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To validate a system to detect ventilator associated events (VAEs) autonomously and in real time.
Retrospective review of ventilated patients using a secure informatics platform to identify VAEs (ie, automated surveillance) compared to surveillance by infection control (IC) staff (ie, manual surveillance), including development and validation cohorts.
The Massachusetts General Hospital, a tertiary-care academic health center, during January–March 2015 (development cohort) and January–March 2016 (validation cohort).
Ventilated patients in 4 intensive care units.
The automated process included (1) analysis of physiologic data to detect increases in positive end-expiratory pressure (PEEP) and fraction of inspired oxygen (FiO2); (2) querying the electronic health record (EHR) for leukopenia or leukocytosis and antibiotic initiation data; and (3) retrieval and interpretation of microbiology reports. The cohorts were evaluated as follows: (1) manual surveillance by IC staff with independent chart review; (2) automated surveillance detection of ventilator-associated condition (VAC), infection-related ventilator-associated complication (IVAC), and possible VAP (PVAP); (3) senior IC staff adjudicated manual surveillance–automated surveillance discordance. Outcomes included sensitivity, specificity, positive predictive value (PPV), and manual surveillance detection errors. Errors detected during the development cohort resulted in algorithm updates applied to the validation cohort.
In the development cohort, there were 1,325 admissions, 479 ventilated patients, 2,539 ventilator days, and 47 VAEs. In the validation cohort, there were 1,234 admissions, 431 ventilated patients, 2,604 ventilator days, and 56 VAEs. With manual surveillance, in the development cohort, sensitivity was 40%, specificity was 98%, and PPV was 70%. In the validation cohort, sensitivity was 71%, specificity was 98%, and PPV was 87%. With automated surveillance, in the development cohort, sensitivity was 100%, specificity was 100%, and PPV was 100%. In the validation cohort, sensitivity was 85%, specificity was 99%, and PPV was 100%. Manual surveillance detection errors included missed detections, misclassifications, and false detections.
Manual surveillance is vulnerable to human error. Automated surveillance is more accurate and more efficient for VAE surveillance.
To assess trends in nutrient intakes and nutritional status of rural adult women (≥18–60 years) and the association of sociodemographic characteristics with overweight/obesity.
Community-based cross-sectional studies carried out during 1975–79 to 2011–12 by the National Nutrition Monitoring Bureau (NNMB) were used. Anthropometric measurements such as height, weight and waist circumference, carried out during the surveys, were used. Association and logistic regression analyses between sociodemographic characteristics and overweight/obesity and abdominal obesity were conducted using a complex samples procedure.
Ten NNMB states of India.
Non-pregnant and non-lactating rural women aged ≥18–60 years covered during the above periods from ten states in India.
The prevalence of chronic energy deficiency has declined from 52 % during 1975–79 to 34 % during 2011–12, while that of overweight/obesity has increased from 7 % to 24 % during the same period. Median intakes of most of the nutrients have increased over the same period, although they were below recommended levels. The chance of overweight/obesity and abdominal obesity was significantly (P<0·01) higher among women aged 40–60 years, those belonging to Christian religion and other backward communities, women living in pucca houses, literate women, women engaged in service and business, and those having higher per capita income.
Prevalence of chronic energy deficiency has declined significantly; however, overweight/obesity has increased during the same period. This increase in overweight/obesity may be attributed to increased consumption of fatty foods, sedentary lifestyle and improved socio-economic status. There is a need to educate the community about regular physical exercise, low intakes of fats and oils, and a balanced diet.
Non-alcoholic fatty liver disease (NAFLD) is an independent predictor of CVD in otherwise healthy individuals. Low n-3 PUFA intake has been associated with the presence of NAFLD; however, the relationship between a biomarker of n-3 status – the Omega-3 Index – and liver fat is yet to be elucidated. A total of eighty overweight adults (fifty-six men) completed the anthropometric and biochemical measurements, including the Omega-3 Index, and underwent proton magnetic resonance spectroscopy assessment of liver fat. Bivariate correlations and multiple regression analyses were performed with reference to prediction of liver fat percentage. The mean Omega-3 Index was high in both NAFLD (intrahepatic lipid concentration≥5·5 %) and non-NAFLD groups. The Omega-3 Index, BMI, waist circumference, glucose, insulin, TAG, high-sensitive C-reactive protein (hsCRP) and alanine aminotransferase (ALT) were positively correlated, and HDL and erythrocyte n-6:n-3 ratio negatively correlated with liver fat concentration. Regression analysis found that simple anthropometric and demographic variables (waist, age) accounted for 31 % of the variance in liver fat and the addition of traditional cardiometabolic blood markers (TAG, HDL, hsCRP and ALT) increased the predictive power to 43 %. The addition of the novel erythrocyte fatty acid variable (Omega-3 Index) to the model only accounted for a further 3 % of the variance (P=0·049). In conclusion, the Omega-3 Index was associated with liver fat concentration but did not improve the overall capacity of demographic, anthropometric and blood markers to predict NAFLD.
Biofortification (delivery of micronutrients via micronutrient-dense crops) can be achieved through plant breeding and offers a cost-effective and sustainable approach to fighting micronutrient malnutrition. The present study was conducted to facilitate the initiation of a breeding programme to improve the concentration of iron (Fe) and zinc (Zn) in peanut (Arachis hypogaea L.) seeds. The experiment was conducted with 64 diverse peanut genotypes for 2 years in eight different environments at the International Crops Research Institute for the Semi-Arid Tropics, Patancheru, India to assess the genetic variation for Fe and Zn concentrations in peanut seeds and their heritability and correlations with other traits. Significant differences were observed among the genotypes and environments for Fe (33–68 mg/kg), Zn (44–95 mg/kg), protein (150–310 mg/g) and oil (410–610 mg/g) concentration in seeds and their heritability was high, thus indicating the possibility of improving them through breeding. As seen in other plants, a significant positive association between concentrations of Fe and Zn was observed. Trade-offs between pod yield and Fe and Zn concentrations were not observed and the same was also true for oil content. Besides being high yielding, genotypes ICGV 06099 (57 mg/kg Fe and 81 mg/kg Zn) and ICGV 06040 (56 mg/kg Fe and 80 mg/kg Zn) had stable performance for Fe and Zn concentrations across environments. These are the ideal choices for use as parents in a breeding programme and in developing mapping populations.
Zinc potassium phosphate hexahydrate (ZnKPO4.6H2O) (abbreviated as ZPPH) single crystal is grown by reacting Potassium dihydrogen phosphate with Zinc Sulphate in equimolar ratio by slow evaporation. This compound crystallizes in the acentric orthorhombic symmetry class (space group Pmn21) and possesses photo induced optical second harmonic generation. The laser induced surface damage threshold for the grown crystal was measured as 1.7 × 1012 mJ/cm2 with Nd:YAG laser assembly which is of the same order as that of the reference KDP used in our experiment. The temperature dependent second harmonic generation studies were also carried out from room temperature to liquid helium temperature and the anomalies at low temperature qualifies this material as efficient low temperature optical switchers.
Bovine herpes virus 1 (BHV-1) is primarily associated with clinical syndromes such as rhinotracheitis, pustular vulvovaginitis and balanoposthitis, abortion, infertility, conjunctivitis and encephalitis in bovine species. The main sources of infection are the nasal exudates and the respiratory droplets, genital secretions, semen, fetal fluids and tissues. The BHV-1 virus can become latent following a primary infection with a field isolate or vaccination with an attenuated strain. The viral genomic DNA has been demonstrated in the sensory ganglia of the trigeminal nerve in infectious bovine rhinotracheitis (IBR) and in sacral spinal ganglia in pustular vulvovaginitis and balanoposthitis cases. BHV-1 infections can be diagnosed by detection of virus or virus components and antibody by serological tests or by detection of genomic DNA by polymerase chain reaction (PCR), nucleic acid hybridization and sequencing. Inactivated vaccines and modified live virus vaccines are used for prevention of BHV-1 infections in cattle; subunit vaccines and marker vaccines are under investigation.
Wild relatives of pigeonpea (Cajanus cajan L.) possess many useful genes that can be utilized for crop improvement, most importantly genes for resistance to Helicoverpa armigera, the legume pod borer. The present study aimed at quantifying diversity in a collection of Cajanus scarabaeoides, Cajanus sericeus,Cajanus reticulatus and C. cajan species selected from a wide geographic range using two PCR-based marker systems, amplified fragment length polymorphism (AFLP) and simple sequence repeats (SSRs), and the hybridization-based restriction fragment length polymorphism (RFLP). Polymorphism was higher among the wild accessions than among the cultivated genotypes. Wild and cultivated Cajanus accessions belonging to different species clustered into four distinct major groups largely based on the interspecific differences. C. scarabaeoides accessions derived from same geographical origins formed one group reflecting similar genetic makeup of these accessions. Dendrograms generated using AFLP, RFLP and SSR marker data were comparable with minor clustering differences, which suggests that either method, or a combination of both can be applied to expanded genetic studies in Cajanus. Mantel testing confirmed the congruence between the genetic distances of three markers, indicating that the markers segregated independently, giving similar grouping patterns of all accessions having similar genetic origin.
Immunohistochemical analysis of skin and draining lymph nodes of sheep repeatedly infested with the ixodid tick Hyalomma anatolicum anatolicum were studied for different antigen-presenting cells and lymphocyte subpopulations. Infiltration of neutrophils, macrophages and lymphocytes adjacent to the tick bite site were observed. Skin biopsies showed significant increases in dermal infiltration of CD8+ and γδ+ T cells at 72 h and 8 days after both primary and secondary infestation. Infiltrations of MHC-II DR/DQ decreased at 72 h after tick infestation, whereas significant increases were recorded for 8-day skin biopsies. CD1+ cellular infiltrations were observed during secondary infestations at the dermis. Decreased ratios of CD4[ratio ]CD8 T cells and MHC-II[ratio ]CD1 antigen-presenting cells were observed in both infestations compared to healthy skin biopsies. Ratios of αβ[ratio ]γδ T cells increased gradually during infestation compared to uninfested skin. The regional lymph nodes from tick-infested sheep showed an increased CD8+, γδ+ T and CD1+ cellular infiltration compared to control lymph nodes. CD4+ T cells were decreased. There were no significant changes in CD45R+ cellular infiltration either at skin lesions or regional lymph nodes.
We present a case of malignant schwannoma (MS) of the parapharyngeal space which completely encircled the internal carotid artery in close proximity to the skull base and required resection of the internal carotid artery along with the excision of the tumour. There have been three previous case reports in the literature of malignant schwannoma of the parapharyngeal space of which one case was associated with neuroflbromatosis. Our patient did not exhibit any feature of neurofibromatosis.
A case illustrating the association between neonaticide and denial of pregnancy is reported. Neonaticide may be a relatively common form of homicide. In some cases it could be preventable, providing the physician responsible for antenatal care is alert.
Water content as well as conductivity have been measured as a function of water vapour pressure on polyaniline and poly-N-methylaniline samples. It is shown that i) absorption is governed by the acid protons of the polymers and ii) enhancement of conductivity needs the existence of protonated imines. It is concluded that moisture favours conductivity through an increase of the interchain transfers.
The authors were sent to Mwinilunga from Ndola to investigate what was reported to the local press as ‘mysterious madness'. The condition was actually an outbreak of epidemic hysteria which was triggerred off by a group of girls who were having educational and emotional problems prior to the epidemic.
A change in the administrative policy of rigidly segregating the sexes apparently prepared an emotionally charged background for the rapid spread of the illness. The salient features and management of the epidemic are discussed.
To compare the genetic group differences in live-weight gains, efficiency of food conversion (in terms of dry matter, total digestible nutrients, digestible crude protein, digestible energy and metabolizable energy) and physiological responses related to heat balance, a total of 24 male lambs (91 to 180 days old), four each of Malpura, Sonadi, and their crosses with Dorset and Suffolk breeds, were given a ration having a roughage to concentrate ratio of 250:750g/kg and metabolizable energy content of 100MJ/kg dry matter. Live-weight gain per day was higher and the food conversion ratio (the intakes of total digestible nutrients, digestible energy and metabolizable energy per kg gain) was lower in the crossbreds than in the native sheep. The crossbreds had higher respiratory rates (153 per min) than the natives (140 per min) but there was no significant difference in rectal temperature between purebreds and crossbreds. The crossbred lambs in the present experiment grew faster, consumed more food and utilized the food more efficiently than did the native lambs, despite the fact that they dissipated more energy as body heat. It was, therefore, concluded that the crossbreds performed better than the native breeds between 3 and 6 months of age, even though they were not permanently acclimatized to hot environmental conditions.
Relative adaptability of Chokla and Rambouillet × Chokla half-breds was compared by observing their responses on exposure to summer stress for 6 days and also under accentuated stress by deprivation of drinking water till the animals lost 30% of their body weight. Responses of both the breed groups were similar on 6 days exposure. Accentuated summer stress resulted in decreased feed intake followed by 15, 26 and 31% loss in body weight on 1st, 2nd and 3rd day of exposure, respectively. Progressive decline in faecal moisture, increase in rectal temperature and decrease in morning respiration rate were also noted in both the breeds while an increase in pulse rate was recorded only in the cross-breds. Increase in respiratory or pulse rate for unit rise in rectal temperature was found to be higher in the cross-breds. On accentuated thermal stress, haematocrit values were higher in the cross-breds and blood potassium concentration was higher in the Chokla while blood glucose decreased in both the groups. Under the conditions of short-term exposure to summer stress the cross-breds maintained homoeothermy as well as the Chokla.
Thirty-two milk-fed Murrah buffalo calves of 3 weeks of age were randomly allotted to four dietary groups: milk, concentrate-berseem hay in the ratios 1:1 and 1:3, or berseem hay alone. Milk intake was gradually reduced and completely stopped after the sixth week of age in the groups given dry feeds. Two calves from each group were slaughtered at 6, 9, 12 and 15 weeks of age. In addition, four buffalo calves were slaughtered at 21 days of age for comparison.
Observations on ruminal tissue weight, content weight and the ruminal capacity indicate that the ruminant stomach of buffalo calves weaned on dry food after the sixth week of age becomes structurally developed by 9 weeks of age, whereas the rumen remains underdeveloped in calves fed milk to 15 weeks of age.
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