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To assess variability in antimicrobial use and associations with infection testing in pediatric ventilator-associated events (VAEs).
Descriptive retrospective cohort with nested case-control study.
Pediatric intensive care units (PICUs), cardiac intensive care units (CICUs), and neonatal intensive care units (NICUs) in 6 US hospitals.
Children≤18 years ventilated for≥1 calendar day.
We identified patients with pediatric ventilator-associated conditions (VACs), pediatric VACs with antimicrobial use for≥4 days (AVACs), and possible ventilator-associated pneumonia (PVAP, defined as pediatric AVAC with a positive respiratory diagnostic test) according to previously proposed criteria.
Among 9,025 ventilated children, we identified 192 VAC cases, 43 in CICUs, 70 in PICUs, and 79 in NICUs. AVAC criteria were met in 79 VAC cases (41%) (58% CICU; 51% PICU; and 23% NICU), and varied by hospital (CICU, 20–67%; PICU, 0–70%; and NICU, 0–43%). Type and duration of AVAC antimicrobials varied by ICU type. AVAC cases in CICUs and PICUs received broad-spectrum antimicrobials more often than those in NICUs. Among AVAC cases, 39% had respiratory infection diagnostic testing performed; PVAP was identified in 15 VAC cases. Also, among AVAC cases, 73% had no associated positive respiratory or nonrespiratory diagnostic test.
Antimicrobial use is common in pediatric VAC, with variability in spectrum and duration of antimicrobials within hospitals and across ICU types, while PVAP is uncommon. Prolonged antimicrobial use despite low rates of PVAP or positive laboratory testing for infection suggests that AVAC may provide a lever for antimicrobial stewardship programs to improve utilization.
Our understanding of the complex relationship between schizophrenia symptomatology and etiological factors can be improved by studying brain-based correlates of schizophrenia. Research showed that impairments in value processing and executive functioning, which have been associated with prefrontal brain areas [particularly the medial orbitofrontal cortex (MOFC)], are linked to negative symptoms. Here we tested the hypothesis that MOFC thickness is associated with negative symptom severity.
This study included 1985 individuals with schizophrenia from 17 research groups around the world contributing to the ENIGMA Schizophrenia Working Group. Cortical thickness values were obtained from T1-weighted structural brain scans using FreeSurfer. A meta-analysis across sites was conducted over effect sizes from a model predicting cortical thickness by negative symptom score (harmonized Scale for the Assessment of Negative Symptoms or Positive and Negative Syndrome Scale scores).
Meta-analytical results showed that left, but not right, MOFC thickness was significantly associated with negative symptom severity (βstd = −0.075; p = 0.019) after accounting for age, gender, and site. This effect remained significant (p = 0.036) in a model including overall illness severity. Covarying for duration of illness, age of onset, antipsychotic medication or handedness weakened the association of negative symptoms with left MOFC thickness. As part of a secondary analysis including 10 other prefrontal regions further associations in the left lateral orbitofrontal gyrus and pars opercularis emerged.
Using an unusually large cohort and a meta-analytical approach, our findings point towards a link between prefrontal thinning and negative symptom severity in schizophrenia. This finding provides further insight into the relationship between structural brain abnormalities and negative symptoms in schizophrenia.
No existing models of alcohol prevention concurrently adopt universal and selective approaches. This study aims to evaluate the first combined universal and selective approach to alcohol prevention.
A total of 26 Australian schools with 2190 students (mean age: 13.3 years) were randomized to receive: universal prevention (Climate Schools); selective prevention (Preventure); combined prevention (Climate Schools and Preventure; CAP); or health education as usual (control). Primary outcomes were alcohol use, binge drinking and alcohol-related harms at 6, 12 and 24 months.
Climate, Preventure and CAP students demonstrated significantly lower growth in their likelihood to drink and binge drink, relative to controls over 24 months. Preventure students displayed significantly lower growth in their likelihood to experience alcohol harms, relative to controls. While adolescents in both the CAP and Climate groups demonstrated slower growth in drinking compared with adolescents in the control group over the 2-year study period, CAP adolescents demonstrated faster growth in drinking compared with Climate adolescents.
Findings support universal, selective and combined approaches to alcohol prevention. Particularly novel are the findings of no advantage of the combined approach over universal or selective prevention alone.
Thick (>150 μm) beryllium coatings are studied as an ablator material of interest for fusion fuel capsules for the National Ignition Facility. DC magnetron sputtering is used because of the relative controllability of the processing temperature and energy of the deposits. However, coatings produced by DC magnetron sputtering leak the fuel gas D2. By using ion-assisted DC magnetron, sputtered coatings can be made that are leak-tight. Transmission electron microscopy (TEM) studies revealed microstructural changes that lead to leak-tight coating. Ultrasmall angle x-ray spectroscopy is used to characterize the void distribution and volume along the spherical surface along with a combination of focused ion beam, scanning electron microscope, and TEM. An in situ multibeam optical stress sensor was used to measure the stress behavior of thick beryllium coatings on flat substrates as the material was being deposited.
Whisker formation in pure Sn coatings on Cu conductors is a serious impediment to the development of Pb-free electronics manufacturing. Understanding whisker formation is complicated by the fact that it is the result of multiple materials kinetic processes including interdiffusion, intermetallic formation and stress generation We report preliminary studies of whisker growth kinetics and stress evolution aimed at developing a fundamental understanding of the whisker growth process. A proposed model of point defect mediated stress generation provides a simple picture of how the different processes are connected.
In the present work we have studied rapid thermally nitrided titanium films which contact self-aligned silicided titanium disilicide (TiSi2-salicided) and non-silicided junctions. We correlate electrical contact resistance data to SIMS results.
A Photoreflectance (PR), Photoluminescence (PL), Raman scattering and Ellipsometry optical characterisation study of He and SiCl4 reactive ion etched 1018cm−3 n-type GaAs is presented. Ellipsometric and PL data reveal significant modifications to the GaAs substrates for the He plasma as a function of etch power and etch gas pressure. Raman data reveal an increase in the depletion depth while the surface electric field data, extracted from PR spectra, decrease with etch severity. This is accounted for by a plasma etch induced decrease in the near surface net carrier density. Ellipsometric and PL measurements of SiCl4 etching reveal evidence of an improvement in the GaAs surface crystallinity while PR and Raman data are consistent with an increase in the surface carrier concentration. Optical characterisation data are correlated with electrical measurements using capacitance-voltage profiling.
The morphology, chemical state and oxidation behaviour of electroless copper films deposited from two different baths were characterised using scanning electron microscopy (SEM), atomic force microscopy (AFM), X-ray diffraction (XRD), secondary ion mass spectrometry (SIMS) and spectroscopic ellipsometry (SE). The electroless solutions used were a commercial electroless formaldehyde (HCHO)-based solution (Cupro-Thick 84, Alfachimici) and an electroless solution developed within the NMRC which was based on dimethylamine borane (DMAB). Both methods produced as-deposited copper films with different morphologies. SE analysis of the as-deposited films and those oxidised in a dry synthetic air environment between 75°C–150°C indicated that the freshly deposited films had inherent oxide layers of between 45Å–92Å and that significant growth of these only occurred at temperatures above 100°C within 180 minutes isothermal oxidation periods. XRD analysis confirmed that the oxidation products formed were a mixture of cuprous oxide (Cu2O) and cupric oxide (CuO). Multiple linear regression analysis of the rates of change in oxide layer thicknesses as a function of both time and temperature indicated that mixed rate laws dominated. The application of an oxidation inhibitor was shown to prevent oxidation of the asdeposited commercial copper films when heat treated at 125°C.
This paper discusses the development of a novel selective electroless copper metallisation route for the plating of epoxy substrates. This has the potential for the development of a more cost effective and environmentally friendly plating process than currently available technologies. The electroless process required that the electrically insulating epoxy substrate was initially activated to catalyse the reduction of the copper (I1) salt which was in solution to a copper (0) deposit. Selective activation was achieved by coating the epoxy substrates with a new proprietary palladium compound and selectively exposing specific areas to 222nm radiation from a KrCI* excimer lamp. It has been shown that only the palladium metal and not the proprietary precursor catalyse the reaction. After selective seeding the patterned epoxy substrates were copper plated in a commercial electroless copper bath. The process conditions and effect of surface preparation on the quality and resolution of the selectively deposited copper patterns are discussed.
The surface morphology of a UV excimer lamp photodefimed palladium activation layer and its effect on subsequent electroless copper deposition have been studied on 96% alumina substrates using an atomic force microscope (AFM). The morphology of the activation layer and the density of the palladium catalyst are important factors affecting the initial stages of the electroless deposition and the microstructure of the copper film. Under activation conditions on which a subsequent electroless copper deposit exhibited good adhesion characteristics, the palladium activation was found to have a nodular structure with a large distribution of palladium particle sizes of the order of 10 nm at grain boundaries and the edges of grain steps, with smaller activation particles observed on smoother areas of the alumina grains. The influence of substrate morphology on the nature of the catalytic sites and thence, on the nature of the subsequently deposited metal was investigated, both at the nucleation stage, and as the autocatalytic electroless deposition reaction proceeded. The recrystallisation of the initial electroless deposit, the morphology of the resulting copper films and its relationship to catalyst particle size are reported. The principal determining factors in the substrate and activation layer morphology which control the microstructure of the electroless copper deposit are discussed.