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OBJECTIVES/SPECIFIC AIMS: Clostridium difficile infection (CDI) is the most common cause of antibiotic-associated diarrhea and an increasingly common infection in children in both hospital and community settings. Between 20% and 30% of pediatric patients will have a recurrence of symptoms in the days to weeks following an initial infection. Multiple recurrences have been successfully treated with fecal microbiota transplantation (FMT), though the body of evidence in pediatric patients is limited primarily to case reports and case series. The goal of our study was to better understand practices, success, and safety of FMT in children as well as identify risk factors associated with a failed FMT in our pediatric patients. METHODS/STUDY POPULATION: This multicenter retrospective analysis included 373 patients who underwent FMT for CDI between January 1, 2006 and January 1, 2017 from 18 pediatric centers. Demographics, baseline characteristics, FMT practices, C. difficile outcomes, and post-FMT complications were collected through chart abstraction. Successful FMT was defined as no recurrence of CDI within 60 days after FMT. Of the 373 patients in the cohort, 342 had known outcome data at two months post-FMT and were included in the primary analysis evaluating risk factors for recurrence post-FMT. An additional six patients who underwent FMT for refractory CDI were excluded from the primary analysis. Unadjusted analysis was performed using Wilcoxon rank-sum test, Pearson χ2 test, or Fisher exact test where appropriate. Stepwise logistic regression was utilized to determine independent predictors of success. RESULTS/ANTICIPATED RESULTS: The median age of included patients was 10 years (IQR; 3.0, 15.0) and 50% of patients were female. The majority of the cohort was White (89.0%). Comorbidities included 120 patients with inflammatory bowel disease (IBD) and 14 patients who had undergone a solid organ or stem cell transplantation. Of the 336 patients with known outcomes at two months, 272 (81%) had a successful outcome. In the 64 (19%) patients that did have a recurrence, 35 underwent repeat FMT which was successful in 20 of the 35 (57%). The overall success rate of FMT in preventing further episodes of CDI in the cohort with known outcome data was 87%. Unadjusted predictors of a primary FMT response are summarized. Based on stepwise logistic regression modeling, the use of fresh stool, FMT delivery via colonoscopy, the lack of a feeding tube, and a lower number of CDI episodes before undergoing FMT were independently associated with a successful outcome. There were 20 adverse events in the cohort assessed to be related to FMT, 6 of which were felt to be severe. There were no deaths assessed to be related to FMT in the cohort. DISCUSSION/SIGNIFICANCE OF IMPACT: The overall success of FMT in pediatric patients with recurrent or severe CDI is 81% after a single FMT. Children without a feeding tube, who receive an early FMT, FMT with fresh stool, or FMT via colonoscopy are less likely to have a recurrence of CDI in the 2 months following FMT. This is the first large study of FMT for CDI in a pediatric cohort. These findings, if confirmed by additional prospective studies, will support alterations in the practice of FMT in children.
The study aims to assess whether supplementation with the probiotic Lactobacillus rhamnosus HN001 (HN001) can reduce the prevalence of gestational diabetes mellitus (GDM). A double-blind, randomised, placebo-controlled parallel trial was conducted in New Zealand (NZ) (Wellington and Auckland). Pregnant women with a personal or partner history of atopic disease were randomised at 14–16 weeks’ gestation to receive HN001 (6×109 colony-forming units) (n 212) or placebo (n 211) daily. GDM at 24–30 weeks was assessed using the definition of the International Association of Diabetes and Pregnancy Study Groups (IADPSG) (fasting plasma glucose ≥5·1 mmol/l, or 1 h post 75 g glucose level at ≥10 mmol/l or at 2 h ≥8·5 mmol/l) and NZ definition (fasting plasma glucose ≥5·5 mmol/l or 2 h post 75 g glucose at ≥9 mmol/l). All analyses were intention-to-treat. A total of 184 (87 %) women took HN001 and 189 (90 %) women took placebo. There was a trend towards lower relative rates (RR) of GDM (IADPSG definition) in the HN001 group, 0·59 (95 % CI 0·32, 1·08) (P=0·08). HN001 was associated with lower rates of GDM in women aged ≥35 years (RR 0·31; 95 % CI 0·12, 0·81, P=0·009) and women with a history of GDM (RR 0·00; 95 % CI 0·00, 0·66, P=0·004). These rates did not differ significantly from those of women without these characteristics. Using the NZ definition, GDM prevalence was significantly lower in the HN001 group, 2·1 % (95 % CI 0·6, 5·2), v. 6·5 % (95 % CI 3·5, 10·9) in the placebo group (P=0·03). HN001 supplementation from 14 to 16 weeks’ gestation may reduce GDM prevalence, particularly among older women and those with previous GDM.
This study explored the subjective experiences of rehabilitation services undergraduate students in a short-term job shadowing experience. Experiential reflections of 61 undergraduate rehabilitation services students (females = 91 per cent, age range 18–22 for 77.5 per cent of sample) from a midsized state university in the USA with a brief job shadowing assignment were gathered utilising reflection journals and analysed through Interpretative Phenomenological Analysis. Four interrelated themes emerged: encouragement to enter case management professions, field experience based definition of case management, appreciation of time management in case manager role, and application of related course material learned in the classroom. Results from the study suggest a brief job shadowing experience does improve students’ career exploration, understanding of aspects of a typical career for undergraduate rehabilitation graduates, and how to connect course material to the field.
Mutations in the progranulin gene (GRN) are a common cause of familial frontotemporal dementia. We used a comprehensive neuropsychological battery to investigate whether early cognitive changes could be detected in GRN mutation carriers before dementia onset. Twenty-four at-risk members from six families with known GRN mutations underwent detailed neuropsychological testing. Group differences were investigated by domains of attention, language, visuospatial function, verbal memory, non-verbal memory, working memory and executive function. There was a trend for mutation carriers (n=8) to perform more poorly than non-carriers (n=16) across neuropsychological domains, with significant between group differences for visuospatial function (p<.04; d=0.92) and working memory function (p<.02; d=1.10). Measurable cognitive differences exist before the development of frontotemporal dementia in subjects with GRN mutations. The neuropsychological profile of mutation carriers suggests early asymmetric, right hemisphere brain dysfunction that is consistent with recent functional imaging data from our research group and the broader literature. (JINS, 2014, 20, 1–10)
We characterized post-infancy child growth patterns and determined the incidence of becoming stunted and of recovery from stunting.
Data came from Young Lives, a longitudinal study of childhood poverty in four low- and middle-income countries.
We analysed length/height measurements for children at ages 1, 5 and 8 years.
Children (n 7171) in Ethiopia, India, Peru and Vietnam.
Mean height-for-age Z-score (HAZ) at age 1 year ranged from −1·51 (Ethiopia) to −1·08 (Vietnam). From age 1 to 5 years, mean HAZ increased by 0·27 in Ethiopia (P < 0·001) and decreased among the other cohorts (range: −0·19 (Peru) to −0·32 (India); all P < 0·001). From 5 to 8 years, mean HAZ increased in all cohorts (range: 0·19 (India) to 0·38 (Peru); all P < 0·001). Prevalence of stunting (HAZ<−2·0) at 1 year ranged from 21 % (Vietnam) to 46 % (Ethiopia). From age 1 to 5 years, stunting prevalence decreased by 15·1 percentage points in Ethiopia (P < 0·001) and increased in the other cohorts (range: 3·0 percentage points (Vietnam) to 5·3 percentage points (India); all P ≤ 0·001). From 5 to 8 years, stunting prevalence decreased in all cohorts (range: 5·0 percentage points (Vietnam) to 12·7 percentage points (Peru); all P < 0·001). The incidence of becoming stunted between ages 1 to 5 years ranged from 11 % (Vietnam) to 22 % (India); between ages 5 to 8 years, it ranged from 3 % (Peru) to 6 % (India and Ethiopia). The incidence of recovery from stunting between ages 1 and 5 years ranged from 27 % (Vietnam) to 53 % (Ethiopia); between ages 5 and 8 years, it ranged from 30 % (India) to 47 % (Ethiopia).
We found substantial recovery from early stunting among children in four low- and middle-income countries.
The present research examines the effects of body-object interaction (BOI) on eye gaze behaviour in a reading task. BOI measures perceptions of the ease with which a human body can physically interact with a word's referent. A set of high BOI words (e.g. cat) and a set of low BOI words (e.g. sun) were selected, matched on imageability and concreteness (as well as other lexical and semantic variables). Facilitatory BOI effects were observed: gaze durations and total fixation durations were shorter for high BOI words, and participants made fewer regressions to high BOI words. The results provide evidence of a BOI effect on non-manual responses and in a situation that taps normal reading processes. We discuss how the results (a) suggest that stored motor information (as measured by BOI ratings) is relevant to lexical semantics, and (b) are consistent with an embodied view of cognition (Wilson 2002).
We present the results of our survey of the projected rotational velocities of 161 O-type stars in the Magellanic Clouds from archival FUSE observations. The evolved and unevolved samples from each environment are compared through the Kolmogorov-Smirnov test to determine if the distribution of equatorial rotational velocities is metallicity dependent for these massive objects. Stellar interior models predict that massive stars with SMC metallicity will have significantly reduced angular momentum loss on the main sequence compared to their Galactic counterparts. Our statistical results find some support for this prediction but also show that even at Galactic metallicity, evolved and unevolved massive stars have fairly similar fractions of stars with large V sin i. What is more compelling are the few evolved objects in the Magellanic Clouds with rotational velocities that approach or even exceed those predicted from the evolutionary models.
To assess the technical success, clinical outcomes and complications of radiologically guided balloon dilatation of benign strictures developing after treatment for head and neck cancer.
Materials and methods:
Forty-six balloon dilatations were performed in 20 patients. All dilatations were performed over a guidewire.
Technical success was 100 per cent. Fifteen of the 20 patients demonstrated clinical improvement in dysphagia scores. Improvement in dysphagia was temporary in all patients (median 102 days), with multiple dilatations usually required (total dilatations ranged from one to seven). Immediate complications were encountered in six of the 46 (13 per cent) dilatations and were all minor. Late complications occurred after two procedures (4 per cent): localised perforation (later complicated by secondary infection) and recurrence of a previous, small, pharyngo-cutaneous fistula.
Radiologically guided balloon dilatation is straightforward to perform and is well tolerated, but there is a small risk of perforation. Relief of symptoms is likely to be temporary, requiring multiple subsequent dilatations. A minority of patients will obtain no symptomatic relief.
Commission 53 on Extrasolar Planets was created at the 2006 Prague General Assembly of the IAU, in recognition of the outburst of astronomical progress in the field of extrasolar planet discovery, characterization, and theoretical work that has occurred since the discovery of the pulsar planets in 1992 and the discovery of the first planet in orbit around a solar-type star in 1995. Commission 53 is the logical successor to the IAU Working Group on Extrasolar Planets WG-ESP, which ended its six years of existence in August 2006. The founding president of Commission 53 is Michael Mayor, in honor of his seminal contributions to this new field of astronomy. The vice-president is Alan Boss, the former chair of the WG-ESP, and the members of the Commission 53 Organizing Committee are the other former members of the WG-ESP.
SuperLupus is a deep transit survey monitoring a Galactic Plane field in the Southern hemisphere. The project is building on the successful Lupus Survey, and will double the number of images of the field from 1700 to 3400, making it one of the longest duration deep transit surveys. The immediate motivation for this expansion is to search for longer period transiting planets (5-8 days) and smaller radii planets. It will also provide near complete recovery for the shorter period planets (1-3 days). In March, April, and May 2008 we obtained the new images and work is currently in progress reducing these new data.
Compared to bright star searches, surveys for transiting planets against fainter (V = 12–18) stars have the advantage of much higher sky densities of dwarf star primaries, which afford easier detection of small transiting bodies. Furthermore, deep searches are capable of probing a wider range of stellar environments. On the other hand, for a given spatial resolution and transit depth, deep searches are more prone to confusion from blended eclipsing binaries. We present a powerful mitigation strategy for the blending problem that includes the use of image deconvolution and high-resolution imaging. The techniques are illustrated with Lupus-TR-3 and very recent IR imaging with PANIC on Magellan. The results are likely to have implications for the CoRoT and KEPLER missions designed to detect transiting planets of terrestrial size.
Rumen protected fats are often included in dairy cow rations in order to increase the energy density of the ration without compromising rumen function. Various studies have examined the effects of protected fats, with some studies reporting an improvement in various fertility parameters (McNamara et al., 2003). This study examined the effect of feeding protected fat (Megalac™) on production parameters, and on the reproductive performance of high-yielding Holstein-Friesian dairy cattle.