diagnosed from 2000-2017 were retrospectively evaluated. RESULTS: Out of 739 GCT diagnoses, IGTS was identified in 33 patients (4.5%). IGTS occurred in 9/191 (4.7%) mixed-malignant GCTs, 4/22 (18.2%) immature teratomas (ITs), 3/472 (0.6%) germinomas/germinomas with mature teratoma, and in 17 secreting non-biopsied tumours. Median age at GCT diagnosis was 10.9 years (range 1.8-19.4). Male gender (84%) and pineal location (88%) predominated. Of 27 patients with elevated markers, median serum AFP and Beta-HCG were 70 ng/mL (range 9.2-932) and 44 IU/L (range 4.2-493), respectively. IGTS occurred at a median time of 2 months (range 0.5-32) from diagnosis, during chemotherapy in 85%, radiation in 3%, and after treatment completion in 12%. Surgical resection was attempted in all, leading to gross total resection in 76%. Most patients (79%) resumed GCT chemotherapy/radiation after surgery. At a median follow-up of 5.3 years (range 0.3-12), all but 2 patients are alive (1 succumbed to progressive disease, 1 to malignant transformation of GCT). CONCLUSION: IGTS occurred in less than 5% of patients with GCT and most commonly after initiation of chemotherapy. IGTS was more common in patients with IT-only on biopsy than with mixed-malignant GCT. Surgical resection is a principal treatment modality. Survival outcomes for patients who developed IGTS are favourable.
Zygogramma bicolorata Pallister is a potential biocontrol agent of Parthenium hysterophorus L. (Asteraceae). This study was carried out to understand the effect of abiotic (temperature and moisture) and biotic factors (age and reproductive status) on the induction and termination of diapause in Z. bicolorata. We also evaluated the effect of diapause on longevity and fecundity of Z. bicolorata. In Z. bicolorata the induction of diapause occurred between the months of July and December. No diapause was observed in May and June, which coincided with the commencement of the monsoon rains. The percentage of diapause induction in Z. bicolorata was found to increase from one generation to another as well as with the age of adults. Diapause significantly increased the fecundity of females as compared to the fecundity in pre-diapause conditions. Soil moisture (80% RH) played an important role in providing the conditions for initiation and termination of diapause. Similarly, 18.4 and 12.5% of diapause adults resumed their activity in 6 and 5 days when exposed to temperatures of 40° and 45° C for 2 h every day, respectively. Exposure of adults to low temperatures, i.e. 5° and 10° C induced 94.3 and 92.5% diapause, respectively, with no adult mortality. Thus, our findings reveal suitable conditions for preventing and inducing diapause in Z. bicolorata, which is of great importance in the suppression of P. hysterophorus. We discuss the implications of these findings in the control of P. hysterophorus.
To investigate the sociodemographic and geographical variation in under- and overnutrition prevalence among children and mothers.
Data from the 2014 Bangladesh Demographic and Health Survey were analysed. Stunting and wasting for children and BMI<18·5 kg/m2 for mothers were considered as undernutrition; overweight was considered as overnutrition for both children and mothers. We estimated the prevalence and performed simple logistic regression analyses to assess the associations between outcome variables and predictors. Bayesian spatial models were applied to estimate region-level prevalence to identify the regions (districts) prone to under- and overnutrition.
Children aged<5 years and their mothers aged 15–49 years in Bangladesh.
A significant difference (P<0·001) was observed in both under- and overnutrition prevalence between poor and rich. A notable regional variation was also observed in under- and overnutrition prevalence. Stunting prevalence ranged from 20·3 % in Jessore to 56·2 % in Sunamgonj, wasting from 10·6 % in Dhaka to 19·2 % in Bhola, and overweight from 0·8 % in Shariatpur to 2·6 % in Dhaka. Of the sixty-four districts, twelve had prevalence of stunting and thirty-two districts had prevalence of wasting higher than the WHO critical threshold levels. Similarly, fifty-three districts had prevalence of maternal underweight higher than the national level. In contrast, the prevalence of overweight was comparatively high in the industrially equipped metropolitan districts.
Observed sociodemographic and geographical inequalities imply slow progress in the overall improvement of both under- and overnutrition. Therefore, effective intervention programmes and policies need to be designed urgently targeting the grass-roots level of such regions.
Mastitis has been one of the major diseases in dairy herds inducing economic costs associated with decreasing milk yield and its quality as well as increasing health care practices. In response to bacterial infection, the concentration of somatic cells increases in the milk of dairy cows (Boettcher et al., 2007). Somatic cell count has been widely utilised as an indicator trait for mastitis. Somatic cell count, like milk yield, varies with stage of lactation and more accurate genetic evaluation of dairy cows could be obtained when a test day model is used (Haile-Mariam et al., 2001). The main aim of this research was to compare fixed and random regression test day models in genetic evaluation of Iranian Holstein first lactation cows based on their predicted breeding value for somatic cell score.
It is increasingly essential for medical researchers to be literate in statistics, but the requisite degree of literacy is not the same for every statistical competency in translational research. Statistical competency can range from ‘fundamental’ (necessary for all) to ‘specialized’ (necessary for only some). In this study, we determine the degree to which each competency is fundamental or specialized.
We surveyed members of 4 professional organizations, targeting doctorally trained biostatisticians and epidemiologists who taught statistics to medical research learners in the past 5 years. Respondents rated 24 educational competencies on a 5-point Likert scale anchored by ‘fundamental’ and ‘specialized.’
There were 112 responses. Nineteen of 24 competencies were fundamental. The competencies considered most fundamental were assessing sources of bias and variation (95%), recognizing one’s own limits with regard to statistics (93%), identifying the strengths, and limitations of study designs (93%). The least endorsed items were meta-analysis (34%) and stopping rules (18%).
We have identified the statistical competencies needed by all medical researchers. These competencies should be considered when designing statistical curricula for medical researchers and should inform which topics are taught in graduate programs and evidence-based medicine courses where learners need to read and understand the medical research literature.
Italian ryegrass is a major weed problem in wheat production worldwide. Field studies were conducted at Fayetteville, AR, to assess morphological characteristics of ryegrass accessions from Arkansas and differences among other Lolium spp.: Italian, rigid, poison, and perennial ryegrass. Plant height, plant growth habit, plant stem color, and node color were recorded every 2 wk until maturity. The number of tillers per plant, spikes per plant, and seeds per plant were recorded at maturity. All ryegrass accessions from Arkansas were identified as Italian ryegrass, which had erect to prostrate growth habit, green to red stem color, green to red nodes, glume (10 mm) shorter than spikelet (19 mm), and medium seed size (5 to 7 mm) with 1 to 3 mm awns. However, significant variability in morphological characteristics was found among Arkansas ryegrass accessions. When Lolium species at the seedling stage (1- to 2-wk-old plants) were compared, poison ryegrass was characterized as having a large main-stem diameter and wide droopy leaves, whereas perennial ryegrass exhibited a short and a very narrow leaf blade. These two can be distinguished from Italian and rigid ryegrass, which have leaf blades wider than perennial ryegrass but narrower than poison ryegrass. Italian and rigid ryegrass are difficult to distinguish at the seedling stage but are distinct at the reproductive stage. At maturity, Italian ryegrass and poison ryegrass seeds are awned, but perennial and rigid ryegrass seeds are awnless. Poison ryegrass awns were at least 4-fold longer than Italian ryegrass awns. Perennial ryegrass flowered 3 wk later than the other species. Poison ryegrass glumes were longer than the spikelets, whereas Italian ryegrass glumes were shorter than the spikelets. Morphological traits indicate that some Italian ryegrass populations are potentially more competitive and more fecund than others.
The management of glyphosate-resistant Palmer amaranth has been a challenge in southern United States cropping systems. Registration of dicamba-resistant crops will provide an alternative management option to control herbicide-resistant Palmer amaranth populations, particularly those having resistance to herbicide Groups 2, 3, 5, 9, 14, and 27. However, repeated use of sublethal doses of dicamba may lead to rapid evolution of herbicide resistance, especially in Palmer amaranth—a species with a strong tendency to evolve resistance. Therefore, selection experiments with dicamba were conducted on Palmer amaranth using sublethal doses. In the greenhouse, a known susceptible Palmer amaranth population was subjected to sublethal dicamba doses for three generations (P1–P3). Susceptibility of the individuals to dicamba was evaluated, and its susceptibility to 2,4-D was characterized. Based on the greenhouse study, following three generations of dicamba selection, the dose required to cause 50% mortality increased from 111 g ae ha−1 for parental individuals (P0) to 309 g ae ha−1 for the P3. Furthermore, reduced susceptibility of the P3 to 2,4-D was also evident. This research presents the first evidence that recurrent use of sublethal dicamba doses can lead to reduced susceptibility of Palmer amaranth to dicamba as well as 2,4-D. Here, we show that selection from sublethal dicamba doses has an important role in rapid evolution of Palmer amaranth with reduced susceptibility to auxin-type herbicides.
Historically, alloy development with better radiation performance has been focused on traditional alloys with one or two principal element(s) and minor alloying elements, where enhanced radiation resistance depends on microstructural or nanoscale features to mitigate displacement damage. In sharp contrast to traditional alloys, recent advances of single-phase concentrated solid solution alloys (SP-CSAs) have opened up new frontiers in materials research. In these alloys, a random arrangement of multiple elemental species on a crystalline lattice results in disordered local chemical environments and unique site-to-site lattice distortions. Based on closely integrated computational and experimental studies using a novel set of SP-CSAs in a face-centered cubic structure, we have explicitly demonstrated that increasing chemical disorder can lead to a substantial reduction in electron mean free paths, as well as electrical and thermal conductivity, which results in slower heat dissipation in SP-CSAs. The chemical disorder also has a significant impact on defect evolution under ion irradiation. Considerable improvement in radiation resistance is observed with increasing chemical disorder at electronic and atomic levels. The insights into defect dynamics may provide a basis for understanding elemental effects on evolution of radiation damage in irradiated materials and may inspire new design principles of radiation-tolerant structural alloys for advanced energy systems.
Finite element modelling has been used to optimise the current/ voltage (I/V) characteristics of metal/ n-SiC and metal/ n-Si diodes incorporating a thin interfacial layer. The electrical properties of the diodes have been examined in relation to the polytype of SiC (3H, 4H or 6C), the doping level, NA, (1015 - 1018cm3) of the substrate, the defect state density, Dit and the work function of the Schottky metal, Φm. The modelling by Technology Computer-Aided Design (TCAD) has shown that the presence of an interfacial insulating layer with a thickness of 1.0 nm has reduced the reverse leakage current of the diode by a factor of ∼102 in Si and 1013 (from 10-19 A to 10-6 A) for SiC with only a minor reduction (∼ 0.8 times) in the forward current in SiC. The properties of the diodes have been modelled at room temperature without thermal annealing.
Palmer amaranth and waterhemp have become increasingly troublesome weeds throughout the United States. Both species are highly adaptable and emerge continuously throughout the summer months, presenting the need for a residual PRE application in soybean. To improve season-long control of Amaranthus spp., 19 PRE treatments were evaluated on glyphosate-resistant Palmer amaranth in 2013 and 2014 at locations in Arkansas, Indiana, Nebraska, Illinois, and Tennessee; and on glyphosate-resistant waterhemp at locations in Illinois, Missouri, and Nebraska. The two Amaranthus species were analyzed separately; data for each species were pooled across site-years, and site-year was included as a random variable in the analyses. The dissipation of weed control throughout the course of the experiments was compared among treatments with the use of regression analysis where percent weed control was described as a function of time (the number of weeks after treatment [WAT]). At the mean (i.e., average) WAT (4.3 and 3.2 WAT for Palmer amaranth and waterhemp, respectively) isoxaflutole + S-metolachlor + metribuzin had the highest predicted control of Palmer amaranth (98%) and waterhemp (99%). Isoxaflutole + S-metolachlor + metribuzin, S-metolachlor + mesotrione, and flumioxazin + pyroxasulfone had a predicted control ≥ 97% and similar model parameter estimates, indicating control declined at similar rates for these treatments. Dicamba and 2,4-D provided some, short-lived residual control of Amaranthus spp. When dicamba was added to metribuzin or S-metolachlor, control increased compared to dicamba alone. Flumioxazin + pyroxasulfone, a currently labeled PRE, performed similarly to treatments containing isoxaflutole or mesotrione. Additional sites of action will provide soybean growers more opportunities to control these weeds and reduce the potential for herbicide resistance.
Cognitive dysfunction is common in major depressive disorder (MDD) and a critical determinant of health outcome. Anhedonia is a criterion item toward the diagnosis of a major depressive episode (MDE) and a well-characterized domain in MDD. We sought to determine the extent to which variability in self-reported cognitive function correlates with anhedonia.
A post hoc analysis was conducted using data from (N=369) participants with a Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision (DSM-IV-TR)-defined diagnosis of MDD who were enrolled in the International Mood Disorders Collaborative Project (IMDCP) between January 2008 and July 2013. The IMDCP is a collaborative research platform at the Mood Disorders Psychopharmacology Unit, University of Toronto, Toronto, Canada, and the Cleveland Clinic, Cleveland, Ohio. Measures of cognitive function, anhedonia, and depression severity were analyzed using linear regression equations.
A total of 369 adults with DSM-IV-TR–defined MDD were included in this analysis. Self-rated cognitive impairment [ie, as measured by the Adult ADHD Self-Report Scale (ASRS)] was significantly correlated with a proxy measure of anhedonia (r=0.131, p=0.012). Moreover, total depression symptom severity, as measured by the total Montgomery–Åsberg Depression Rating Scale (MADRS) score, was also significantly correlated with self-rated measures of cognitive dysfunction (r=0.147, p=0.005). The association between anhedonia and self-rated cognitive dysfunction remained significant after adjusting for illness severity (r=0.162, p=0.007).
These preliminary results provide empirical data for the testable hypothesis that anhedonia and self-reported cognitive function in MDD are correlated yet dissociable domains. The foregoing observation supports the hypothesis of overlapping yet discrete neurobiological substrates for these domains.
Johnsongrass populations that are resistant to 5-enolpyruvyl-3-shikimate synthase (EPSPS)–, acetyl coenzyme A carboxylase (ACCase)–, or acetolactate synthase (ALS)–inhibiting herbicides are increasingly common throughout the midsouth. Three trials were conducted in 2012, 2013, and 2014 in Fayetteville, AR and Alexandria, LA to evaluate strategies with and without ALS- and ACCase inhibitors for management of rhizomatous johnsongrass in the absence of glyphosate. Fluometuron or fluometuron plus pyrithiobac applied PRE followed by (fb) EPOST, MPOST, and LAYBY tank mixtures containing multiple effective mechanisms of action (MOA) controlled johnsongrass at least 90%. Simplifying the program by removing a herbicide or eliminating an application timing reduced control, and increased vegetative and sexual reproduction of johnsongrass. To manage severe infestations or escapes glufosinate plus clethodim fb glufosinate plus clethodim or clethodim plus pyrithiobac fb clethodim) effectively controlled 15-cm johnsongrass. However, johnsongrass control was reduced when ALS and ACCase inhibitors were tank mixed, especially for the second POST application, compared to ACCase inhibitors alone. Effective herbicide programs are available to growers to control johnsongrass in the absence of glyphosate, but the use of PRE herbicides followed by multiple applications of POST herbicides is critical for successful management.
Herbicide-resistant Amaranthus spp. continue to cause management difficulties in soybean. New soybean technologies under development, including resistance to various combinations of glyphosate, glufosinate, dicamba, 2,4-D, isoxaflutole, and mesotrione, will make possible the use of additional herbicide sites of action in soybean than is currently available. When this research was conducted, these soybean traits were still regulated and testing herbicide programs with the appropriate soybean genetics in a single experiment was not feasible. Therefore, the effectiveness of various herbicide programs (PRE herbicides followed by POST herbicides) was evaluated in bare-ground experiments on glyphosate-resistant Palmer amaranth and glyphosate-resistant waterhemp (both tall and common) at locations in Arkansas, Illinois, Indiana, Missouri, Nebraska, and Tennessee. Twenty-five herbicide programs were evaluated; 5 of which were PRE herbicides only, 10 were PRE herbicides followed by POST herbicides 3 to 4 wks after (WA) the PRE application (EPOST), and 10 were PRE herbicides followed by POST herbicides 6 to 7 WA the PRE application (LPOST). Programs with EPOST herbicides provided 94% or greater control of Palmer amaranth and waterhemp at 3 to 4 WA the EPOST. Overall, programs with LPOST herbicides resulted in a period of weed emergence in which weeds would typically compete with a crop. Weeds were not completely controlled with the LPOST herbicides because weed sizes were larger (≥ 15 cm) compared with their sizes at the EPOST application (≤ 7 cm). Most programs with LPOST herbicides provided 80 to 95% control at 3 to 4 WA applied LPOST. Based on an orthogonal contrast, using a synthetic-auxin herbicide LPOST improves control of Palmer amaranth and waterhemp over programs not containing a synthetic-auxin LPOST. These results show herbicides that can be used in soybean and that contain auxinic- or HPPD-resistant traits will provide growers with an opportunity for better control of glyphosate-resistant Palmer amaranth and waterhemp over a wide range of geographies and environments.
To report the International Nosocomial Infection Control Consortium surveillance data from 40 hospitals (20 cities) in India 2004–2013.
Surveillance using US National Healthcare Safety Network’s criteria and definitions, and International Nosocomial Infection Control Consortium methodology.
We collected data from 236,700 ICU patients for 970,713 bed-days
Pooled device-associated healthcare-associated infection rates for adult and pediatric ICUs were 5.1 central line–associated bloodstream infections (CLABSIs)/1,000 central line–days, 9.4 cases of ventilator-associated pneumonia (VAPs)/1,000 mechanical ventilator–days, and 2.1 catheter-associated urinary tract infections/1,000 urinary catheter–days
In neonatal ICUs (NICUs) pooled rates were 36.2 CLABSIs/1,000 central line–days and 1.9 VAPs/1,000 mechanical ventilator–days
Extra length of stay in adult and pediatric ICUs was 9.5 for CLABSI, 9.1 for VAP, and 10.0 for catheter-associated urinary tract infections. Extra length of stay in NICUs was 14.7 for CLABSI and 38.7 for VAP
Crude extra mortality was 16.3% for CLABSI, 22.7% for VAP, and 6.6% for catheter-associated urinary tract infections in adult and pediatric ICUs, and 1.2% for CLABSI and 8.3% for VAP in NICUs
Pooled device use ratios were 0.21 for mechanical ventilator, 0.39 for central line, and 0.53 for urinary catheter in adult and pediatric ICUs; and 0.07 for mechanical ventilator and 0.06 for central line in NICUs.
Despite a lower device use ratio in our ICUs, our device-associated healthcare-associated infection rates are higher than National Healthcare Safety Network, but lower than International Nosocomial Infection Control Consortium Report.
Infect. Control Hosp. Epidemiol. 2016;37(2):172–181