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Patients receiving hematopoietic stem cell transplants (HSCT) are at increased risk for Clostridioides difficile infection (CDI). The purpose of this study was to assess the effectiveness of oral vancomycin prophylaxis (OVP) for CDI in HSCT patients.
Design:
Single-center, retrospective cohort.
Setting:
Tertiary care academic medical center in New Jersey.
Patients:
Patients ≥18 years old during admission for the HSCT were included. Patients who were admitted <72 hours or who had an active CDI prior to HSCT day 0 were excluded.
Methods:
Medical records of patients admitted between January 2015 and August 2022 to undergo an allogeneic or autologous HSCT were reviewed. The primary end point was the incidence of in-hospital CDI. Secondary end points included the incidence of vancomycin-resistant enterococci (VRE) bloodstream infections, VRE isolated from any clinical culture, gram-negative bloodstream infections, hospital survival, and hospital length of stay. Exploratory end points, including 1-year survival, relapse, and incidence of graft-versus-host disease, were also collected.
Results:
A total of 156 HSCT patients were included. There was 1 case of CDI (1 of 81, 1.23%) in the OVP group compared to 8 CDI cases (8 of 75, 10.67%) in the no OVP group (P = .0147). There were no significant (P > .05) between-group differences in incidence of gram-negative bloodstream infections, hospital survival, and length of stay. There were zero clinical cultures positive for VRE.
Conclusions:
In-hospital incidence of CDI in HSCT patients was significantly decreased with OVP. Randomized controlled trials are needed in this high-risk population to assess the efficacy and risks of OVP for CDI.
The importance of various sediment components in the oxidation of As(III) (arsenite) to As(V) (arsenate) by freshwater lake sediments in southern Saskatchewan was examined. Treating the sediments with hydroxylamine hydrochloride or sodium acetate to remove Mn greatly decreased the oxidation of As(III). Furthermore, synthetic Mn(IV) oxide was a very effective oxidant with respect to As(III): 216 µg As(V)/ml was formed in solution when 1000 µg As(III)/ml was added to suspensions of 0.1 g of the oxide. These results indicate that Mn in the sediment was probably the primary electron acceptor in the oxidation of As(III). The conversion of As(III) to As(V) by naturally occurring carbonate and silicate minerals common in sediments was not evident in the system studied. Sediment particles >20 µm in size are the least effective in oxidizing As(III); the oxidizing ability of the 5–20-, 2–5-, and <2-µm particle size fractions varies depending on the sediment. The concentration of As(V) in equilibrated solutions after adding increasing amounts of As(III) (as much as 100 µg/ml) to 1 g of the three sediments ranged from approximately 3.5 to 19 µg/ml. Because As(III) is more toxic and soluble than As(V), Mn-bearing components of both the colloidal and non-colloidal fractions of the sediments may potentially detoxify any As(III) that may enter aquatic environments by converting it to As(V). This is very important in reducing the As contamination and in maintaining the ecological balance in aquatic environments.
The adsorption of hydroxy-Al by the 2–0·2 μ size fractions of muscovite, biotite, K-depleted micas, vermiculite and montmorillonite was studied. The differences in the amounts of hydroxy-Al adsorbed were apparently related to the expansibility and layer charge of minerals, the ionic saturation and degree of K-depletion, the basicity (OH/Al ratio) of the equilibrating hydroxy-Al solution, and the solution-clay ratio. The CEC reduction was not necessarily proportional to the amount of Al adsorbed because CEC reduction may occur through occupation of cation exchange sites by hydroxy-Al, or through hindrance to the entry of the replacing cation to these sites. Aluminum interlayering generally increases the K/Ca cation exchange selectivity (CES) of Na-vermiculite and K-depleted biotite, whereas the K/Ca CES of Na-montmorillonite was little affected. The basicity of the initial hydroxy-Al solution appeared to affect the K/Ca CES of Na-vermiculite and K-depleted biotite by controlling the amount of hydroxyl-Al adsorbed. The data indicate that in addition to the “propping effect”, hydroxy-Al interlayers may affect the K/Ca CES through the following mechanisms; (1) the “preferential occupation” of Ca adsorbing sites, and/or (2) the “retarding effect” on the entry of the more hydrated Ca ions.
Ultrafast optical probing is a widely used method of underdense plasma diagnostic. In relativistic plasma, the motion blur limits spatial resolution in the direction of motion. For many high-power lasers the initial pulse duration of 30–50 fs results in a 10–15 μm motion blur, which can be reduced by probe pulse post-compression. Here we used the compression after compressor approach [Phys.-Usp. 62, 1096 (2019); JINST 17 P07035 (2022)], where spectral broadening is performed in thin optical plates and is followed by reflections from negative-dispersion mirrors. Our initially low-intensity probe beam was down-collimated for a more efficient spectral broadening and higher probe-to-self-emission intensity ratio. The setup is compact, fits in a vacuum chamber and can be implemented within a short experimental time slot. We proved that the compressed pulse retained the high quality necessary for plasma probing.
The influence of Mn2+ on the formation of Fe oxides at pHs of 6.0 and 8.0 and varying Mn/Fe molar ratios (0, 0.1, 1.0, and 10.0) in the FeCl2-NH4OH and FeSO4-NH4OH systems was studied by X-ray powder diffraction (XRD), infrared absorption, transmission electron microscopic, and chemical analyses. In the absence of Mn2+, lepidocrocite (γ-FeOOH) and maghemite (γ-Fe2O3) were the crystalline species formed at pHs of 6.0 and 8.0, respectively, in the FeCl2 system, whereas lepidocrocite and goethite (α-FeOOH) and lepidocrocite were the crystalline species formed at pHs of 6.0 and 8.0, respectively, in the FeSO4 system. The amount of Mn coprecipitated with Fe (as much as 8.1 mole % in the FeCl2 system and 15.0 mole % in the FeSO4 system) increased as the initial solution Mn/Fe molar ratio increased from 0 to 10.0, resulting in the perturbation of the crystallization processes of the hydrolytic products of Fe formed. At pH 6.0, the perturbation led to the formation of poorly ordered lepidocrocite, as reflected in the increasing broadening of its characteristic peaks in the XRD patterns. At pH 8.0, poorly ordered iepidocrocite and a honessite-like mineral (Mn-Fe-SO4-H2O) formed in the FeCl2 and FeSO4 systems, respectively.
The influence of manganese oxide minerals (cryptomelane, hausmannite, and pyrolusite) on the formation of iron oxides was studied in the FeCl2-NH4OH system at different Mn/Fe molar ratios (0, 0.01, 0.1, and 1.0) and pHs (3.0, 4.0, 5.0, and 6.0) by X-ray powder diffraction, infrared absorption, transmission electron microscopic, and chemical analyses. In the absence of Mn minerals, lepidocrocite (γ-FeOOH) precipitated at pHs 5.0 and 6.0; however, no precipitate formed at lower pHs. All the Mn minerals studied promoted the precipitation of iron oxides and oxyhydroxides. In the presence of Mn oxides, Fe2+ was oxidized to Fe3+, which hydrolyzed and precipitated as noncrystalline and/or different crystalline iron oxides and oxyhydroxides, depending on the nature of the Mn oxides present in the system. Simultaneously, Mn2+ was detected in solution after the reaction by electron spin resonance spectroscopy. The presence of cryptomelane and hausmannite resulted in the formation of åkaganeite (β-FeOOH) and magnetite (Fe3O4), respectively. Thus, the effect of Mn oxides on the formation of Fe oxide minerals in the weathering zone merits attention.
Hydroxide and oxyhydroxide products of aluminum were formed at room temperature at an initial Al concentration of 2 × 10-3 M, pH 8.2, and at varying concentrations of organic and inorganic ligands commonly found in nature. The effectiveness of the ligands in promoting the formation of noncrystalline products over crystalline Al(OH)3 polymorphs was found to be in the following order: phthalate ≅ succinate < glutamate < aspartate < oxalate < silicate ≅ fluoride < phosphate < salicylate ≅ malate < tannate < citrate < tartrate. The lowest ligand/Al molar ratio at which the production of Al hydroxides or oxyhydroxides was inhibited ranged from 0.02 to 15. Above critical ligand/Al ratios, crystalline products were inhibited and ligands coprecipitated with noncrystalline products which remained unchanged for at least 5 months. Polydentate and large ligands generally were more inhibitive than those with fewer functional groups or of smaller size.
The perturbing ligands promoted and stabilized the formation of pseudoboehmite over crystalline Al(OH)3 polymorphs in the following sequence: chloride < sulfate < phthalate ≅ succinate < glutamate < silicate < aspartate < phosphate < salicylate ≅ malate < tannate < citrate < tartrate. The optimal range of the ligand/Al molar ratios for the formation of pseudoboehmite varied, for example, from 0.005–0.015 for tartrate to 600–1000 for chloride. Pseudoboehmite was not formed in the presence of fluoride.
Reactions between hydroxy-Al ions and orthosilicic acid as influenced by citric acid were studied at an initial Si concentration of 1.6 × 10−3 M, Si/Al molar ratios of 0.5 and 1.0, OH/Al molar ratios of 1.0-3.0, and citric acid/Al molar ratios of 0-0.3. In the absence of citric acid and at OH/A1 ratios of 1.0-2.8, imogolite (>0.01 μm) was dominant in the precipitates. At citric acid/Al ratios of 0.01-0.1, imogolite and/or pseudoboehmite were dominant in the precipitates at OH/Al ratios of 1.0 and 2.0, and imogolite and/or ill-defined aluminosilicate complexes at OH/Al ratio of 2.8. Instead of allophane or “proto-imogolite” allophane being the predominant species in the precipitates, the formation of ill-defined aluminosilicate complexes at OH/Al ratio of 3.0 was steadily promoted by increasing the solution citric acid/Al ratios from 0 to 0.3. The freeze-dried soluble products (<0.01 μ) ranged from silica gel to “proto-imogolite,” depending upon the basicity of Al and the level of citric acid of the parent solution. The amount of “proto-imogolite” increased with increasing citric acid/Al ratios from 0 to 0.1 in solution. Complexing low molecular weight organic acids, such as citric acid, impeded the formation of the short-range ordered aluminosilicates, allophanes and imogolite.
The formation of hydroxy-Al-interlayered montmorillonite was affected by complexing organic acids. Montmorillonite (<2.0 μm) was aged for three months at an initial pH of 5.0 or 6.0 in AlCl3 solutions containing citric or tannic acid at organic acid/Al molar ratios from 0 to 1.0. The Al/clay ratio in the system was 900 meq Al3+/100 g of montmorillonite. Ion-exchange experiments revealed that organically complexed Al ions have both positive and negative charges. Evidence from X-ray powder diffraction, electron microscopic examination, measurements of specific surface, cation-exchange capacity, organic carbon, and the nature of sorbed Al indicates that citric and tannic acids influence differently the hydroxy-Al interlayer formation in montmorillonite. Hydroxy-Al-citrate can be adsorbed as interlayers in montmorillonite, but hydroxy-Al-tannate exists principally as a separate phase binding the clay particles. The differences observed between the influence of citric and tannic acids on Al interlayering are probably due to their differences in molecular weight (size) and structure.
The effects of humic acid (HA) on the crystallization of precipitation products of Al under mildly acidic to alkaline conditions were investigated. The extent of Al precipitation substantially decreased with increasing HA concentration (0 to 75 µg/ml) in the pH range 6 to 10 during the 80-day aging period. The X-ray powder diffraction (XRD) data show that, at pH 6.0, the amount of pseudoboehmite formed in the systems decreased with the increasing concentration of HA present. The proportion of Al hydroxide polymorphs (gibbsite and bayerite) was greatly influenced by the amounts of HA present in the systems. At pH 6.0 and HA concentration of 37.5 µg/ml, all the precipitation products of Al were noncrystalline. At pH 8.0 and a HA concentration of 12.5 µg/ml, the formation of gibbsite and bayerite was completely inhibited and only pseudoboehmite was evident in the XRD patterns. Further increase in HA concentration (25–75 µg/ml HA) at pH 8.0 resulted in no precipitation of Al, and only a broad peak at ∼3.3 Å, characteristic of HA, was observed. The XRD patterns of the precipitates of Al formed in the absence of HA at pH 10.0 showed the characteristic peaks of bayerite. At pH 10.0, the precipitation products of Al formed even at the HA concentration of 2.5 µg/ml yielded no XRD peaks. Infrared absorption spectra and transmission electron micrographs of the precipitation products of Al formed in the systems studied substantiate the findings obtained by XRD. The data obtained in this study indicate that HA affects the formation of Al hydroxide polymorphs, pseudoboehmites and short-range ordered mineral colloids.
The catalytic power of Ca-nontronite, Ca-bentonite, and Ca-kaolinite in promoting the abiotic ring cleavage of pyrogallol (1,2,3-trihydroxybenzene) and the associated formation of humic polymers was studied in systems free of microbial activity. The presence of Ca-kaolinite and especially Ca-nontronite in the pyrogallol solutions at pH 6.00 greatly enhanced the absorbance at both 472 and 664 nm of the supernatants. At an initial pH of 6.00 and at the end of a 90-hr reaction period, the amounts of CO2 released from the ring cleavage of pyrogallol and the yields of the resultant humic polymers formed in the reaction systems followed the same sequence: Ca-nontronite > Ca-kaolinite > Ca-bentonite. The data indicate that the catalytic power of Fe(III) on the edges and in the structure of nontronite was substantially greater than that of Al on the edges of kaolinite and montmorillonite and of a small amount of Fe(III) in the structure of montmorillonite in promoting the reactions. The infrared and electron spin resonance spectra and the solid-state, cross-polarization magic-angle-spinning 13C nuclear magnetic resonance spectra of humic polymers formed in the reaction systems resembled those of natural humic substances.
The rate of Fe(II) oxidation at a constant rate of oxygen supply in the presence of citrate was measured at pH 6.0 at various citrate/Fe(II) molar ratios at 23.5°C in 0.01 M ferrous Perchlorate system. The kinetics followed a first-order reaction with respect to Fe(II) concentration at constant pH (6.0) and aeration (5 ml/min). The rate constant decreased exponentially from 41.3 × 10-4 to 7.6 × 10-4/min with an increase in the citrate/Fe(II) molar ratio from 0 to 0.1.
The nature of the hydrolytic products formed after 120 min of oxidation was arrived at by X-ray powder diffraction (XRD), infrared spectrometry (IR), and transmission electron microscopic (TEM) analyses. In the absence of citrate, goethite (α-FeOOH) and poorly crystalline lepidocrocite (γ-FeOOH) were the oxidation products formed at pH 6.0. The formation of lepidocrocite was promoted at the expense of goethite at citrate/Fe(II) molar ratios of 0.0005 to 0.005. The formation of lepidocrocite was especially pronounced at a citrate/Fe(II) molar ratio of 0.001, as observed from the width at half height (WHH) and the area of the 020 XRD peak of lepidocrocite. At a citrate/Fe(II) molar ratio of 0.01, however, the crystallization was perturbed resulting in the formation of noncrystalline Fe oxides, and no precipitate was observed at a citrate/Fe molar ratio of 0.1. The strong complexation of Fe(II) with citrate retarded the kinetics of Fe(II) oxidation and the formation and hydrolysis of Fe(III). The complexation, electrostatic, and steric effects of the coexisting citrate anions in solution apparently influenced the oxygen coordination and the way by which the double rows of edge-sharing Fe(O,OH)6 octahedra linked during crystallization, resulting in the formation of lepidocrocite.
Solutions containing AlCl3 and Si(OH)4 (concentrations ≤ 1.5 mM with molar Si:Al ratios of 1:2, 1:1 and 3:1) and FeCl2 (0, 0.5 and 1.0 mM) were adjusted to pH 8 with Ca(OH)2, and incubated at 23°C and 89°C without exclusion of air in the presence of CaCO3 for 8–12 weeks. The products were characterized by infrared spectroscopy and X-ray diffraction. Systems with 3:1 and 1:1 Si:Al ratios without Fe gave hydrous feldspathoids at 23° and 89°C. Systems with 3:1 Si:Al ratios containing Fe gave aluminous nontronites at 89°C and noncrystalline, nontronite-like products at 23°C. Systems with 1:1 Si:Al ratios with added Fe gave Fe(III)-substituted hydrous feldspathoids at 23°C. At 89°C, the system with 1:1 Si:Al ratios and 0.5 mM Fe produced a “protohalloysite,” while that with 1.0 mM Fe gave a poorly ordered nontronite-like layer silicate. In systems with 1:2 Si:Al ratios, the formation of “protoimogolite” at 23°C was little affected by additions of Fe. At 89°C, the “protoimogolite” decomposed to boehmite and poorly-ordered layer silicate phases. Inclusion of 1 mM MgCl2 in the above systems had no effect on the products at 23°C, but at 89°C produced saponites and a mixed layer saponite-chlorite in the 3:1 Si:Al systems, and saponite-like layer structures in the 1:1 and 1:2 Si:Al systems.
We evaluated whether universal chlorhexidine bathing (decolonization) with or without COVID-19 intensive training impacted COVID-19 rates in 63 nursing homes (NHs) during the 2020–2021 Fall/Winter surge. Decolonization was associated with a 43% lesser rise in staff case-rates (P < .001) and a 52% lesser rise in resident case-rates (P < .001) versus control.
Polynuclear Al13 tridecamer species are the major hydrolyzed species of aluminum, but their occurrence in terrestrial environments has not been established. X-ray diffraction (XRD), 27Al nuclear magnetic resonance (NMR), and scanning electron microscope (SEM) analyses show that the presence of tartaric acid (concentration range of 10−5–10−3 M), one of the commonly occurring low-molecular-weight organic acids, inhibits the formation of the Al13 tridecamer species.
In the absence of tartaric acid, the basic aluminum sulfate crystals were of tetrahedral morphology and conformed to isometric symmetry with a = 17.748 Å and space group of P4232. Increasing amounts of tartaric acid [tartaric acid/Al molar ratio (R) ranging from 0.01 to 0.05] modified the crystal morphology from the tetrahedral particles of isometric symmetry (R = 0) to rod-shaped particles of monoclinic symmetry (R = 0.01) to irregularly shaped X-ray noncrystalline microparticles (R = 0.05). Failure to detect the presence of Al13 tridecamer, the dominant hydrolyzed species of aluminum, in terrestrial environments may be partially attributed to the presence of low-molecular-weight organic acids, which inhibit the formation of Al13 tridecamer species.
This investigation was carried out to study the effect of different concentrations of citric acid and glycine, which are common in freshwaters, on the kinetics of the adsorption of Hg by kaolinite under various pH conditions. The data indicate that Hg adsorption by kaolinite at different concentrations of citric acid and glycine obeyed multiple first order kinetics. In the absence of the organic acids, the rate constants of the initial fast process were 46 to 75 times faster than those of the slow adsorption process in the pH range of 4.00 to 8.00. Citric acid had a significant retarding effect on both the fast and slow adsorption process at pHs of 6.0 and 8.0. It had a significant promoting effect on the fast and slow adsorption process at pH 4.00. Glycine had a pronounced enhancing effect on the rate of Hg adsorption by kaolinite during the fast process. The rise in pH of the system further increased the effect of glycine on Hg adsorption. The magnitude of the retarding/promoting effect upon the rate of Hg adsorption was evidently dependent upon the pH, structure and functionality of organic acids, and molar ratio of the organic acid/Hg. The data obtained suggest that low-molecular-weight organic acids merit close attention in studying the kinetics and mechanisms of the binding of Hg by sediment particulates and the subsequent food chain contamination.
Substantial studies have been carried out to investigate the mechanism of the formation of Al(OH)3 polymorphs. The influence of the nature of Al precipitation products on the formation of Al(OH)3 polymorphs still remains obscure. In this study, X-ray diffraction, infrared and thermal analyses, and electron microscopic observations of the Al precipitates formed at the initial pH 8.2 and at a citric acid/Al molar ratio of 0.01 and aged for 3 hr to 60 days revealed that the transformation from the initially formed noncrystalline materials to pseudoboehmite occurred through the formation of intermediate materials with various degrees of ordering and sizes of particles that apparently had a wide range of solubility. By increasing the pH of the suspension of precipitation products of Al to 10.0 after 3 hr and 3, 11, 31, and 60 days or longer, the crystalline precipitation products were hayerite, nordstrandite and bayerite, nordstrandite and pseudoboehmite, pseudoboehmite and gibbsite, and pseudoboehmite, respectively. This work shows evidence that, as the nature of the starting Al precipitates changed, the rate of their dissolution apparently changed, and various Al(OH)3 polymorphs consequently formed. Therefore, the data substantiate the hypothesis that the mechanism of the formation of an Al(OH)3 polymorph is determined by the rate of its nucleation, which is, in turn, influenced by the rate of dissolution of the noncrystalline or poorly ordered Al-oxides initially formed.
In soil environments, the surfaces of clay minerals are often coated with hydrolytic products of Al. However, limited information is available on the effect of hydroxyaluminum coatings on the interlayering of enzymes for montmorillonite. The objective of this study was to compare the adsorption of tyrosinase onto montmorillonite as influenced by levels of hydroxyaluminum coatings. Tyrosinase is one of the strongest catalysts in the transformation of phenolic compounds. Adsorption of tyrosinase onto Ca-montmorillonite (Ca-Mte) and different hydroxyaluminum-montmorillomte complexes (Al(OH)x-Mte), containing 1.0, 2.5 and 5.0 mmol coated Al/g clay, was studied both in the absence and in the presence of a phosphate buffer at pH 6.5 and 25°C. Except for Ca-Mte in the absence of phosphate where the adsorption isotherm was of C type (linear), the adsorption isotherms were of L type (Langmuir). More tyrosinase molecules were adsorbed onto Ca-Mte than onto the Al(OH)x-Mte complexes, both in the absence and in the presence of phosphate. This indicated the easy accessibility of the enzyme to the uncoated Ca-Mte surfaces. The presence of phosphate did not significantly affect the amount of tyrosinase adsorbed onto Ca-Mte, but substantially reduced the adsorption of tyrosinase onto Al(OH)x-Mte complexes. The higher the level of hydroxyaluminum coatings, the lower the amount of tyrosinase was adsorbed. Because of their affinity to the aluminous surfaces, phosphate ions evidently competed strongly with tyrosinase for Al(OH)x-Mte complexes adsorption sites. The intercalation of tyrosinase by Ca-Mte was indicated by the increased d-spacing of the complex as the amount of the enzyme adsorbed increased. The infrared spectra of tyrosinase-Ca-Mte complex showed that the amide II band of tyrosinase at 1540 cm-1 was practically unaffected by adsorption. The amide I band at 1654 cm-1 was shifted toward a higher frequency, indicating a slight perturbation in the protein conformation. This perturbation became more noticeable in the presence of Al(OH)x-Mte complexes. The data indicated that hydroxyaluminum coatings play an important role in retarding the adsorption of tyrosinase by montmorillonite, and phosphate effectively competes with tyrosinase for the adsorption sites on Al(OH)x-Mte complexes.