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The control of human visceral leishmaniasis (VL) is hard since there are no vaccines available as well as the treatment is hampered by toxicity and resistant parasites. Furthermore, as human, and canine VL causes immunosuppression, the combination of drugs with immunostimulatory agents is interesting to upregulate the immunity, reducing side-effects, improving treatment approaches against disease. Herein, we assessed the immunochemotherapy using miltefosine along with a vaccine formulated by Leishmania braziliensis antigens + saponin + monophosphoryl lipid-A (LBSapMPL) in L. infantum-infected hamsters. Two months after infection, the animals received treatments, and after 15 days they were evaluated for the treatment effect. The potential anti-Leishmania effect of miltefosine + LBSapMPL-vaccine was revealed by a specific immune response activation reflecting in control of spleen parasitism using half the miltefosine treatment time. The treated animals also showed an increase of total and T-CD4 splenocytes producing IFN-γ and TNF-α and a decrease of interleukin-10 and anti-Leishmania circulating IgG. In addition, it was demonstrated that the control of spleen parasitism is related to the generation of a protective Th1 immune response. Hence, due to the combinatorial action of miltefosine with LBSapMPL-vaccine in immunostimulating and controlling parasitism, this immunochemotherapy protocol can be an important alternative option against canine and human VL.
Substantial progress has been made in the standardization of nomenclature for paediatric and congenital cardiac care. In 1936, Maude Abbott published her Atlas of Congenital Cardiac Disease, which was the first formal attempt to classify congenital heart disease. The International Paediatric and Congenital Cardiac Code (IPCCC) is now utilized worldwide and has most recently become the paediatric and congenital cardiac component of the Eleventh Revision of the International Classification of Diseases (ICD-11). The most recent publication of the IPCCC was in 2017. This manuscript provides an updated 2021 version of the IPCCC.
The International Society for Nomenclature of Paediatric and Congenital Heart Disease (ISNPCHD), in collaboration with the World Health Organization (WHO), developed the paediatric and congenital cardiac nomenclature that is now within the eleventh version of the International Classification of Diseases (ICD-11). This unification of IPCCC and ICD-11 is the IPCCC ICD-11 Nomenclature and is the first time that the clinical nomenclature for paediatric and congenital cardiac care and the administrative nomenclature for paediatric and congenital cardiac care are harmonized. The resultant congenital cardiac component of ICD-11 was increased from 29 congenital cardiac codes in ICD-9 and 73 congenital cardiac codes in ICD-10 to 318 codes submitted by ISNPCHD through 2018 for incorporation into ICD-11. After these 318 terms were incorporated into ICD-11 in 2018, the WHO ICD-11 team added an additional 49 terms, some of which are acceptable legacy terms from ICD-10, while others provide greater granularity than the ISNPCHD thought was originally acceptable. Thus, the total number of paediatric and congenital cardiac terms in ICD-11 is 367. In this manuscript, we describe and review the terminology, hierarchy, and definitions of the IPCCC ICD-11 Nomenclature. This article, therefore, presents a global system of nomenclature for paediatric and congenital cardiac care that unifies clinical and administrative nomenclature.
The members of ISNPCHD realize that the nomenclature published in this manuscript will continue to evolve. The version of the IPCCC that was published in 2017 has evolved and changed, and it is now replaced by this 2021 version. In the future, ISNPCHD will again publish updated versions of IPCCC, as IPCCC continues to evolve.
Indigenous literature suggests Māori businesses are distinct within Aotearoa New Zealand, due to facing unique challenges and having different operating preferences. It could also be argued that Māori and non-Māori enterprises in the private, public and not-for-profit sectors are identical as a function of operating in similar markets. However, there is a paucity of empirical evidence, and the present article rectifies this with a study of 230 Aotearoa enterprises, including 24 Māori. We test differences and find Māori enterprises report higher cultural capital, which relates to employees' knowledge and skills towards working with and respecting cultural values. However, we find no differences across human capital, relational capital, entrepreneurial culture, and organisational performance. The findings suggest that apart from a culturally specific factor, Māori and non-Māori enterprises appear to be similarly enabled, which provides a useful benchmark for understanding Māori business. We discuss the implications for research.
Candida auris infections continue to occur across the United States and abroad, and healthcare facilities that care for vulnerable populations must improve their readiness to respond to this emerging organism. We aimed to identify and better understand challenges faced and lessons learned by those healthcare facilities who have experienced C. auris cases and outbreaks to better prepare those who have yet to experience or respond to this pathogen.
Semi-structured qualitative interviews.
Health departments, long-term care facilities, acute-care hospitals, and healthcare organizations in New York, Illinois, and California.
Infectious disease physicians and nurses, clinical and environmental services, hospital leadership, hospital epidemiology, infection preventionists, emergency management, and laboratory scientists who had experiences either preparing for or responding to C. auris cases or outbreaks.
In total, 25 interviews were conducted with 84 participants. Interviews were coded using NVivo qualitative coding software by 2 separate researchers. Emergent themes were then iteratively discussed among the research team.
Key themes included surveillance and laboratory capacity, inter- and intrafacility communication, infection prevention and control, environmental cleaning and disinfection, clinical management of cases, and media concerns and stigma.
Many of the operational challenges noted in this research are not unique to C. auris, and the ways in which we address future outbreaks should be informed by previous experiences and lessons learned, including the recent outbreaks of C. auris in the United States.
The keynote article by Mayberry and Kluender (2017) clearly shows that there are important effects of delayed exposure to a first language (L1), in linguistic comprehension, production, processing, and even in the brain areas that are active for language. This set of findings is of great importance for both theoretical and practical reasons. As Mayberry and Kluender show, one implication of such findings bears on the theory that a critical period for language (CPL) leads to changes in the ways that language develops when accessible exposure is delayed.
Stellar occultations are a unique technique to access physical characteristics of distant solar system objects from the ground. They allow the measure of the size and the shape at kilometric level, the detection of tenuous atmospheres (few nanobars), and the investigation of close vicinity (satellites, rings) of Transneptunian objects and Centaurs. This technique is made successful thanks to accurate predictions of occultations. Accuracy of the predictions depends on the uncertainty in the position of the occulted star and the object's orbit. The Gaia stellar catalogue (Gaia Collaboration (2017)) now allows to get accurate astrometric stellar positions (to the mas level). The main uncertainty remains on the orbit. In this context, we now take advantage of the NIMA method (Desmars et al.(2015)) for the orbit determination and of the Gaia DR1 catalogue for the astrometry. In this document, we show how the orbit determination is improved by reducing current and some past observations with Gaia DR1. Moreover, we also use more than 45 past positive occultations observed in the 2009-2017 period to derive very accurate astrometric positions only depending on the position of the occulted stars (about few mas with Gaia DR1). We use the case of (10199) Chariklo as an illustration. The main limitation lies in the imprecision of the proper motions which is going to be solved by the Gaia DR2 release.
Organisational culture of institutions providing care for older people is increasingly recognised as influential in the quality of care provided. There is little research, however, that specifically examines the processes of care home culture and how these may be associated with quality of care. In this paper we draw from an empirical study carried out in the United Kingdom (UK) investigating the relationship between care home culture and residents' experience of care. Eleven UK care homes were included in an in-depth comparative case study design using extensive observation and interviews. Our analysis indicates how organisational cultures of care homes impact on the quality of care residents receive. Seven inter-related cultural elements were of key importance to quality of care. Applying Schein's conceptualisation of organisational culture, we examine the dynamic relationship between these elements to show how organisational culture is locally produced and shifting. A particular organisational culture in a care home cannot be achieved simply by importing a set of organisational values or the ‘right’ leader or staff. Rather, it is necessary to find ways of resolving the everyday demands of practice in ways that are consistent with espoused values. It is through this everyday practice that assumptions continuously evolve, either consistent with or divergent from, espoused values. Implications for policy makers, providers and practitioners are discussed.
To examine the use of vitamin D supplements during infancy among the participants in an international infant feeding trial.
Information about vitamin D supplementation was collected through a validated FFQ at the age of 2 weeks and monthly between the ages of 1 month and 6 months.
Infants (n 2159) with a biological family member affected by type 1 diabetes and with increased human leucocyte antigen-conferred susceptibility to type 1 diabetes from twelve European countries, the USA, Canada and Australia.
Daily use of vitamin D supplements was common during the first 6 months of life in Northern and Central Europe (>80 % of the infants), with somewhat lower rates observed in Southern Europe (>60 %). In Canada, vitamin D supplementation was more common among exclusively breast-fed than other infants (e.g. 71 % v. 44 % at 6 months of age). Less than 2 % of infants in the USA and Australia received any vitamin D supplementation. Higher gestational age, older maternal age and longer maternal education were study-wide associated with greater use of vitamin D supplements.
Most of the infants received vitamin D supplements during the first 6 months of life in the European countries, whereas in Canada only half and in the USA and Australia very few were given supplementation.
Archaeology, consistently warned off religion by wise old heads, here rushes deeper into the thicket to tackle the thorny topic of ancient witchcraft. The occasion was a seminar at Harvard organised by Stephen Mitchell and Neil Price to mark the twentieth anniversary of Carlo Ginzburg's influential book on the connections between witches and shamanism – and by implication the possible connections with prehistoric ritual and belief. Archaeology was by no means the only voice at the meeting, which was attended by scholars active in history, literature, divinity and anthropology. The discussions revealed much that was entangled in the modern psyche: ‘don't let's tame strangeness’ was one leitmotiv of this stimulating colloquium. A romantic attachment to the irrational is a feature of our time, especially among academics. But maybe taming strangeness is an archaeologist's real job…
This chapter is concerned with the clause structure of Brazilian Sign Language (LSB) and American Sign Language (ASL). In order to investigate clause structure, we devote some consideration to issues of basic and derived word order. These considerations allow us to formulate a proposed structure which captures the word order possibilities.
We find that LSB and ASL share a basic word order of Subject-Verb-Object (SVO). However, other word orders are also possible due to a variety of syntactic processes including topicalization, object shift and focus.
The chapter also discusses ways in which clause structure is different for sentences with agreeing verbs versus plain verbs (cf. chapters in this volume by Mathur and Rathmann and by Padden et al. on verb agreement). These differences motivate distinct phrase structures for sentences of the two types.
The structures in this chapter are presented using the terminology of generative syntax (see, among others, Chomsky 1995, Bošković & Lasnik 2007). We find that the formalism of this approach allows us to ask specific, detailed questions and make explicit proposals. The observations and generalizations we make are empirically based, however, and should be of interest to linguists using other approaches as well.
Our approach contributes to the overall goal of this volume by exploring the crosslinguistic similarities and differences between two geographically distinct sign languages. LSB and ASL have many similarities in word order and clause structure, but they also show intriguing differences.
States, including Illinois, have passed legislation mandating the use of International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes for reporting healthcare-associated infections, such as methicillin-resistant Staphylococcus aureus (MRSA).
To evaluate the sensitivity of ICD-9-CM code combinations for detection of MRSA infection and to understand implications for reporting.
We reviewed discharge and microbiology databases from July through August of 2005, 2006, and 2007 for ICD-9-CM codes or microbiology results suggesting MRSA infection at a tertiary care hospital near Chicago, Illinois. Medical records were reviewed to confirm MRSA infection. Time from admission to first positive MRSA culture result was evaluated to identify hospital-onset MRSA (HO-MRSA) infections. The sensitivity of MRSA code combinations for detecting confirmed MRSA infections was calculated using all codes present in the discharge record (up to 15); the effect of reviewing only 9 diagnosis codes, the number reported to the Centers for Medicare and Medicaid Services, was also evaluated. The sensitivity of the combination of diagnosis codes for detection of HO-MRSA infections was compared with that for community-onset MRSA (CO-MRSA) infections.
We identified 571 potential MRSA infections with the use of screening criteria; 403 (71%) were confirmed MRSA infections, of which 61 (15%) were classified as HO-MRSA. The sensitivity of MRSA code combinations was 59% for all confirmed MRSA infections when 15 diagnoses were reviewed compared with 31% if only 9 diagnoses were reviewed (P < .001). The sensitivity of code combinations was 33% for HO-MRSA infections compared with 62% for CO-MRSA infections (P < .001).
Limiting analysis to 9 diagnosis codes resulted in low sensitivity. Furthermore, code combinations were better at revealing CO-MRSA infections than HO-MRSA infections. These limitations could compromise the validity of ICD-9-CM codes for interfacility comparisons and for reporting of healthcare-associated MRSA infections.
UK-based operations that range from ship routing and resource exploration to weather forecasting and glaciology have direct and growing interests in the oceans of the polar regions. Typically, information describing sea-ice conditions in localised regions is required on short time scales. To explore this market, the UK's Defence Research Agency, as part of a programme of the British National Space Centre, has commissioned the development of a prototype sea-ice workstation by a consortium led by Earth Observation Sciences Ltd.
The sea-ice workstation (SIWS) uses data from several current earth observation sensors, thereby combining the advantages of regional survey, all-weather capability, and high-resolution imagery. The workstation has been designed to run with a minimum of operator intervention in order to optimise speed of operation and ensure consistency of results. The geophysical processing chains generate charts of the ice edge, ice type, ice concentration, ice-motion vectors, and sea-surface temperatures.
Although taking full advantage of developments made elsewhere, the project has also made significant progress in research into the automated mapping of ice types. Existing ice-motion algorithms have been significantly enhanced as well. Considerable emphasis is being placed on the validation of the results from the system in order to assess their quality, this being one of the major concerns of potential users. The sea-ice workstation was completed in July 1994 and will form the basis for a series of evaluations that are intended to assess the value of the system for mapping and monitoring sea ice.