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Between 2010 and 2012, 3 outbreaks of nosocomial infections in German neonatal intensive care units (NICUs) attracted considerable public interest. Headlines on national television channels and in newspapers had important consequences for the involved institutions and a negative impact on the relationship between families and staff in many German NICUs.
To determine whether NICU outbreaks reported in the media influenced provider behavior in the community of neonatal care and led to more third-line antibiotic prescribing.
Observational cohort study.
To investigate secular trends, we evaluated data for very-low-birth-weight infants (VLBWIs, birth weight <1,500 g) enrolled in the German Neonatal Network (GNN) between 2009 and 2014 (N=10,253). For outbreak effects, we specifically analyzed data for VLBWIs discharged 6 months before (n=2,428) and 6 months after outbreaks (n=2,508).
The exposure of all VLBWIs to third-line antibiotics increased after outbreaks (19.4% before vs 22.5% after; P=.007). This trend particularly affected male infants (4.6% increase; P=.005) and infants with a birth weight between 1,000 and 1,499 g (3.5% increase; P=.001)
In a logistic regression analysis, month of discharge as linear variable of time was associated with increased exposure to third-line antibiotics (odds ratio [OR], 1.01; 95% confidence interval [CI], 1.009–1.014; P<.001), and discharge within the 6-month period after outbreak reports independently contributed to this long-term trend (OR, 1.14; 95% CI, 1.017–1.270; P=.024).
Media reports directly affect medical practice, eg, overuse of third-line antibiotics. Future communication and management strategies must be based on objective dialogues between the scientific community and investigative journalists.
By definition, monozygotic (MZ) twins carry an identical set of genetic information. The observation of early post-twinning mutational events was shown to cause phenotypic discordance among MZ twin pairs. These mutational events comprise genomic alterations at different scales, ranging from single nucleotide changes to larger copy-number variations (CNVs) of varying sizes, as well as epigenetic changes. Here, we performed whole-exome sequencing (WES) in nine discordant MZ twins to identify somatic mutational events in the affected twin that might exert a dominant negative effect. Five of these MZ twin pairs were discordant for congenital heart defects (CHD), two for endocrine disorders, one for omphalocele, and one for congenital diaphragmatic hernia (CDH). Analysis of WES data from all nine MZ twin pairs using the de novo probability tool DeNovoGear detected only one apparent de novo variation in TMPRSS13 in one of the CHD-affected twins. Analysis of WES data from all nine MZ twin pairs by using standard filter criteria without the de novo probability tool DeNovoGear revealed a total of 6,657 variations in which both the twin pairs differed. After filtering for variations only present in the affected twins and absent in in-house controls, 722 variations remained. Visual inspection for read quality decreased this number to 12, present only in the affected twin. However, Sanger sequencing of the overall 13 variations failed to confirm the variation in the affected twin. These results suggest that somatic mutational events in coding regions do not seem to play a major role in the phenotypic expression of MZ discordant twin pairs.
Observations show that glaciers around the world are in retreat and losing mass. Internationally coordinated for over a century, glacier monitoring activities provide an unprecedented dataset of glacier observations from ground, air and space. Glacier studies generally select specific parts of these datasets to obtain optimal assessments of the mass-balance data relating to the impact that glaciers exercise on global sea-level fluctuations or on regional runoff. In this study we provide an overview and analysis of the main observational datasets compiled by the World Glacier Monitoring Service (WGMS). The dataset on glacier front variations (∼42 000 since 1600) delivers clear evidence that centennial glacier retreat is a global phenomenon. Intermittent readvance periods at regional and decadal scale are normally restricted to a subsample of glaciers and have not come close to achieving the maximum positions of the Little Ice Age (or Holocene). Glaciological and geodetic observations (∼5200 since 1850) show that the rates of early 21st-century mass loss are without precedent on a global scale, at least for the time period observed and probably also for recorded history, as indicated also in reconstructions from written and illustrated documents. This strong imbalance implies that glaciers in many regions will very likely suffer further ice loss, even if climate remains stable.
The mechanical properties of porous ceramics are greatly influenced by their microstructure. Therefore, mechanical behavior of highly porous ceramics is different from that of dense ceramics. In this work, we evaluate different mechanical testing methods such as static compression, Brazilian disc test and 3-point bending on their suitability for comparison of highly porous ceramic materials. It is shown that 3-point bending is more suitable than static compression or Brazilian disc testing, as the material exhibits no critical crack propagation under compressive loading. With 3-point bending tests, a quantitative comparison of the mechanical properties of foams with different microstructures and porosities is possible. Under cyclic compression the foams exhibit a very high degree of crack tolerance in combination with preservation of their structural integrity even at high strains of 10%.
Early post-twinning mutational events can account for discordant phenotypes in monozygotic (MZ) twin pairs. Such mutational events may comprise genomic alterations of different sizes, ranging from single nucleotides to large copy-number variations (CNVs). Anorectal malformations (ARM) and the bladder exstrophy-epispadias complex (BEEC) represent the most severe end of the urorectal malformation spectrum. Recently, CNV studies in patients with sporadic ARM and the BEEC have identified de novo events that occur in specific chromosomal regions. We hypothesized that early arising, post-twinning CNVs might contribute to discordance in MZ twin pairs with ARM or the BEEC; knowledge of such CNVs might help to identify additional chromosomal regions involved in the development of these malformations. We investigated four discordant MZ twin pairs (three ARM and one BEEC) using molecular karyotyping arrays comprising 1,140,419 markers with a median marker spacing of 1.5 kb. Filtering the coding regions for possible disease-causing post-twinning de novo CNVs present only in the affected twin, but not in the unaffected twin or the parents, identified a total of 136 CNVs. These 136 CNVs were then filtered against publicly available databases and finally re-evaluated visually. No potentially causative CNV remained after applying these filter criteria. Our results suggest that post-twinning CNV events that affect coding regions of the genome did not contribute to the discordant phenotypes in MZ twin pairs that we investigated. Possible causes for the discordant phenotypes include changes in regulatory elements or smaller genetic changes within coding regions which may be detectable by whole-exome sequencing.
This study contributes to the paleoenvironmental reconstruction of the loess–paleosol sequence of Nussloch, Germany, by using n-alkanes as plant leaf-wax-derived lipid biomarkers. We found that n-alkane patterns and concentrations in the Saalian loess and the last interglacial Eemian paleosol of Nussloch point to very strong degradation and prevailing deciduous vegetation. Degradation effects in the overlying paleosols and loess layers are less pronounced and allow for the application of an end-member mixing model to estimate vegetation changes semi-quantitatively. Our findings highlight the potential for the interpretation of degradation-corrected n-alkane ratios. n-Alkane modelling results for loess layers, paleosols and an in-filled paleochannel dated to ~ 60–32 ka suggest that up to ~ 50% of the n-alkanes were derived from deciduous trees or shrubs. This finding is in agreement with the abundant occurrence of wood fragments and indicates a highly variable and dynamic landscape dominated by tundra shrubland. On the other hand, deciduous trees or shrubs did not contribute significantly to the soil organic matter in the late Weichselian loess layers and the intercalated Gelic Gleysols (~ 32–18 ka).
3D x-ray diffraction contrast tomography (DCT) is a non-destructive technique for the determination of grain shape and crystallography in polycrystalline bulk materials. Using this technique, a strontium titanate specimen was repeatedly measured between annealing steps.. A systematic analysis of the growth history of selected grains before and after the ex-situ annealing step allows to extract the topological and morphological changes during grain growth. Furthermore, misorientation as well as interface orientation information of the microstructure reconstructions have been determined. The interface normal distribution clearly shows a preference for (100) oriented interfaces in the selected grains when annealed at 1600°C. This observation can be connected to existent interfacial energy estimations resulting from capillarity vector reconstructions.
Micro-Raman spectroscopy is used to measure stress distributions in 1.5 µm thick polycrystalline silicon thin film solar cells on glass. These measurements are combined with transmission electron microscopy and atomic force microscopy to assign the measured local stresses to the sample's microstructure. Expansion and contraction of the silicon lattice in the layer and the borosilicate glass substrate during the thermal processing of the solar cell as well as quartz beads of µm size that reside on the glass substrate for light-trapping purposes induce internal stresses that locally vary with structural features. While the thermal processing induces an average tensile stress in the silicon layer originating from the thermal mismatch between glass and silicon, the latter results in lateral stress gradients up to 208 ± 12 MPa in the mapped area.
We report a 17 year old boy with a large fistula from the right coronary artery to the right ventricle. The fistula consisted of two major branches. The smaller branch could be embolised with three detachable platinum microcoils without problems. The high flow of blood in the larger branch, however, prevented conventional occlusion using coils. Interventional occlusion of this branch was achieved in a second attempt. Following creation of an arterio-venous wire-loop, we advanced a balloon catheter into the distal end of the fistula. Under temporary occlusion of the fistula, complete closure was achieved by delivery of 7 detachable platinum microcoils. Thus, even large coronary arterial fistulas can be closed safely with these new platinum detachable microcoils. The procedure, however, requires temporary control of the flow of blood by balloon occlusion.
Enthalpies of formation were determined for β-sialon phases (Si6–zAlzOzN8–z, z = 0.46 to 3.6) by high-temperature oxidative drop solution calorimetry using an alkali-metal borate (52 wt% LiBo2; 48 wt% NaBO2) solvent. Oxygen gas was bubbled through the melt to accelerate oxidation of the oxynitride samples during dissolution. Sialons near z = 2 appear less stable energetically than ones with higher or lower nitrogen content. A large configurational entropy contribution for sialons with z > 2 may further stabilize these materials. This larger free energy driving form may be the reason for success in pulse-activated processing of these materials. The enthalpies of formation further suggest that a greater driving form for oxynitride formation exists in batch synthesis using SiO2 rather than Al2O3.
A cluster of cerebrospinal fluid Gram's stains showing gram-positive bacilli and of cerebrospinal fluid cultures growing Bacillus species in a large community teaching hospital prompted an epidemiologic and microbiologic investigation. Pseudomeningitis was suspected and confirmed when cultures of uninoculated commercial trypticase soy broth with 5% Fildes enrichment grew Bacillus species. Secondary contamination of the pipettes used for inoculation accounted for the positive cerebrospinal fluid Gram's stains. The costs of this pseudo-outbreak included unnecessary antibiotic therapy, lumbar punctures, and hospitalization. Such adverse effects can be minimized by increased physician awareness of pseudoinfections and by prompt investigation of such occurrences.
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