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Clostridioides difficile infection (CDI) causes significant morbidity and mortality; however, the diagnosis of CDI remains controversial. The primary aim of our study was to evaluate the association of polymerase chain reaction (PCR) cycle threshold (Ct) values with CDI disease severity, recurrence, and mortality among adult patients with CDI.
Design:
Retrospective cohort study.
Setting:
Single tertiary-care hospital.
Patients:
Adult patients diagnosed with hospital-onset, healthcare facility–associated CDI from June 2014 to September 2015.
Methods:
We performed a retrospective chart review of included patients. Univariate and multivariable logistic regression methods were used to evaluate the association between Ct values and CDI severity, 8-week recurrence, and 30-day mortality.
Results:
Among 318 included patients, 51% were male and the mean age was 62 years; ~32% of the patients developed severe CDI and 11% developed severe–complicated CDI. The 30-day all-cause mortality rate was 11% and the 8-week recurrence rate was 9.5%. The overall mean Ct value was 32.9 (range, 23–40). Multivariable analyses showed that lower values of PCR Ct were associated with increased odds of 30-day morality (odds ratio [OR] 0.83; 95% confidence interval [CI], 0.72–0.96) but were not independently associated with CDI severity (OR, 0.99; 95% CI, 0.90–1.09) or recurrence (OR, 0.88; 95% CI, 0.77–1.00).
Conclusions:
Our findings suggest that PCR Ct values at the time of diagnosis may have a limited predictive value and utility in clinical decision making for inpatients with CDI. Larger, prospective studies across different patient populations are needed to confirm our findings.
Toddler milk (i.e. a nutrient-fortified milk-based drink marketed for children 12–36 months old) is increasingly being marketed in the USA despite not being recommended for young children. There is evidence of targeted toddler milk marketing to Latinos in the USA. This study aimed to explore toddler milk perceptions and behaviours among Latino and non-Latino parents.
Design:
An online survey assessed toddler milk perceptions, behaviours and interpretations of nutrition-related claims. Multivariable logistic and linear regression explored socio-demographic correlates of parent reported past purchases and perceived healthfulness.
Setting:
Online.
Participants:
National convenience sample of 1078 US parents of children aged 2–12 years (48 % Latino).
Results:
About half of parents (51 %) had previously purchased toddler milk and few (11 %) perceived toddler milk as unhealthy. Latino parents were more likely to have purchased toddler milk than non-Latino parents (P < 0·001), but there were no differences in perceived product healthfulness (P = 0·47). Compared to parents born in the USA, parents living in the USA 10 years or less were more likely to have purchased toddler milk (P < 0·001) and perceive toddler milk as healthier (P = 0·002). Open-ended interpretations of claims were primarily positive, suggesting ‘health halo’ effects.
Conclusions:
Common misperceptions about toddler milk healthfulness suggest stronger labelling regulations are needed. Greater reported purchases by Latino parents and recent immigrants warrant further investigation.
The influence of repetitive transcranial magnetic stimulation (rTMS) on mood in healthy people is uncertain, as former studies show divergent results. Previous studies in healthy volunteers focused exclusively on the immediate effect of a single session of rTMS on mood.
Aims
The aim of this study was to analyse the influence on mood of a series of 9 High Frequency (HF) rTMS stimulations of the left dorsolateral prefrontal cortex (DLPFC).
Methods
44 young healthy male volunteers were randomly assigned to receive 9 sessions of active HF-rTMS (n = 22) or sham rTMS (n = 22) over the left DLPFC. Each session in the active group consisted of 15 trains of 25 Hz starting with 100% of motor threshold. Sham stimulation was performed following the same protocol, but using a sham coil. The variables of interest were the Beck Depression Inventory (BDI) and Visual Analogue Scales (VAS) which quantified “mood”, “enjoyment” and “energy”.
Results
We found a significant reduction of the BDI score in the active group (GLM, p < 0.001) whereas no significant changes of the BDI score were caused by sham stimulation (GLM, p = 0.109). We did not find significant differences caused by active or sham stimulation in VAS scales except for the VAS labelled lively/gloomy immediately after stimulation. The active group was found to be more “gloomy” (p = 0.001).
Conclusions
Our data support the hypothesis that a 9-day long series of HF-rTMS of the left DLPFC improves mood, analysed by BDI in healthy young men.
Positive symptoms are a useful predictor of aggression in schizophrenia. Although a similar pattern of abnormal brain structures related to both positive symptoms and aggression has been reported, this observation has not yet been confirmed in a single sample.
Method
To study the association between positive symptoms and aggression in schizophrenia on a neurobiological level, a prospective meta-analytic approach was employed to analyze harmonized structural neuroimaging data from 10 research centers worldwide. We analyzed brain MRI scans from 902 individuals with a primary diagnosis of schizophrenia and 952 healthy controls.
Results
The result identified a widespread cortical thickness reduction in schizophrenia compared to their controls. Two separate meta-regression analyses revealed that a common pattern of reduced cortical gray matter thickness within the left lateral temporal lobe and right midcingulate cortex was significantly associated with both positive symptoms and aggression.
Conclusion
These findings suggested that positive symptoms such as formal thought disorder and auditory misperception, combined with cognitive impairments reflecting difficulties in deploying an adaptive control toward perceived threats, could escalate the likelihood of aggression in schizophrenia.
Older people have a higher risk of drug-related problems (DRPs). However, little is known about the prevalence of DRPs in community-dwelling people who screened positive for dementia. Our study aimed to determine (1) the prevalence and types of DRPs and (2) the socio-demographic and clinical variables associated with DRPs in people screened positive for dementia in primary care.
Methods:
The Dementia: life- and person-centered help in Mecklenburg-Western Pomerania (DelpHi-MV) study is a general practitioner (GP)-based cluster-randomized controlled intervention study to implement and evaluate an innovative concept of collaborative dementia care management in the primary care setting in Germany. Medication reviews of 446 study participants were conducted by pharmacists based on a comprehensive baseline assessment that included a computer-based home medication assessment. ClinicalTrials.gov Identifier: NCT01401582.
Results:
A total of 1,077 DRPs were documented. In 414 study participants (93%), at least one DRP was detected by a pharmacist. The most frequent DRPs were administration and compliance problems (60%), drug interactions (17%), and problems with inappropriate drug choice (15%). The number of DRPs was significantly associated with the total number of drugs taken and with a formal diagnosis of a mental or behavioral disorder.
Conclusions:
Degree of cognitive impairment (MMSE defined) and formal diagnosis of dementia were not risk factors for an increased number of DRPs. However, the total number of drug taken and the presence of a diagnosis of mental and behavioral disorders were associated with an increased total number of DRPs.
Dormant states of organisms are easier to store than the living state because they tolerate larger variations in temperature, light, storage space etc., making them attractive for laboratory culture stocks and also for experiments under special circumstances, especially space flight experiments. Like several other organisms, Euglena gracilis is capable of forming desiccation tolerant resting states in order to survive periods of unfavourable environmental conditions. In earlier experiments it was found that dormant Euglena cells must not become completely desiccated. Some residual moisture is required to ensure recovery of the resting states. To analyse the water demand in recovery of Euglena resting states, cells were transferred to a defined amount of cotton wool (0.5 g). Subsequently different volumes of medium (1, 2, 3, 4, 5, 8, 10 and 20 ml) were added in order to supply humidity; a control was set up without additional liquid. Samples were sealed in transparent 50 ml falcon tubes and stored for 9 months under three different conditions:
• Constant low light conditions in a culture chamber at 20°C,
• In a black box, illuminated with short light emitting diode-light pulses provided by joule thieves and
• In darkness in a black box.
After 9 months, cells were transferred to fresh medium and cell number, photosynthetic efficiency and movement behavior was monitored over 3 weeks. It was found that cells recovered under all conditions except in the control, where no medium was supplied. Transcription levels of 21 genes were analysed with a Multiplex-polymerase chain reaction. One hour after rehydration five of these genes were found to be up-regulated: ubiquitin, heat shock proteins HSP70, HSP90, the calcium-sensor protein frequenin and a distinct protein kinase, which is involved in gravitaxis. The results indicate a transient general stress response of the cells.
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.
Methods
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).
Results
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.
Conclusions
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.
Stunting is a measure of overall nutritional status and is a major public health concern because of its association with child mortality and morbidity and later adult performance. This study examined the effects of pregnancy events, birth characteristics and infant risk exposure on stunting at age 2 years. The study, established in 1990 in Soweto, an urban South African township, included 1098 mother–infant pairs enroled in the Birth to Twenty Plus longitudinal birth cohort study. In total, 22% of children were stunted at age 2 years, with males at greater risk than females [24.8 v. 19.4%, odds ratio (OR)=1.38; 95% confidence interval (CI): 1.03, 1.83]. In unadjusted analysis, male sex, household socio-economic status (SES), overcrowding, maternal age, maternal education, single motherhood, ethnicity, birth weight, gestational age and duration of infant breastfeeding were all significantly associated with stunting. In multivariable analysis, higher birth weight was protective against stunting for both sexes. Higher maternal education was protective for females only (adjusted odds ratio (AOR)=0.35; 95% CI: 0.14, 0.87), whereas wealthier household SES protected males (AOR for richest SES group=0.39; 95% CI: 0.16, 0.92). In this and other similar settings, current stunting prevention efforts focussing on primarily providing targeted proximal interventions, such as food supplements, risk undermining the critical importance of addressing key distal determinants of stunting such as SES and maternal education.
Inpatients with blood cultures positive for Staphylococcus aureus, Enterococcus faecalis, E. faecium, Streptococcus pneumoniae, S. pyogenes, S. agalactiae, S. anginosus, Streptococcus spp., and Listeria monocytogenes during the 6 months before and after implementation of Verigene Gram-positive blood culture microarray (BC-GP) with an antimicrobial stewardship intervention.
METHODS
Before the intervention, no rapid diagnostic technology was used or antimicrobial stewardship intervention was undertaken, except for the use of peptide nucleic acid fluorescent in situ hybridization and MRSA agar to identify staphylococcal isolates. After the intervention, all Gram-positive blood cultures underwent BC-GP microarray and the antimicrobial stewardship intervention consisting of real-time notification and pharmacist review.
RESULTS
In total, 513 patients with bacteremia were included in this study: 280 patients with S. aureus, 150 patients with enterococci, 82 patients with stretococci, and 1 patient with L. monocytogenes. The number of antimicrobial switches was similar in the pre–BC-GP (52%; 155 of 300) and post–BC-GP (50%; 107 of 213) periods. The time to antimicrobial switch was significantly shorter in the post–BC-GP group than in the pre–BC-GP group: 48±41 hours versus 75±46 hours, respectively (P<.001). The most common antimicrobial switch was de-escalation and time to de-escalation, was significantly shorter in the post-BC-GP group than in the pre–BC-GP group: 53±41 hours versus 82±48 hours, respectively (P<.001). There was no difference in mortality or hospital length of stay as a result of the intervention.
CONCLUSIONS
The combination of a rapid microarray diagnostic test with an antimicrobial stewardship intervention improved time to antimicrobial switch, especially time to de-escalation to optimal therapy, in patients with Gram-positive blood cultures.
Previous studies of the dimensional structure of panic attack symptoms have mostly identified a respiratory and a vestibular/mixed somatic dimension. Evidence for additional dimensions such as a cardiac dimension and the allocation of several of the panic attack symptom criteria is less consistent. Clarifying the dimensional structure of the panic attack symptoms should help to specify the relationship of potential risk factors like anxiety sensitivity and fear of suffocation to the experience of panic attacks and the development of panic disorder.
Method.
In an outpatient multicentre study 350 panic patients with agoraphobia rated the intensity of each of the ten DSM-IV bodily symptoms during a typical panic attack. The factor structure of these data was investigated with nonlinear confirmatory factor analysis (CFA). The identified bodily symptom dimensions were related to panic cognitions, anxiety sensitivity and fear of suffocation by means of nonlinear structural equation modelling (SEM).
Results.
CFA indicated a respiratory, a vestibular/mixed somatic and a cardiac dimension of the bodily symptom criteria. These three factors were differentially associated with specific panic cognitions, different anxiety sensitivity facets and suffocation fear.
Conclusions.
Taking into account the dimensional structure of panic attack symptoms may help to increase the specificity of the associations between the experience of panic attack symptoms and various panic related constructs.
The identification of multipotent adipose-derived stromal cells (ASC) has raised hope that tissue regeneration approaches established with bone-marrow-derived stromal cells (BMSC) can be reproduced with a cell-type that is far more accessible in large quantities. Recent detailed comparisons, however, revealed subtle functional differences between ASC and BMSC, stressing the concept of a common mesenchymal progenitor existing in a perivascular niche across all tissues. Focussing on bone and cartilage repair, this review summarises recent in vitro and in vivo studies aiming towards tissue regeneration with ASC. Advantages of good accessibility, high yield and superior growth properties are counterbalanced by an inferiority of ASC to form ectopic bone and stimulate long-bone healing along with their less pronounced osteogenic and angiogenic gene expression signature. Hence, particular emphasis is placed on establishing whether stem cell activity of ASC is so far proven and relevant for successful osteochondral regeneration, or whether trophic activity may largely determine therapeutic outcome.
We report on the maskless integration of micron-sized GaAs crystals on patterned Si substrates by metal organic vapor phase epitaxy. In order to adapt the mismatch between the lattice parameter and thermal expansion coefficient of GaAs and Si, 2 μm tall Ge crystals were first grown as virtual substrate by low energy plasma enhanced chemical vapor deposition. We investigate the morphological evolution of the GaAs structures grown on top of the Ge crystals at the transition towards full pyramids with energetically stable {111} facets. A substantial release of strain is shown in GaAs crystals with a height of 2 μm and lateral sizes up to 15×15 μm2 by both X-ray diffraction and photoluminescence.
A comparison of the photocurrent spectra of organic bulk heterojunction solar cells of various thicknesses is presented. Increasing the thickness of the active layer in both MDMO-PPV /PCBM and P3HT/PCBM solar cells reduces the magnitude of the photocurrent due to the low mobility of the photogenerated holes. Measurements show that the photocurrent reduction is predominately due to a loss in carriers generated at the polymer absorption maximum, while the low energy response is relatively unaffected. In a thick enough sample, the low energy response (1.5-2 eV) dominates, and a photocurrent peak is no longer observed at the main absorption maximum (2.6 eV). The results imply that hole transport is blocked for carriers generated in the polymer at higher energy. Because these holes are generated at the absorption maximum their low mobility could be a major factor limiting solar cell efficiency.
We describe the geometry and kinematics of a Jurassic to Early Cretaceous transpressive sinistral strike-slip system within a metamorphic basement inlier of the Mesozoic magmatic arc near Bahia Agua Dulce at latitudes 31–32°S in north-central Chile and discuss possible relations with the Atacama Fault System further north. Sinistral transpression overprints structures of an accretionary system that is represented by the metamorphic basement. Sub-vertical semi-ductile NNW-striking strike-slip shear zones are the most conspicuous structures. Chlorite and sericite grew, and white mica and quartz dynamically recrystallized, suggesting low-grade metamorphic conditions during semi-ductile deformation. Folds at the 10–100 metre scale developed before and during strike-slip shearing. The folds are deforming a former sub-horizontal transposition foliation that originated during prior accretion processes. The folds have axes sub-parallel to the strike-slip shear zones and sub-vertical axial surfaces indicating a component of shortening parallel to the shear-zone boundaries, suggesting an overall transpressive deformation regime. Transpressive strike-slip deformation also affects Middle Triassic (Anisian) basal breccias of the El Quereo Formation. 40Ar–39Ar laser ablation ages of synkinematically recrystallized white mica in one of the shear zones provide an age of 174–165 Ma for the waning stages of semi-ductile strike-slip shearing. The semi-ductile shear zones are cut by mafic and rhyolite dykes. Two rhyolite dykes yield 40Ar–39Ar ages of 160.5 ± 1.7 Ma and 131.9 ± 1.7 Ma, respectively. The latter dyke has been affected by brittle faulting. Fault-slip analysis shows that the kinematics of the faulting event is similar to the one of the semi-ductile shearing event, suggesting that sinistral transpression continued after ~130 Ma. Timing, kinematics and geographic position suggest that the shear zones at Bahia Agua Dulce represent a southern continuation of the prominent Atacama Fault System that affected the Jurassic/Early Cretaceous arc over its ~1400 km length.
The inner composition, defect content and morphology of AlGaAs nanowires (NWs) grown on (111)B-GaAs by Au-catalyzed MOVPE is reported. The NWs grow tapered with their [111] axis normal to the substrate. The Raman spectra of single AlGaAs NWs were measured in non-resonant conditions with sub-μ-meter spatial resolution, allowing determination of the Al content. NWs consist of GaAs for TG<475°C, but show a two-fold compositional structure for TG >475°C, namely an AlxGa1-xAs core surrounded by an AlyGa1-yAs (y<x) shell, ascribed to the combination of Au-catalyzed (axial) and conventional (sidewall) growth. The cross-sectional shape of AlGaAs NWs changes from triangular (for TG=500÷525°C) to almost hexagonal (for TG=550°C), due to an exchange between and {110} planes as the slowest to grow. The NWs have free-electron concentrations ∼1018 cm-3, due to Si contamination of the Al source.
Persistent tobacco use and excessive alcohol consumption are major public health concerns worldwide. Both alcohol and nicotine dependence (AD, ND) are genetically influenced complex disorders that exhibit a high degree of comorbidity. To identify gene variants contributing to one or both of these addictions, we first conducted a pooling-based genomewide association study (GWAS) in an Australian population, using Illumina Infinium 1M arrays. Allele frequency differences were compared between pooled DNA from case and control groups for: (1) AD, 1224 cases and 1162 controls; (2) ND, 1273 cases and 1113 controls; and (3) comorbid AD and ND, 599 cases and 488 controls. Secondly, we carried out a GWAS in independent samples from the Netherlands for AD and for ND. Thirdly, we performed a meta-analysis of the 10, 000 most significant AD- and ND-related SNPs from the Australian and Dutch samples. In the Australian GWAS, one SNP achieved genomewide significance (p < 5 x 10-8) for ND (rs964170 in ARHGAPlOon chromosome 4, p = 4.43 x 10”8) and three others for comorbid AD/ND (rs7530302 near MARK1 on chromosome 1 (p = 1.90 x 10-9), rs1784300 near DDX6 on chromosome 11 (p = 2.60 x 10-9) and rs12882384 in KIAA1409 on chromosome 14 (p = 4.86 x 10-8)). None of the SNPs achieved genomewide significance in the Australian/Dutch meta-analysis, but a gene network diagram based on the top-results revealed overrepre-sentation of genes coding for ion-channels and cell adhesion molecules. Further studies will be requirec before the detailed causes of comorbidity between AC and ND are understood.
The mechanics of systems of non-cross-linked fiber networks is studied in this work using a computational model inspired from the bead-spring models of polymeric melts. The fibers have random orientation and distribution in space, interact via stiff repulsive potentials and are characterized by their axial and bending stiffness. Fiber-fiber Coulombian friction is considered. The system is subjected to isostatic compression (strain control) and various statistical measures are evaluated. As the system is compacted, a critical density is reached at which stiffness develops. At this stage there is in average one fiber-fiber contact per fiber and the fiber free segment length has a uniform probability distribution function. Upon further compaction, the number of contacts per fiber increases and the segment length distribution becomes exponential. The respective cross-over densities depend on the fiber length and the friction coefficient. Significant hysteresis is observed upon loading-unloading in the total energy and the number of contacts per fiber. It is also observed that the distribution of contact energies in the range of densities where the system forms a topological network is a power law.
Conducting polymers and hydrogels are two classes of polymers that currently receive an increasing attention in the field of biomaterials, particularly for their application in the assembly of artificial muscles. In this paper we present the development of Polyacrylamide (PAAM) microfibers and polyaniline (PANI) - poly vinyl alcohol (PVA) conductive gel membrane.
The fabricated PAAM microfibers have diameters between 1 and 12μm depending on the preparation parameters. These microfibers respond instantaneously to 100mV electrical stimulation, which solves the problem of time response of the hydrogels. On the other hand, we showed that the inclusion of conducting chains within a crosslinked gel matrix allows combining the conductivity of the PANI with the mechanical flexibility of PVA in order to provide flexible gel membranes that can adhere to the PAAM microfibers to ensure their electrical stimulation.
Synthetic hydrogels have poor mechanical properties that limit their use in load bearing applications. In contrast, biological hydrogels are tough and strong due to reinforcement with nano to micron size fibers. Our work is focused on designing new class of hydrogel assemblies based on fiber reinforced hydrogel composites. In analogy to the spinning of a spider web, a pultrusion system was developed to spin micron-diameter polymer fibers from solution in order to build predefined three dimensional patterned fiber-reinforced hydrogel structures. The gel chemistry is based on epoxy-amine crosslinking. We have formulated various epoxy-amine gels with swellability ranges from 0% to 1000% in water. The fibrous reinforcement affects the swelling and mechanical properties of the gel. For mechanical characterization flat punch probe indentation technique was performed. The effect of fiber density and extent of swelling on the reinforcement of epoxy matrix is investigated. Based on a better understanding of fiber reinforcement of gels, we hope to be able to design strong gels for biomedical devices and soft machines.