To save content items to your account,
please confirm that you agree to abide by our usage policies.
If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account.
Find out more about saving content to .
To save content items to your Kindle, first ensure email@example.com
is added to your Approved Personal Document E-mail List under your Personal Document Settings
on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part
of your Kindle email address below.
Find out more about saving to your Kindle.
Note you can select to save to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi.
‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
Pompe disease results from lysosomal acid α-glucosidase deficiency, which leads to cardiomyopathy in all infantile-onset and occasional late-onset patients. Cardiac assessment is important for its diagnosis and management. This article presents unpublished cardiac findings, concomitant medications, and cardiac efficacy and safety outcomes from the ADVANCE study; trajectories of patients with abnormal left ventricular mass z score at enrolment; and post hoc analyses of on-treatment left ventricular mass and systolic blood pressure z scores by disease phenotype, GAA genotype, and “fraction of life” (defined as the fraction of life on pre-study 160 L production-scale alglucosidase alfa). ADVANCE evaluated 52 weeks’ treatment with 4000 L production-scale alglucosidase alfa in ≥1-year-old United States of America patients with Pompe disease previously receiving 160 L production-scale alglucosidase alfa. M-mode echocardiography and 12-lead electrocardiography were performed at enrolment and Week 52. Sixty-seven patients had complete left ventricular mass z scores, decreasing at Week 52 (infantile-onset patients, change −0.8 ± 1.83; 95% confidence interval −1.3 to −0.2; all patients, change −0.5 ± 1.71; 95% confidence interval −1.0 to −0.1). Patients with “fraction of life” <0.79 had left ventricular mass z score decreasing (enrolment: +0.1 ± 3.0; Week 52: −1.1 ± 2.0); those with “fraction of life” ≥0.79 remained stable (enrolment: −0.9 ± 1.5; Week 52: −0.9 ± 1.4). Systolic blood pressure z scores were stable from enrolment to Week 52, and no cohort developed systemic hypertension. Eight patients had Wolff–Parkinson–White syndrome. Cardiac hypertrophy and dysrhythmia in ADVANCE patients at or before enrolment were typical of Pompe disease. Four-thousand L alglucosidase alfa therapy maintained fractional shortening, left ventricular posterior and septal end-diastolic thicknesses, and improved left ventricular mass z score.
Social Media Statement: Post hoc analyses of the ADVANCE study cohort of 113 children support ongoing cardiac monitoring and concomitant management of children with Pompe disease on long-term alglucosidase alfa to functionally improve cardiomyopathy and/or dysrhythmia.
Inadequate protein quality may be a risk factor for poor growth. To examine the effect of a macronutrient–micronutrient supplement KOKO Plus (KP), provided to infants from 6 to 18 months of age, on linear growth, a single-blind cluster-randomised study was implemented in Ghana. A total of thirty-eight communities were randomly allocated to receive KP (fourteen communities, n 322), a micronutrient powder (MN, thirteen communities, n 329) and nutrition education (NE, eleven communities, n 319). A comparison group was followed cross-sectionally (n 303). Supplement delivery and morbidity were measured weekly and anthropometry monthly. NE education was provided monthly. Baseline, midline and endline measurements at 6, 12 and 18 months included venous blood draws, diet, anthropometry, morbidity, food security and socio-economics. Length-for-age Z-score (LAZ) was the primary outcome. Analyses were intent-to-treat using mixed-effects regressions adjusted for clustering, sex, age and baseline. No differences existed in mean LAZ scores at endline (−1·219 (sd 0·06) KP, −1·211 (sd 0·03) MN, −1·266 (sd 0·03) NE). Acute infection prevalence was lower in the KP than NE group (P = 0·043). Mean serum Hb was higher in KP infants free from acute infection (114·02 (sd 1·87) g/l) than MN (107·8 (sd 2·5) g/l; P = 0·047) and NE (108·8 (sd 0·99) g/l; P = 0·051). Compliance was 84·9 % (KP) and 87·2 % (MN) but delivery 60 %. Adjusting for delivery and compliance, LAZ score at endline was significantly higher in the KP v. MN group (+0·2 LAZ; P = 0·026). A macro- and micronutrient-fortified supplement KP reduced acute infection, improved Hb and demonstrated a dose–response effect on LAZ adjusting consumption for delivery.
An experiment was conducted in growth chambers to determine the influence of cold temperature regimes, designed to simulate winter temperature conditions and spring recovery, on the interaction between purple deadnettle and soybean cyst nematode (SCN). The study was a factorial arrangement of treatments with five levels of temperature (20, 15, 10, 5, or 0 C), two levels of exposure time to the temperature (10 or 20 d), and two levels of recovery time at 20 C following exposure (0 or 20 d). In general, purple deadnettle shoot and root growth increased with temperature and time. The ability of purple deadnettle to recover from cold temperatures declined as the length of time that the plant was subjected to the cold temperature increased. SCN juveniles per gram of root at the conclusion of the temperature treatment declined as the temperature increased from 0 to 15 C, likely a result of continued purple deadnettle root growth and the inhibition of SCN hatch, growth, or development at those temperatures. SCN female, cyst, and egg production per gram of root generally increased with temperature and occurred under all temperature regimes. The results of this research indicate that, after hatching, SCN juveniles can survive a period of cold temperature inside the roots of a winter annual and continue development when transferred to warmer temperatures. Therefore, in a field environment, where fall or spring alone may not be sufficient for SCN to complete a reproductive cycle on a winter annual weed, the nematode may be able to reproduce by combining the fall and spring developmental periods.
Certain winter annual weeds have been documented as alternative hosts to soybean cyst nematode (SCN), and infestations by such species are common in no-till production fields in the midwestern United States of Indiana, Ohio, and Illinois. The objective of this research was to determine the influence of crop rotation and winter annual weed management on winter weed growth, SCN population density, and crop yield. Two crop rotations (SS and soybean–corn rotation) and six winter annual weed-management systems (autumn-applied herbicide, spring-applied herbicide, autumn + spring applied herbicides, autumn-seeded Italian ryegrass, autumn-seeded wheat, and a nontreated check) were evaluated in long-term, no-tillage systems at West Lafayette, IN, and Vincennes, IN. In the fourth and fifth years of these experiments, the 2-yr corn–soybean rotation generally resulted in increased soybean yield, decreased winter annual weed growth, and reduced SCN population density compared with SS. Autumn or spring herbicide applications or both were a more effective option than cover crops at reducing winter annual weed density. Cover-crop systems generally did not differ from the nontreated check in winter weed density. Between years three and five, winter annual weed SCN hosts in nontreated check plots increased approximately threefold to levels as high as 102 and 245 plants m−2 at West Lafayette, IN, and Vincennes, IN, respectively, which are infestation levels at or above those commonly observed in production fields. However, controlling winter annual weeds did not influence crop yields or SCN population density. The results of these studies suggest that winter weed management, even at the high levels of weed infestation present in these studies, appears to have little value as a tool for SCN management in corn and soybean production systems in the midwestern United States.
Certain winter annual weeds have been documented as alternative hosts to soybean cyst nematode (SCN), and infestations of such species have become common in no-till production fields in the Midwest. This research was conducted to determine the influence of herbicide- and cover-crop-based winter annual weed management systems and crop rotation on winter annual weed growth and seed production, SCN population density, and crop yield. Two crop rotations (continuous soybean and soybean-corn) and six winter annual weed management systems (a nontreated control, fall and spring herbicide applications, spring-applied herbicide, fall-applied herbicide, fall-seeded annual ryegrass, and fall-seeded winter wheat) were evaluated in no-tillage systems from fall 2003 to 2006 at West Lafayette, IN and Vincennes, IN. Fall or spring herbicide treatments generally resulted in lower winter annual weed densities than cover crops. Densities of henbit and purple deadnettle increased over years in the cover crop systems but remained constant in the herbicide systems. Averaged over sites and years, winter annual weed densities were nearly 45% lower in the spring than the fall due to winter mortality. Corn yield was reduced by the cover crops at West Lafayette but not Vincennes. Winter annual weed management system had no influence on soybean yield. SCN population density was reduced by including corn in the crop sequence but was not influenced by winter annual weed management. The density of weedy host species of SCN in the experimental area was relatively low (less than 75 plants m−2) compared to densities that can be observed in production fields. The results of these experiments suggest that inclusion of corn into a cropping sequence is a much more valuable SCN management tool than winter annual weed management. In addition, control of winter annual weeds, specifically for SCN management, may not be warranted in fields with low weed density.
Infants in the neonatal intensive care unit (NICU) are at increased risk for methicillin-resistant Staphylococcus aureus (MRSA) acquisition. Outbreaks may be difficult to identify due in part to limitations in current molecular genotyping available in clinical practice. Comparison of genome-wide single nucleotide polymorphisms (SNPs) may identify epidemiologically distinct isolates among a population sample that appears homogenous when evaluated using conventional typing methods.
To investigate a putative MRSA outbreak in a NICU utilizing whole-genome sequencing and phylogenetic analysis to identify recent transmission events.
Clinical and surveillance specimens collected during clinical care and outbreak investigation.
A total of 17 neonates hospitalized in a 43-bed level III NICU in northeastern Florida from December 2010 to October 2011 were included in this study.
We assessed epidemiological data in conjunction with 4 typing methods: antibiograms, PFGE, spa types, and phylogenetic analysis of genome-wide SNPs.
Among the 17 type USA300 isolates, 4 different spa types were identified using pulsed-field gel electrophoresis. Phylogenetic analysis identified 5 infants as belonging to 2 clusters of epidemiologically linked cases and excluded 10 unlinked cases from putative transmission events. The availability of these results during the initial investigation would have improved infection control interventions.
Whole-genome sequencing and phylogenetic analysis are invaluable tools for epidemic investigation; they identify transmission events and exclude cases mistakenly implicated by traditional typing methods. When routinely applied to surveillance and investigation in the clinical setting, this approach may provide actionable intelligence for measured, appropriate, and effective interventions.
Infect. Control Hosp. Epidemiol. 2015;36(7):777–785
Human capital theory suggests that job opportunities will create incentives for human capital investment. If job information does not flow freely, or if they prefer not to move, students will make investment decisions based upon local job markets. Communities with a high percentage of low-skill jobs which do not reward high school and higher education do not create incentives for students to finish high school or continue beyond high school. Data from Virginia support this hypothesis. Targeted job creation, and improved labor market information may create incentives for increased human capital investment in many rural communities.
Effectiveness studies of preschool social–emotional programs are needed in low-income, diverse populations to help promote the well-being of at-risk children. Following an initial program efficacy study 2 years prior, 248 culturally diverse Head Start preschool children participated in the current effectiveness trial and received either the Emotion-Based Prevention Program (EBP) or the I Can Problem Solve (ICPS) intervention. Pre- and postdata collection included direct child assessment, teacher report, parent interview, and independent observations. Teachers implementing the EBP intervention demonstrated good and consistent fidelity to the program. Overall, children in EBP classrooms gained more emotion knowledge and displayed greater decreases in negative emotion expressions and internalizing behaviors across the implementation period as compared to children in ICPS classrooms. In addition, cumulative risk, parental depressive symptoms, and classroom climate significantly moderated treatment effects. For children experiencing more stress or less support, EBP produced more successful outcomes than did ICPS. These results provide evidence of EBP sustainability and program effectiveness, as did previous findings that demonstrated EBP improvements in emotion knowledge, regulation skills, and behavior problems replicated under unsupervised program conditions.
“I was fed up with my wife, I was not happy at all, because in the four years since I had married her she was not pregnant” (Tutuola, 1981: 21). Thus does the narrator of Amos Tutuola's The Witch Herbalist of the Remote Town express his distress at his wife's barrenness. The problem so pained him that he undertook a six-year quest in search of a cure, because to remain childless would be untenable. The issue of fertility and the need to perpetuate the family into future generations inspired Tutuola, whose story examines the singularly important issue of fertility as a social, cultural, and medical concern among the Yoruba of Nigeria and, by extrapolation, the peoples in transition in West Africa.
Amos Tutuola, a clerk in the Nigerian department of labor, has written several quest novels, all of which reflect various aspects of Yoruba culture. A native of Abeokuta in western Nigeria, Tutuola received the equivalent of a Western sixth-grade education. Raised as a Christian, he infuses his works with religious morality coupled with traditional perspectives.
Tutuola's writing career began as a relief from the boredom of his everyday job. He wrote his first novel in a two-day spurt of activity and sent it to what he thought was a publishing house, but which turned out to be a Methodist missionary group. The group forwarded the manuscript to the London publishers Faber and Faber and The Palm-Wine Drinhard was published in 1952 with little revision. Written in a distinct style of nonstandard English, the strange, fantastic story received praise from Western readers and critics, but derision from their African counterparts.
The expert systems business has been through a terrible period in 1987–88. In the USA, the “Gang of Four”—the new venture software companies which once led the industry—have all run into losses and cut back staff more or less severely. Symbolics, whose high priced Lisp workstations have made it the biggest single company in artificial intelligence (AI), has hit an equally dramatic reversal of fortunes.
Recognition of seasonal trends in hospital infections may improve diagnosis, use of empirical therapy, and infection prevention interventions. There are very few data available regarding the seasonal variability of these infections. We quantified the seasonal variation in the incidences of hospital infection caused by common bacterial pathogens and estimated the association between temperature changes and infection rates.
A cohort of all adult patients admitted to the University of Maryland Medical Center during the period from 1998 through 2005 was analyzed. Time-series analyses were used to estimate the association of the number of infections per month caused by Pseudomonas aeruginosa, Acinetobacter baumannii, Enterobacter cloacae, Escherichia coli, Staphylococcus aureus, and enterococci with season and temperature, while controlling for long-term trends.
There were 218,594 admissions to the index hospital, and analysis of 26,624 unique clinical cultures that grew the organisms of interest identified increases in the mean monthly rates of infection caused by P. aeruginosa (28% of isolates recovered; P < .01), E. cloacae (46%; P < .01), E. coli (12%; P < .01), and A. baumannii (21%; P = .06). For each 10°F increase, we observed a 17% increase in the monthly rates of infection caused by P. aeruginosa (P = .01) and A. baumanii (P = .05).
Significantly higher rates of gram-negative infection were observed during the summer months, compared with other seasons. For some pathogens, higher temperatures were associated with higher infection rates, independent of seasonality. These findings have important implications for infection prevention, such as enhanced surveillance during the warmer months, and for choice of empirical antimicrobial therapy among hospitalized adults. Future, quasi-experimental investigations of gram-negative infection prevention initiatives should control for seasonal variation.
Low socioeconomic status (SES) background has been identified as a risk for several mental disorders. However evidence regarding SES and the developmental course of personality disorder (PD) has not been addressed. Nor is it clear whether an SES relationship to PD symptom course may be attributable to known associated risks. Further, specificity of such relationships to a particular PD diagnostic pattern independent of comorbidity with other PD or with depression has not been investigated. Data are from a general population studied longitudinally between ages 10 and 36 in four assessment waves. Effects of SES-associated risks on the level of symptoms of schizotypal and borderline disorders are estimated and compared to effects on depressive symptoms. Low family SES had robust modest independent effects on both PDs over the entire age span despite substantial cumulative effects of trauma history, stressful recent life events, IQ, poor parenting, and comorbid symptoms. SES effects on depressive symptoms were generally absent, but a small “protective” effect of low SES appeared when comorbidity with PD symptoms was taken into account. Cumulatively, these risks account for developmental failures of substantial magnitude and consequence, marking the importance of understanding the remaining mechanisms of SES effects and programmatic implications for minimizing associated risk.
The occurrence of nosocomial infections due to third-generation cephalosporin–resistant gram-negative bacteria is increasing. Gastrointestinal colonization is an important reservoir for antibiotic-resistant bacteria, and it often precedes clinical infection.
To estimate the prevalence of gastrointestinal colonization with ceftazidime-resistant gram-negative bacteria among intensive care unit (ICU) patients at a university-affiliated tertiary-care hospital during 2 distinct periods and to assess whether, at any time during the index hospitalization, colonized patients had a clinical culture positive for the same organism that was recovered from surveillance culture.
Two ICUs at the University of Maryland Medical Center, a 656-bed tertiary-care hospital located in Baltimore, Maryland. Both ICUs provide care to adult patients.
We performed a cross-sectional study of adult patients admitted to the medical ICU or the surgical ICU from June 14 to July 14, 2003, and from June 14 to July 14, 2006. Perirectal swab samples were obtained for surveillance culture on admission to the intensive care unit, weekly thereafter, and at discharge. Each culture sample was plated onto MacConkey agar supplemented with ceftazidime.
In 2003, a total of 33 (18.8%) of 176 patients were colonized with ceftazidime-resistant gram-negative bacilli; in 2006, 60 (31.4%) of 191 patients were (P<.01). This increase was largely driven by an increase in ceftazidime-resistant Klebsiella isolates (which accounted for 6.4% of isolates in 2003 and for 22.8% in 2006; P<.01). In 2003, a total of 16 (48.5%) of 33 colonized patients had a clinical culture positive for the same organism that was recovered from the perirectal surveillance culture, compared with 22 (36.6%) of 60 colonized patients in 2006 (P = .28).
Our data suggest that gastrointestinal colonization with ceftazidime-resistant gram-negative bacilli is common, that its prevalence is increasing, and that colonization may result in clinical cultures positive for these bacilli.
The ability to recover bacteria from frozen culture specimens has important implications. The purpose of this study was to validate the utility of frozen specimens for recovery of several gram-positive and gram-negative bacterial species by culture. Results demonstrate that 98% of 250 bacterial isolates identified on initial culture were subsequently recovered by culture of frozen specimens after a median storage period of 564 days.
We assessed methicillin-resistant Staphylococcus aureus (MRSA) infection and colonization in hospitalized prisoners. Of 434 admission surveillance cultures, 58 (13%) were positive for MRSA. The sensitivity of admission surveillance cultures of samples from the anterior nares was 72% and increased to 84% when the calculation included cultures of wound samples. Hospitalized prisoners are at high risk for MRSA infection and colonization, and surveillance should include cultures of nares and wound samples.
In 2002, the Chicago Department of Public Health (CDPH; Chicago, Illinois) convened the Chicago-Area Neonatal MRSA Working Group (CANMWG) to discuss and compare approaches aimed at control of methicillin-resistant Staphylococcus aureus (MRSA) in neonatal intensive care units (NICUs). To better understand these issues on a regional level, the CDPH and the Evanston Department of Health and Human Services (EDHHS; Evanston, Illinois) began an investigation.
Survey to collect demographic, clinical, microbiologic, and epidemiologic data on individual cases and clusters of MRSA infection; an additional survey collected data on infection control practices.
Level III NICUs at Chicago-area hospitals.
Neonates and healthcare workers associated with the level III NICUs.
From June 2001 through September 2002, the participating hospitals reported all clusters of MRSA infection in their respective level III NICUs to the CDPH and the EDHHS.
Thirteen clusters of MRSA infection were detected in level III NICUs, and 149 MRSA-positive infants were reported. Infection control surveys showed that hospitals took different approaches for controlling MRSA colonization and infection in NICUs.
The CANMWG developed recommendations for the prevention and control of MRSA colonization and infection in the NICU and agreed that recommendations should expand to include future data generated by further studies. Continuing partnerships between hospital infection control personnel and public health professionals will be crucial in honing appropriate guidelines for effective approaches to the management and control of MRSA colonization and infection in NICUs.
Non-polar surfaces of HVPE grown GaN were characterized by cathodoluminescence (CL), scanning electron microscopy (SEM), and secondary ion mass spectrometry (SIMS). Both of a- and m-plane GaN were prepared by growing thick GaN along the c-axis, and cutting in transverse orientations. The exposed non-polar surfaces were prepared by mechanical polishing (MP) and chemically mechanical polishing (CMP). Non-uniform luminescent characteristics on a- and m-plane GaN were observed in CL images, indicating a higher concentration of impurities in the area of more luminescence. CL spectra from the bulk samples revealed two peaks: 364 nm and 510 nm, related to band edge and impurity defects respectively. The detection by SIMS confirmed that oxygen was inhomogeneously incorporated during the growth of thick GaN layers. Surface qualities of a- and m-plane GaN were also investigated. The lower optical intensities from a-plane GaN at low acceleration voltages indicated more surface damages were introduced during polish. The optical intensity difference from the two samples was reduced at higher acceleration voltages. Similar CL intensities at low acceleration voltages from a- and m-plane GaN substrates prepared by CMP indicated improved surface qualities.
Reductive removal by hydrogeneration using supported Pd/M (M= Cu, Pt, Ag, Co, Fe, Mo, Ni, Rh, Ir, Mn and Cr) bimetallic catalysts has emerged as a promising alternative for nitrate removal in drinking water . Fundamental understanding how the atomic arrangement of Pd and a second element, such as Cu, affect the activity nitrite reduction and selectivity of dinitrogen will be accomplished by coordinated synthesis (Shapley), activity/selectivity/efficiency measurements (Werth) and nanostructure determination (Yang & Xu). In this paper, we report a systematic study of novel polyvinylpyrrolidone (PVP) stabilized nanoscale Pd-Cu colloids, with homogeneous and narrow size distribution, with Pd: Cu ratios varying from 50:50 to 90:10. Initial measurements on catalytic activity for nitrate reduction demonstrated a dependence on the relative composition. Electron microscopy studies, including Z-contrast imaging , energy-dispersive X-ray emission (EDX), electron diffraction and high-resolution electron microscopy (HREM), revealed a surprising change in structure at the 80:20 Pd-Cu composition, where, with less than 80% Pd,the nanoparticle forms a core-shell structure but for nanoparticles containing 80% or more Pd, it is homogeneous. We are at the pivotal point of directly correlating these nano-structures with the catalytic activity. Such an understanding is essential for the efficient development of catalysts for the purification of drinking water.