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Catheter-associated urinary tract infections in 592 hospitals immediately declined after federal value-based incentive program implementation, but this was fully attributable to a concurrent surveillance case definition revision. Post revision, more hospitals had favorable standardized infection ratios, likely leading to artificial inflation of their performance scores unrelated to changes in patient safety.
There have been significant changes in the diagnostic criteria for diffuse gliomas in the 2016 WHO CNS tumor classification, with the incorporation of molecular criteria into a number of definitions. This has placed a greater emphasis on the availability of key immunohistochemical and molecular tests. In order to determine the effect that these changes have had on neuropathology practice and the access of different centres to these tests, we designed a survey that was sent to all members of the Canadian Association of Neuropathology member list in the fall of 2017. This survey asked a number of questions relating to the approach to glioma diagnosis, immunohistochemical/molecular test ordering patterns, in-house test availability, and need to send out for testing. In this presentation we will present preliminary results from this survey, with a focus on institutional testing capabilities. This provides a valuable resource that could ultimately need to a national database of immunohistochemical and molecular test availability for each neuropathology centre.
This presentation will enable the learner to:
1.Review the key molecular markers in the diagnosis of adult gliomas and methods of testing for them
2.Discuss the effect that the 2016 WHO CNS tumor update has had on clinical practice in Canada
Maternal systemic inflammation during pregnancy may restrict embryo−fetal growth, but the extent of this effect remains poorly established in undernourished populations. In a cohort of 653 maternal−newborn dyads participating in a multi-armed, micronutrient supplementation trial in southern Nepal, we investigated associations between maternal inflammation, assessed by serum α1-acid glycoprotein and C-reactive protein, in the first and third trimesters of pregnancy, and newborn weight, length and head and chest circumferences. Median (IQR) maternal concentrations in α1-acid glycoprotein and C-reactive protein in the first and third trimesters were 0.65 (0.53–0.76) and 0.40 (0.33–0.50) g/l, and 0.56 (0.25–1.54) and 1.07 (0.43–2.32) mg/l, respectively. α1-acid glycoprotein was inversely associated with birth size: weight, length, head circumference and chest circumference were lower by 116 g (P = 2.3 × 10−6), and 0.45 (P = 3.1 × 10−5), 0.18 (P = 0.0191) and 0.48 (P = 1.7 × 10−7) cm, respectively, per 50% increase in α1-acid glycoprotein averaged across both trimesters. Adjustment for maternal age, parity, gestational age, nutritional and socio-economic status and daily micronutrient supplementation failed to alter any association. Serum C-reactive protein concentration was largely unassociated with newborn size. In rural Nepal, birth size was inversely associated with low-grade, chronic inflammation during pregnancy as indicated by serum α1-acid glycoprotein.
Better understanding of interplay among symptoms, cognition and functioning in first-episode psychosis (FEP) is crucial to promoting functional recovery. Network analysis is a promising data-driven approach to elucidating complex interactions among psychopathological variables in psychosis, but has not been applied in FEP.
This study employed network analysis to examine inter-relationships among a wide array of variables encompassing psychopathology, premorbid and onset characteristics, cognition, subjective quality-of-life and psychosocial functioning in 323 adult FEP patients in Hong Kong. Graphical Least Absolute Shrinkage and Selection Operator (LASSO) combined with extended Bayesian information criterion (BIC) model selection was used for network construction. Importance of individual nodes in a generated network was quantified by centrality analyses.
Our results showed that amotivation played the most central role and had the strongest associations with other variables in the network, as indexed by node strength. Amotivation and diminished expression displayed differential relationships with other nodes, supporting the validity of two-factor negative symptom structure. Psychosocial functioning was most strongly connected with amotivation and was weakly linked to several other variables. Within cognitive domain, digit span demonstrated the highest centrality and was connected with most of the other cognitive variables. Exploratory analysis revealed no significant gender differences in network structure and global strength.
Our results suggest the pivotal role of amotivation in psychopathology network of FEP and indicate its critical association with psychosocial functioning. Further research is required to verify the clinical significance of diminished motivation on functional outcome in the early course of psychotic illness.
Several life-threatening diseases of the kidney have their origins in mutational events that occur during embryonic development. In this study, we investigate the role of the Wolffian duct (WD), the earliest embryonic epithelial progenitor of renal tubules, in the etiology of autosomal dominant polycystic kidney disease (ADPKD). ADPKD is associated with a germline mutation of one of the two Pkd1 alleles. For the disease to occur, a second event that disrupts the expression of the other inherited Pkd1 allele must occur. We postulated that this secondary event can occur in the pronephric WD. Using Cre-Lox recombination, mice with WD-specific deletion of one or both Pkd1 alleles were generated. Homozygous Pkd1-targeted deletion in WD-derived tissues resulted in mice with large cystic kidneys and serologic evidence of renal failure. In contrast, heterozygous deletion of Pkd1 in the WD led to kidneys that were phenotypically indistinguishable from control in the early postnatal period. High-throughput sequencing, however, revealed underlying gene and microRNA (miRNA) changes in these heterozygous mutant kidneys that suggest a strong predisposition toward developing ADPKD. Bioinformatic analysis of this data demonstrated an upregulation of several miRNAs that have been previously associated with PKD; pathway analysis further demonstrated that the differentially expressed genes in the heterozygous mutant kidneys were overrepresented in signaling pathways associated with maintenance and function of the renal tubular epithelium. These results suggest that the WD may be an early epithelial target for the genetic or molecular signals that can lead to cyst formation in ADPKD.
In this study, the pull-in phenomenon of a Nano-actuator is investigated employing a nonlocal Bernoulli-Euler beam model with clamped-clamped conditions. The model accounts for viscous damping, residual stresses, the van der Waals (vdW) force and electrostatic forces with nonlocal effects. The hybrid differential transformation/finite difference method (HDTFDM) is used to analyze the nonlocal effects on a graphene sheet nanobeam, which is electrostatically actuated under the influence of the coupling effect, the von Kármán nonlinear strains and the fringing field effect. The pull-in voltage as calculated by the presented model deviates by no more than 0.29% from previous literature, verifying the validity of the HDTFDM. Furthermore, the nonlocal nonlinear behavior of the electrostatically actuated nanobeam is investigated, and the effects of viscous damping, residual stresses, and length-gap ratio are examined in detail. Overall, the results reveal that small scale effects significantly influence the characteristics of the graphene sheet nanobeam actuator.
Oxidative stress is implicated in the aetiology of schizophrenia, and the antioxidant defence system (AODS) may be protective in this illness. We examined the major antioxidant glutathione (GSH) in prefrontal brain and its correlates with clinical and demographic variables in schizophrenia.
GSH levels were measured in the dorsolateral prefrontal region of 28 patients with chronic schizophrenia using a magnetic resonance spectroscopy sequence specifically adapted for GSH. We examined correlations of GSH levels with age, age at onset of illness, duration of illness, and clinical symptoms.
We found a negative correlation between GSH levels and age at onset (r = −0.46, p = 0.015), and a trend-level positive relationship between GSH and duration of illness (r = 0.34, p = 0.076).
Our findings are consistent with a possible compensatory upregulation of the AODS with longer duration of illness and suggest that the AODS may play a role in schizophrenia.
The COllaborative project of Development of Anthropometrical measures in Twins (CODATwins) project is a large international collaborative effort to analyze individual-level phenotype data from twins in multiple cohorts from different environments. The main objective is to study factors that modify genetic and environmental variation of height, body mass index (BMI, kg/m2) and size at birth, and additionally to address other research questions such as long-term consequences of birth size. The project started in 2013 and is open to all twin projects in the world having height and weight measures on twins with information on zygosity. Thus far, 54 twin projects from 24 countries have provided individual-level data. The CODATwins database includes 489,981 twin individuals (228,635 complete twin pairs). Since many twin cohorts have collected longitudinal data, there is a total of 1,049,785 height and weight observations. For many cohorts, we also have information on birth weight and length, own smoking behavior and own or parental education. We found that the heritability estimates of height and BMI systematically changed from infancy to old age. Remarkably, only minor differences in the heritability estimates were found across cultural–geographic regions, measurement time and birth cohort for height and BMI. In addition to genetic epidemiological studies, we looked at associations of height and BMI with education, birth weight and smoking status. Within-family analyses examined differences within same-sex and opposite-sex dizygotic twins in birth size and later development. The CODATwins project demonstrates the feasibility and value of international collaboration to address gene-by-exposure interactions that require large sample sizes and address the effects of different exposures across time, geographical regions and socioeconomic status.
Antimicrobial stewardship programs typically use days of therapy to assess antimicrobial use. However, this metric does not account for the antimicrobial spectrum of activity. We applied an antibiotic spectrum index to a population of very-low-birth-weight infants to assess its utility to evaluate the impact of antimicrobial stewardship interventions.
Crystallization from solutions is a complex process completed in several stages. The first stage is the formation of supersaturated solution because the spontaneous appearance of a new phase can occur only when a system is in a nonequilibrium condition. In the next stage, molecules dissolved in solution begin to aggregate to relieve the supersaturation and move the system toward equilibrium. The molecular aggregation process eventually leads to the formation of nuclei that can act as centers of crystallization. A nucleus can be defined as the minimum amount of a new phase capable of independent existence (Khamskii 1969). The nature of nuclei (i.e., whether they are amorphous particles or tiny crystals) is still unknown. The birth of these small nuclei in an initially metastable phase is called nucleation, which is a major mechanism of first-order phase transition. Kashchiev and van Rosmalen (2003) describe nucleation as the process of fluctuational appearance of nanoscopically small clusters of the new crystalline phase, which can grow spontaneously to macroscopic sizes. The growth stage, which immediately follows nucleation, is governed by the diffusion of particles, called growth units, to the surface of the existing nuclei and their incorporation into the structure of the crystal lattice (Khamskii 1969). This stage continues until all the solute in excess of saturation is consumed for the development of mature crystals. The initial stages of crystallization, which can be defined as the period between the achievement of supersaturation and the formation of nuclei, plays a decisive role in determining properties of the resulting solid phase, such as purity, crystal structure, and particle size. Thus higher levels of control over crystallization cannot be achieved without understanding the fundamentals of nucleation.
Crystallization can be regarded as a self-assembly process in which randomly organized molecules in a fluid come together to form an ordered three-dimensional molecular array with a periodic repeating pattern. It is vital to many processes occurring in nature and manufacturing. Geologic crystallization is responsible from huge deposits of carbonates, sulfates, and phosphates that often grow in mountains and quarries. This process occurs over long periods of time, often at high temperatures and pressures, and results in large and usually highly ordered crystals such as diamond.