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We undertook a quality improvement project to address challenges with pulmonary artery catheter (PAC) line maintenance in a setting of low-baseline central-line infection rates. We observed a subsequent reduction in Staphylococcal PAC line infections and a trend toward a reduction in overall PAC infection rates over 1 year.
In patients with β-lactam allergies, administration of non–β-lactam surgical prophylaxis is associated with increased risk of infection. Although many patients self-report β-lactam allergies, most are unconfirmed or mislabeled. A quality improvement process, utilizing a structured β-lactam allergy tool, was implemented to improve the utilization of preferred β-lactam surgical prophylaxis.
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.
Elderly patients have been consistently shown to receive suboptimal therapy for cancers of the head and neck. This study was performed to determine the peri-operative outcomes of these patients and compare them with those of younger patients.
In this retrospective analysis, 115 patients aged 70 years or more undergoing major surgery for head and neck cancers were matched with 115 patients aged 50–60 years, and univariate analysis was performed.
Elderly patients had a reduced performance status (p < 0.001) and more co-morbid illnesses (p = 0.007), but a comparable intra-operative course. They had a longer median hospital stay (p = 0.016), longer intensive care unit stay (p = 0.04), longer median tracheostomy dependence (p = 0.04) and were more often discharged with feeding tubes (p < 0.001). They also had a higher incidence of post-operative non-fatal cardiac events (p = 0.045).
Elderly patients with good performance status should receive curative-intent surgery. Although hospital stay and tube dependence are longer, morbidity and mortality are comparable with younger patients.
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.
A discordant twin gestation, in which one fetus is significantly growth restricted, compared to the other normal twin, is a unique model that can be used to elucidate the mechanism(s) by which the intrauterine environment affects fetal growth. In many model systems, placental transcription factor genes regulate fetal growth. Transcription factors regulate growth through their activation or repression of downstream target genes that mediate important cell functions. The objective of this study was to determine the expression of the placental HLX homeobox gene transcription factor and its downstream target genes in dizygotic twins with growth discordance. In this cross-sectional study, HLX and its downstream target genes’ retinoblastoma 1 (RB1) and cyclin kinase D (CDKN1C) expression levels were determined in placentae obtained from dichorionic diamniotic twin pregnancies (n = 23) where one of the twins was growth restricted. Fetal growth restriction (FGR) was defined as small for gestational age with abnormal umbilical artery Doppler indices when compared with the normal control co-twin. Homeobox gene HLX expression was significantly decreased at both the mRNA and protein levels in FGR twin placentae compared with the normal control co-twin placentae (p < .05). Downstream target genes CDKN1C and RB1 were also significantly decreased and increased, respectively, at both the mRNA and protein levels in FGR twin placentae compared with normal control co-twin placentae (p < .05). Together, these observations suggest an important association between HLX transcription factor expression and abnormal human placental development in discordant twin pregnancies.
Mental hospitals in India, as elsewhere in the world, have played an important role in the care of persons with mental illness. Since their inception, they have both been decried for gross violations of human rights and dignity as well as lauded as places of refuge and care for persons turned away by the communities. In a country where community interventions for mental health care are still fragmentary, the mental hospital still continues to be a relevant and legitimate locus of care along with other limited resources available for the care of persons with mental illness outside of the family. In India, positive changes in the infrastructure and resourcing of mental hospitals, reductions in involuntary admissions and improvements in facilities have largely occurred through judicial interventions. Recent pilot interventions for rehabilitation of long-stay patients point towards the need to develop rehabilitation and community facilities for persons with severe mental illness.
The analysis of axial dispersion of solute is presented in a pulsatile flow of Casson fluid through a tube in the presence of interfacial mass transport due to irreversible first-order reaction catalysed by the tube wall. The theory of dispersion is studied by employing the generalized dispersion model proposed by Sankarasubramanian & Gill (Proc. R. Soc. Lond. A, vol. 333 (1592), 1973, pp. 115–132). This dispersion model describes the whole dispersion process in terms of three effective transport coefficients, i.e. exchange, convection and dispersion coefficients. In the present study, the effects of yield stress of Casson fluid
, wall absorption parameter
, amplitude of fluctuating pressure component
and Womersley frequency parameter
on the dispersion process are discussed under the influence of pulsatile pressure gradient. In a pulsatile flow, the plug flow radius changes during the period of oscillation and it has an effect on the dispersion process. Even with the Casson fluid model also, in an oscillatory flow, for small values of
, the dispersion coefficient
is positive, but when the value of
is as large as 3,
takes both positive and negative values due to the fluctuations in the velocity profiles. This nature becomes more predominant for
. It is observed that initially, for small time, the amplitude and magnitude of fluctuations of
becomes more rapid and increases with time but it decreases after certain time and reaches a non-transient state for large time. Like in the case of Newtonian model, double frequency period for
is observed at small time for large values of
with the Casson model for blood. It is seen that critical time for which
reaches a non-transient state is independent of
but is dependent on
. It is also observed that the axial distribution of mean concentration
of solute depends on
. But the effect of
is not very significant. This dispersion model in non-Newtonian pulsatile flow can be applied to study the dispersion process in the cardiovascular system and blood oxygenators.
Mid-Infrared optofluidics based silicon sensor platforms are demonstrated. Silicon is a great candidate for mid-infrared optofluidics for the following reasons: (1) Silicon has a broad transmission window up to 7 um (2) Silicon offers CMOS compatible and monolithic fabrication (3) Silicon has high chemical resistance that can withstand high temperature, acid/base solution and organic solvents. (4) Silicon is a non-toxic environmentally friendly material. The fabricated mid-infrared optofluidic sensor can replace bulky instruments, such as FTIR, with a lab-on-a-chip system, while achieving much higher sensitivity.
One dimensional photonic crystal 1D-PhC silicon waveguide resonators with quality factor, Q∼105, are demonstrated at mid-infrared wavelengths between 2 um to 5 um. Silicon has several advantages for mid-infrared applications including its broad mid-infrared transmission spectrum which extends out to 9 um, CMOS compatible fabrication processing, and ease of electronic-photonic integration. The proposed resonators are composed of photonic crystal cavities with optimized (i) lattice parameter a, (ii) cavity width w and (iii) hole radius r. Finite difference time domain (FDTD) simulations are used to adjust these three parameters, a, w, and r, to select a resonant frequency of interest within the mid-infrared spectral range. Due to the high quality factor Q, these PhC silicon waveguide resonators have much higher sensitivity as chemical sensors and have the potential to replace bulky instruments such as an FTIR.
To study the outcome of patients with sinonasal teratocarcinosarcoma treated at a single institution.
We reviewed the medical records of 22 patients with histopathologically proven sinonasal teratocarcinosarcoma diagnosed during the period 1993–2007. Treatment was completed in 16 patients.
Fourteen patients underwent surgery (six received craniofacial resection, four open surgery and four endoscopic resection); this was followed by radiation therapy with or without chemotherapy in 11 patients. Two patients received chemoradiation as the definitive treatment. At median follow up in surviving patients of 34 months (range one to 180 months), only five were controlled. Disease recurred in 11 patients, with a median time to recurrence of seven months. The two-year disease-free survival rate and the overall survival rate were 28 and 46 per cent, respectively.
Sinonasal teratocarcinosarcoma appears to be an aggressive disease, with the majority of patients suffering locoregional failure. Multimodality treatment, in the form of a combination of surgery, radiation therapy and chemotherapy, appears to be the optimal approach.
Immunoassays are currently the main analytical technique for quantification of a wide range of analytes of clinical, medical, biotechnological, and environmental significance with high sensitivity and specificity. Miniaturization of immunoassays is achieved using microfluidics coupled with integrated optical detection of the antibody-antigen molecular recognition reaction using thin-film amorphous silicon (a-Si:H) photodiodes. The detection system used consists of an a-Si:H photodiode aligned with a polydimethylsiloxane (PDMS) microchannel. An enzymatic reaction taking place in the microchannel yields a product which is a light-absorbent molecule and hence can be optically detected by the integrated photodiode. Specific antigen-antibody reaction was detected and distinguished from the non-specific reaction.
We propose a novel method for self-assembled packing of silica microsphere in micro-channel which can be potentially used for on-chip chromatography. Chromatography has been one of the most widely used techniques for the analysis and separation of the mixtures of biochemical compounds in research laboratories and industrial factories. Numerous chromatography techniques such as High-Performance Liquid Chromatography (HPLC), Thin Layer Chromatography (TLC) use absorbents (ex: silica, alumina, cellulose) as stationary phase material . Effective loading of absorbents in those techniques has been a huge challenge since it requires additional implementation of high-pressure pump system (for HPLC) or limits selective coating of absorbents on supporting plate (for TLC). In order for chromatography to be efficiently integrated with micro-fluidic Lab-on-a-chip devices, novel techniques for easy and simple packing of absorbents within micro channels should be developed.
Solvent-evaporation based 2-D crystallization technique  can enable mono-dispersed micro-particles to be self-assembled by capillary attractive forces. We apply this technique to assemble dense packing of silica microsphere and form ultra thin layers (2˜3 layers) within open microchannel. Open micro-channel has been constructed by conventional photolithography of SU8 photoresist. A small droplet (Volume: 0.1μL) of silica suspension (Diameter: 3μm, Solvent: DI Water, Concentration: 1.25wt%) has been placed in the defined inlet of micro channel. Capillary force within the open SU8 microchannel induces the flow of silica suspension in the channel. The packing of microsphere starts from the outlet side of the channel, where the thickness of solvent drastically decreases due to sudden increase of cross-sectional area of channel, and this packing propagates to the inlet side of the channel until solvent evaporates completely. As a result, a dense packing of silica microspheres are successfully assembled and a thin layer of silica microspheres are formed within open micro-channel.
We will present the characterization of silica packing with regard to various process parameters and also will include theoretical interpretation of this packing technique in more detail. We will also present our future approach to integrate our technique on-chip chromatography applications.
The stability of Soret-driven thermosolutal convection in a shallow horizontal layer of a porous medium subjected to inclined thermal and solutal gradients of finite magnitude is investigated theoretically by means of a linear stability analysis. The horizontal components of these gradients induce a Hadley circulation, which becomes unstable when vertical components are sufficiently large. We employed a two-term Galerkin approximation for various modes of instability. The effect of the Soret parameter on the mechanism of instability of the thermosolutal convection is investigated. Results are presented for various values of the governing parameters of the flow. It is observed that the Soret parameter has a significant effect on convective instability and this is discussed.
A large outbreak of hepatitis E occurred in 2005 in Hyderabad, Andhra Pradesh, India. A total of 1611 cases were reported between 1 March and 31 December 2005 (attack rate 40/100 000). The epidemic curve suggested a continuing common source outbreak. Cases were centred around open sewage drains that crossed the old city. The attack rate was significantly higher in neighbourhood blocks supplied by water supply lines that crossed open drains (203/100 000) than in blocks supplied by non-crossing water pipes with a linear trend (38/100 000, P<0·00001). Crossing water pipelines were repaired and the attack rates declined.
The study was aimed at developing better orally active albendazole (ALB) formulations. Six formulations (ALB-1 to ALB-6) were prepared and tested against Brugia malayi in Mastomys coucha and jird (Meriones unguiculatus) at 200 mg/kg, orally, for 5 consecutive days. The anti-filarial efficacy was assessed against microfilariae (mf), adult worms and female reproductive potential. Three of the 6 ALB formulations showed greatly improved female worm sterilizing potential (ALB-1: 90%; ALB-3: 63%; ALB-4: 77% of untreated control) in B. malayi – M. coucha model. Sterilization efficacy of ALB-1 was also better than that shown by pure-ALB (P<0·001) or its marketed tablet formulation, Zentel (P<0·01), while that of ALB-4 was better than pure-ALB (P<0·05). The activity of ALB-3, pure-ALB and Zentel was, however, comparable. ALB-1 also showed late microfilaricidal activity with a maximum of 78% fall in microfilarial count. In contrast, neither the pure ALB nor Zentel showed any microfilaricidal activity. In the jird – B. malayi model, ALB-1 and ALB-4 showed marginal sterilizing efficacy whereas pure ALB or Zentel were ineffective. In conclusion the anti-filarial efficacy of ALB-1 was found to be superior to pure-ALB or Zentel.