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Objective: Focal cortical dysplasia (FCD) is a common cause of refractory, focal onset epilepsy in children. Interictal, scalp electroencephalograph (EEG) markers have been associated with these pathologies and epilepsy surgery may be an option for some patients. We aim to study how scalp EEG and magnetic resonance imaging (MRI) markers of FCD affect referral of these patients for surgical evaluation. Methods: A single-center, retrospective review of children with focal onset epilepsy. Patients were included if they were between 1 month and 18 years of age, had focal onset seizures, prolonged scalp EEG monitoring, and an MRI conducted after 2 years of age. Statistics were carried out using the chi-squared and student’s t-test, as well as a logistic regression model. Results: Sixty-eight patients were included in the study. Thirty-seven of these patients were referred to a comprehensive pediatric epilepsy program (CPEP) for surgical evaluation, and of these 22% showed FCD EEG markers, 32% FCD MRI markers, and 10% had both. These markers were also present in patients not referred to a CPEP. The MRI markers were significantly associated with CPEP referral, whereas EEG markers were not. Neither marker type was associated with epilepsy surgery. Conclusion: This study found that children with focal onset epilepsy were more likely to be referred for surgical evaluation if they were medically refractory, or were diagnosed with FCD or tumor on MRI. Scalp EEG markers of FCD were not associated with CPEP referral. The online tool CASES may be a useful physician guide for identifying appropriate children for epilepsy surgery referral.
The Taipan galaxy survey (hereafter simply ‘Taipan’) is a multi-object spectroscopic survey starting in 2017 that will cover 2π steradians over the southern sky (δ ≲ 10°, |b| ≳ 10°), and obtain optical spectra for about two million galaxies out to z < 0.4. Taipan will use the newly refurbished 1.2-m UK Schmidt Telescope at Siding Spring Observatory with the new TAIPAN instrument, which includes an innovative ‘Starbugs’ positioning system capable of rapidly and simultaneously deploying up to 150 spectroscopic fibres (and up to 300 with a proposed upgrade) over the 6° diameter focal plane, and a purpose-built spectrograph operating in the range from 370 to 870 nm with resolving power R ≳ 2000. The main scientific goals of Taipan are (i) to measure the distance scale of the Universe (primarily governed by the local expansion rate, H0) to 1% precision, and the growth rate of structure to 5%; (ii) to make the most extensive map yet constructed of the total mass distribution and motions in the local Universe, using peculiar velocities based on improved Fundamental Plane distances, which will enable sensitive tests of gravitational physics; and (iii) to deliver a legacy sample of low-redshift galaxies as a unique laboratory for studying galaxy evolution as a function of dark matter halo and stellar mass and environment. The final survey, which will be completed within 5 yrs, will consist of a complete magnitude-limited sample (i ⩽ 17) of about 1.2 × 106 galaxies supplemented by an extension to higher redshifts and fainter magnitudes (i ⩽ 18.1) of a luminous red galaxy sample of about 0.8 × 106 galaxies. Observations and data processing will be carried out remotely and in a fully automated way, using a purpose-built automated ‘virtual observer’ software and an automated data reduction pipeline. The Taipan survey is deliberately designed to maximise its legacy value by complementing and enhancing current and planned surveys of the southern sky at wavelengths from the optical to the radio; it will become the primary redshift and optical spectroscopic reference catalogue for the local extragalactic Universe in the southern sky for the coming decade.
To examine variation in antibiotic coverage and detection of resistant pathogens in community-onset pneumonia.
A total of 128 hospitals in the Veterans Affairs health system.
Hospitalizations with a principal diagnosis of pneumonia from 2009 through 2010.
We examined proportions of hospitalizations with empiric antibiotic coverage for methicillin-resistant Staphylococcus aureus (MRSA) and Pseudomonas aeruginosa (PAER) and with initial detection in blood or respiratory cultures. We compared lowest- versus highest-decile hospitals, and we estimated adjusted probabilities (AP) for patient- and hospital-level factors predicting coverage and detection using hierarchical regression modeling.
Among 38,473 hospitalizations, empiric coverage varied widely across hospitals (MRSA lowest vs highest, 8.2% vs 42.0%; PAER lowest vs highest, 13.9% vs 44.4%). Detection rates also varied (MRSA lowest vs highest, 0.5% vs 3.6%; PAER lowest vs highest, 0.6% vs 3.7%). Whereas coverage was greatest among patients with recent hospitalizations (AP for anti-MRSA, 54%; AP for anti-PAER, 59%) and long-term care (AP for anti-MRSA, 60%; AP for anti-PAER, 66%), detection was greatest in patients with a previous history of a positive culture (AP for MRSA, 7.9%; AP for PAER, 11.9%) and in hospitals with a high prevalence of the organism in pneumonia (AP for MRSA, 3.9%; AP for PAER, 3.2%). Low hospital complexity and rural setting were strong negative predictors of coverage but not of detection.
Hospitals demonstrated widespread variation in both coverage and detection of MRSA and PAER, but probability of coverage correlated poorly with probability of detection. Factors associated with empiric coverage (eg, healthcare exposure) were different from those associated with detection (eg, microbiology history). Providing microbiology data during empiric antibiotic decision making could better align coverage to risk for resistant pathogens and could promote more judicious use of broad-spectrum antibiotics.
We present wide-field, spatially and highly resolved spectroscopic observations of Balmer filaments in the northeastern rim of Tycho’s supernova remnant in order to investigate the signal of cosmic-ray (CR) acceleration. The spectra of Balmer-dominated shocks (BDSs) have characteristic narrow (FWHM ~ 10 km s−1) and broad (FWHM ~ 1000 km s−1) Hα components. CRs affect the Hα-line parameters: heating the cold neutrals in the interstellar medium results in broadening of the narrow Hα-line width beyond 20 km s−1, but also in reduction of the broad Hα-line width due to energy being removed from the protons in the post-shock region. For the first time we show that the width of the narrow Hα line, much larger than 20 km s−1, is not a resolution or geometric effect nor a spurious result of a neglected intermediate (FWHM ~ 100 km s−1) component resulting from hydrogen atoms undergoing charge exchange with warm protons in the broad-neutral precursor. Moreover, we show that a narrow line width ≫ 20 km s−1 extends across the entire NE rim, implying CR acceleration is ubiquitous, and making it possible to relate its strength to locally varying shock conditions. Finally, we find several locations along the rim, where spectra are significantly better explained (based on Bayesian evidence) by inclusion of the intermediate component, with a width of 180 km s−1 on average.
Marine upwelling along coastal Peru can be intense and variable, making radiocarbon dating marine and coastal systems complex. Historical and proxy records of upwelling along coastal Peru are few, and long-lived species such as corals do not grow in the cold coastal waters. Mollusk shell carbonate, however, can record both the magnitude of the local marine reservoir correction, ΔR, and of seasonal oscillations in the ventilation age of coastal waters. If large, these seasonal oscillations would complicate radiocarbon dating of marine organisms. To examine this possibility, we sampled for δ13C, δ18O, and 14C content a set of pre-bomb Argopecten purpuratus shells collected from coastal Peru during 1908 and 1926. Intrashell variations of up to 216 14C yr were noted, but these were not consistently correlated with seasonal changes in δ18O or δ13C. Only an 11 yr difference was observed in the weighted average ΔR of Callao Bay shells collected during normal (1908) and El Niño (1926) years. Despite the intrashell 14C variation noted, weighted average ΔR values from all 3 sample sites and from normal and El Niño years all overlap at 1 σ. We report ΔR values of 183 ± 18 and 194 ± 23 yr from Callao Bay (12°4′S), 165 ± 24 yr from Salaverry (8°14′S), and 189 ± 23 yr from Sechura Bay (5°45′S).
Mollusk shells provide brief (<5 yr per shell) records of past marine conditions, including marine radiocarbon reservoir age (R) and upwelling. We report 21 14C ages and R calculations on small (∼2 mg) samples from 2 Mesodesma donacium (surf clam) shells. These shells were excavated from a semi-subterranean house floor stratum 14C dated to 7625 ± 35 BP at site QJ-280, Quebrada Jaguay, southern Peru. The ranges in marine 14C ages (and thus R) from the 2 shells are 530 and 170 14C yr; R from individual aragonite samples spans 130 ± 60 to 730 ± 170 14C yr. This intrashell 14C variability suggests that 14C dating of small (time-slice much less than 1 yr) marine samples from a variable-R (i.e. variable-upwelling) environment may introduce centuries of chronometric uncertainty.
The emerging statistical properties from the first 50 extrasolar planets are startlingly different from the picture that was imagined prior to 1995. About 0.75% of nearby solar type stars harbor jovian planets in 3 to 5 day circular orbits. Another ∽7% of stars have jupiter–mass companions orbiting in eccentric orbits within 3.5 AU. The mass distribution of substellar companions rises abruptly near 5 MJup and continues increasing down to the detection limit near 1 MJup-Orbital eccentricities correlate positively with semimajor axes, even for planets beyond the tidal circularization zone within 0.1 AU, distinguishing planets from binary stars. The planet bearing stars are metal–rich relative to both nearby stars and to the Sun. Analogs of Solar System planets have not been detected to date as they require precision of 3 m s−1 maintained for more than a decade.
This volume not only defines medievalism's margins, as well as its role in marginalizing other fields, ideas, people, places, and events, but also provides tools and models for exploring those issues and indicates new subjects to which they might apply. The eight opening essays address the physical marginalizing of medievalism in annotated texts on medieval studies; the marginalism of oneself via medievalism; medievalism's dearth of ecotheory and religious studies; academia's paucity of pop medievalism; and the marginalization of races, ethnicities, genders, sexual orientations, and literary characters in contemporary medievalism. The seven subsequent articles build on this foundation while discussing: the distancing of oneself (and others) during imaginary visits to the Middle Ages; lessons from the margins of Brazilian medievalism; mutual marginalization among factions of Spanish medieval studies; and medievalism in the marginalization of lower socio-economic classes in late-eighteenth- and early nineteenth-century Spain, of modern gamers, of contemporary laborers, and of Alfred Austin, a late-nineteenth- and early twentieth-century poet also known as Alfred the Little. In thus investigating the margins of and marginalization via medievalism, the volume affirms their centrality to the field. Karl Fugelso is Professor of Art History at Towson University in Baltimore, Maryland. Contributors: Nadia R. Altschul, Megan Arnott, Jaume Aurell, Juan Gomis Coloma, Elizabeth Emery, Vincent Ferré, Valerie B. Johnson, Alexander L. Kaufman, Erin Felicia Labbie, VickieLarsen, Kevin Moberly, Brent Moberly, Alicia C. Montoya, Serina Patterson, Jeff Rider, Lindsey Simon-Jones, Richard Utz, Helen Young.