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Antibiotics are among the most common medications prescribed in nursing homes. The annual prevalence of antibiotic use in residents of nursing homes ranges from 47% to 79%, and more than half of antibiotic courses initiated in nursing-home settings are unnecessary or prescribed inappropriately (wrong drug, dose, or duration). Inappropriate antibiotic use is associated with a variety of negative consequences including Clostridioides difficile infection (CDI), adverse drug effects, drug–drug interactions, and antimicrobial resistance. In response to this problem, public health authorities have called for efforts to improve the quality of antibiotic prescribing in nursing homes.
Congenital renal and urinary tract anomalies are common, accounting for up to 21% of all congenital abnormalities . The reported incidence is approximately 1:250–1:1000 pregnancies  and the routine use of prenatal ultrasonography allows relatively early detection, particularly for the obstructive uropathies, which account for the majority. According to the latest UK renal registry report in 2015, ‘obstructive uropathy’ was the second leading cause (19%) of chronic renal failure in children under 16 years of age after renal dysplasia +/− reflux . The obstructions may occur within the upper or lower urinary tract, and their prognosis varies significantly, with obstructions at the level of the bladder neck being associated with the majority of neonatal mortality and renal failure. In untreated cases, perinatal mortality is high (up to 45%, often because of associated severe oligohydramnios and pulmonary hypoplasia) , and 30% of the survivors suffer from end-stage renal failure (ESRF) requiring dialysis and renal transplantation before the age of 5 . The overall chance of survival in childhood is lowest if renal support therapy or transplantation is commenced before 2 years old when compared with starting at 12–16 years old (hazard ratio [HR] of 4.1, 95% confidence interval [CI] 1.7–9.9, P = 0.002) . Therefore, in utero intervention, by the insertion of a vesicoamniotic shunt, or therapeutic treatment by fetal cystoscopy and valvular ablation, has been attempted to attenuate in utero progression of these pathologies (and their consequences) and to alter the natural history of congenital bladder neck obstruction in childhood. In this chapter, we discuss the etiology, pathophysiology, prenatal presentation and diagnosis of congenital bladder neck obstruction. Suggested algorithms for screening and the prenatal prognostic evaluation in selecting candidates for in utero therapy will be discussed.
The Bulge Asymmetries and Dynamical Evolution (BAaDE) survey aims to explore the complex structure of the inner Galaxy and Galactic Bulge, by using the 43 GHz receivers at the Karl G. Jansky Very Large Array (VLA) and the 86 GHz receivers at the Atacama Large Millimeter/submillimeter Array (ALMA) to observe SiO maser lines in red giant stars. The goal is to construct a sample of stellar point-mass probes that can be used to test models of the gravitational potential, and the final sample is expected to provide at least 20,000 line-of-sight velocities and positions. A possible bias between the VLA and the ALMA SiO maser lines is explored, and the 86 GHz SiO line-peak velocities agree using either of the four sampled lines. Additionally, the SiO maser velocities agree with the OH maser derived velocities.
The Bulge Asymmetries and Dynamical Evolution (BAaDE) survey aims to use circumstellar SiO maser line-of-sight velocities as probes for the Galactic gravitational potential and dynamical structure. The SiO masers are detected at a high rate in specific color-selected MSX infrared sources. Furthermore, the SiO maser properties and line ratios, in combination with infrared spectral energy distributions and location in the Galaxy, will statistically yield detailed information on population and evolution of low- to intermediate-mass evolved stars in the Galaxy.
The carbon-rich AGB star V Hya is believed to be in the very brief transition phase between the AGB and a planetary nebula (PN). Using HST/STIS, we previously found a high-velocity (> 200 kms−1) jet or blob of gas ejected only a few years ago from near (< 0.3 arcsec or 150 AU) the star (Sahai et al. 2003, Sahai et al. 2016). From multi-epoch high-resolution spectroscopy we found time-variable high-velocity absorption features in the CO 4.6 μm vibration-rotation lines of V Hya (Sahai et al. 2009). Modeling shows that these are produced in compact clumps of outflowing gas with significant radial temperature gradients consistent with strong shocks. Here, we present very high resolution (∼100 milliarcsecond) imaging of the central region of V Hya using the coronagraphic mode of the Gemini Planet Imager (GPI) in the 1 μm band and spectral-spatial imaging of 4.6 μm CO 1-0 transitions using the Phoenix spectrometer. We report the detection of a compact central dust disk from GPI, and molecular emission from the Phoenix observations at relatively larger scales. We discuss models for the central structures in V Hya, in particular disks and outflows, using these and complementary images in the optical and radio.
We report on the Bulge Asymmetries and Dynamic Evolution (BAaDE) survey which has observed 19 000 MSX color selected red giant stars for SiO maser emission at 43 GHz with the VLA and is in the process of observing 9 000 of these stars with ALMA at 86 GHz in the Southern sky. Our setup covers the main maser transitions, as well as those of isotopologues and selected lines of carbon-bearing species. Observations of this set of lines allow a far-reaching catalog of line-of-sight velocities in the dust-obscured regions where optical surveys cannot reach. Our preliminary detection rate is close to 70%, predicting a wealth of new information on the distribution of metal rich stars, their kinematics as function of location in the Galaxy, as well as the occurrence of lines and line ratios between the different transitions in combination with the spectral energy distribution from about 1 to 100 μm. Similar to the OH/IR stars, a clear kinematic signature between disk and bulge stars can be seen. Furthermore, the SiO J = →10 (v=3) line plays a prominent role in the derived maser properties.
Families of children born with CHD face added stress owing to uncertainty about the magnitude of the financial burden for medical costs they will face. This study seeks to assess the family responsibility for healthcare bills during the first 12 months of life for commercially insured children undergoing surgery for severe CHD.
The MarketScan® database from Truven was used to identify commercially insured infants in 39 states from 2010 to 2012 with an ICD-9 diagnosis code for transposition of the great arteries, tetralogy of Fallot, or truncus arteriosus, as well as the corresponding procedure code for complete repair. Data extraction identified payment responsibilities of the patients’ families in the form of co-payments, deductibles, and co-insurance during the 1st year of life.
There were 481 infants identified who met the criteria. Average family responsibility for healthcare bills during the 1st year of life was $2928, with no difference between the three groups. The range of out-of-pocket costs was $50–$18,167. Initial hospitalisation and outpatient care accounted for the majority of these responsibilities.
Families of commercially insured children with severe CHD requiring corrective surgery face an average of ~$3000 in out-of-pocket costs for healthcare bills during the first 12 months of their child’s life, although the amount varied considerably. This information provides a framework to alleviate some of the uncertainty surrounding healthcare financial responsibilities, and further examination of the origination of these expenditures may be useful in informing future healthcare policy discussion.
Congenital genitourinary tract anomalies are some of the most commonly identified prenatal abnormalities, being identified in between 1 in 250 and 1 in 1000 pregnancies. They consist of a wide spectrum of heterogeneous malformations. Obstructive uropathies account for the majority of these abnormalities. the second-trimester detailed scan (often at 18+0–21+6 weeks) is the examination in which the majority of genitourinary abnormalities are diagnosed. However, with the widespread use of first-trimester ultrasound screening, severe renal anomalies and “megacystis” are being noted between 11+0 and 13+6 weeks. Additionally, third-trimester ultrasound may reveal late-onset uropathies, often associated with changes in liquor volume.
Victoria Hodgetts Morton, Institute of Metabolism & Systems Research, Centre for Women's & New Born's Health, University of Birmingham, Birmingham, UK,
R. Katie Morris, Institute of Metabolism & Systems Research, Centre for Women's & New Born's Health, University of Birmingham, Birmingham, UK,
Mark D. Kilby, Birmingham Centre for Women's & New Born's Health, University of Birmingham College of Medicine & Dental Sceinces, Birmingham, UK
Congenital genitourinary tract anomalies are some of the most commonly identified prenatal abnormalities, being identified in between 1 in 250 and 1 in 1000 pregnancies. They consist of a wide spectrum of heterogeneous malformations. Obstructive uropathies account for the majority of these abnormalities.3–5 the second-trimester detailed scan (often at 18+0–21+6 weeks) is the examination in which the majority of genitourinary abnormalities are diagnosed. However, with the widespread use of first-trimester ultrasound screening, severe renal anomalies and “megacystis” are being noted between 11+0 and 13+6 weeks. Additionally, third-trimester ultrasound may reveal late-onset uropathies, often associated with changes in liquor volume.
Antenatal diagnosis allows for the planning of appropriate prenatal and postnatal care. In addition, it allows triage of the anomalies into those that are severe and potentially life-threatening, those that are amenable to in utero intervention, and those that may require postnatal investigation and follow-up. As with all prenatal diagnosis, an explanation of the condition to parents, with discussion of the range of outcomes, is mandatory.
Normal Sonographic Appearance of the Urinary Tract
A first-trimester ultrasound (see also Chapter 7) is offered to all pregnant women in the UK for:
• dating of the pregnancy
• exclusion of multiple pregnancy
• confirmation of viability, and
• to offer screening for autosomal aneuploidy (commonly at 11+0–13+6 weeks).
At this scan the fetal bladder may be identified in up to 93% of cases (Figure 17.1). If the crown–rump length is > 67 mm and the bladder cannot be visualized this should be considered as abnormal.
In the UK, a second-trimester scan is also offered to all women at about 20 weeks. The details of that scan are discussed in Chapter 7. During the second and third trimester, the bladder will empty and refill during the course of an ultrasound examination. The fetal bladder can be identified lying between the two umbilical arteries within the pelvis (identified by the use of color flow Doppler). The sonographic appearance of the kidneys is discussed below. The ureters and urethra are not normally visible.
When Gabriele Brandstetter published Tanz-Lektüren: Körperbilder und Raumfiguren der Avantgarde in 1995, German dance studies hardly existed. The book was a pioneering effort that exerted considerable influence on dance studies in Germany as it developed over the next decades. Now, twenty years later, Tanz-Lektüren has been translated into English, and its appearance is most welcome. The book's importance is not merely historical; on the contrary, it has much to offer today's anglophone reader, particularly in Brandstetter's use of Aby Warburg's theories to analyze dance imagery and movement patterns. Important, too, is her inclusion of numerous writers and artists whose views on dance are little known, or at least little analyzed, in English.
Epidemiology formed the basis of ‘the Barker hypothesis’, the concept of ‘developmental programming’ and today’s discipline of the Developmental Origins of Health and Disease (DOHaD). Animal experimentation provided proof of the underlying concepts, and continues to generate knowledge of underlying mechanisms. Interventions in humans, based on DOHaD principles, will be informed by experiments in animals. As knowledge in this discipline has accumulated, from studies of humans and other animals, the complexity of interactions between genome, environment and epigenetics, has been revealed. The vast nature of programming stimuli and breadth of effects is becoming known. As a result of our accumulating knowledge we now appreciate the impact of many variables that contribute to programmed outcomes. To guide further animal research in this field, the Australia and New Zealand DOHaD society (ANZ DOHaD) Animals Models of DOHaD Research Working Group convened at the 2nd Annual ANZ DOHaD Congress in Melbourne, Australia in April 2015. This review summarizes the contributions of animal research to the understanding of DOHaD, and makes recommendations for the design and conduct of animal experiments to maximize relevance, reproducibility and translation of knowledge into improving health and well-being.
We summarize work on the central parsec of the Galactic center based on imaging and spectroscopic observations at the Keck and Gemini telescopes. These observations include stellar positions in two dimension and the velocity in three dimensions. Spectroscopic observations also enables measurements of the physical properties of individual stars, such as the spectral type and in some cases the effective temperature, metallicity, and surface gravity. These observations show a complex stellar population with a young (4-6 Myr) compact star cluster in the central 0.5 pc embedded in in an older and much more massive nuclear star cluster. Surprisingly, the old late-type giants do not show a cusp profile as long been expected from theoretical work. The majority of the stars have higher than solar metallicity, with only about 6% of the stars having [M/Fe] < −0.5, which is consistent with an origin from the MW disk.
The history of supermassive black holes’ activity can be partly constrained by monitoring the diffuse X-ray emission possibly created by the echoes of past events propagating through the molecular clouds of their respective environments. In particular, using this method we have demonstrated that our Galaxy’s supermassive black hole, Sgr A⋆, has experienced multiple periods of higher activity in the last centuries, likely due to several short but very energetic events, and we now investigate the possibility of studying the past activity of other supermassive black holes by applying the same method to M31⋆. We set strong constraints on putative phase transitions of this more distant galactic nucleus but the existence of short events such as the ones observed in the Galactic center cannot be assessed with the upper limits we derived.
We present constraints on the variability and binarity of young stars in the central 10 arcseconds (~ 0.4 pc) of the Milky Way Galactic Center (GC) using Keck Adaptive Optics data over a 12 year baseline. Given our experiment’s photometric uncertainties, at least 36% of our sample’s known early-type stars are variable. We identified eclipsing binary systems by searching for periodic variability. In our sample of spectroscopically confirmed and likely early-type stars, we detected the two previously discovered GC eclipsing binary systems. We derived the likely binary fraction of main sequence, early-type stars at the GC via Monte Carlo simulations of eclipsing binary systems, and find that it is at least 32% with 90% confidence.
A radio survey of red giant SiO sources in the inner Galaxy and bulge is not hindered by extinction. Accurate stellar velocities (<1 km/s) are obtained with minimal observing time (<1 min) per source. Detecting over 20,000 SiO maser sources yields data comparable to optical surveys with the additional strength of a much more thorough coverage of the highly obscured inner Galaxy. Modeling of such a large sample would reveal dynamical structures and minority populations; the velocity structure can be compared to kinematic structures seen in molecular gas, complex orbit structure in the bar, or stellar streams resulting from recently infallen systems. Our Bulge Asymmetries and Dynamic Evolution (BAaDE) survey yields bright SiO masers suitable for follow-up Galactic orbit and parallax determination using VLBI.
Here we outline our early VLA observations at 43 GHz in the northern bulge and Galactic plane (0<l°<250), and ALMA observations at 86 GHz in the southern bulge (250<l°<360). We report a preliminary overall 70% detection rate in our color-selected MSX sources.
Perinatal mortality is increased considerably in multiple pregnancies compared to singleton pregnancies, with single intrauterine fetal demise (sIUFD) presenting a rare but unique perinatal problem. Monochorionic pregnancies are at particular risk of sIUFD due to bidirectional inter-twin placental vascular anastomoses. The resulting inter-twin blood flow can become unbalanced, causing acute and chronic inter-twin transfusion and profound anemia secondary to fetal exsanguination into the low-pressure circulation of the dead fetus. If the sIUFD occurs after 14 weeks’ gestation it is believed to have the most significant effect on the continuing pregnancy as the co-twin is at increased risk of preterm delivery, long-term neurological complications, and death. This article will focus on fetal brain injury in the surviving co-twin in the case of sIUFD, as it is the most common kind of injury in sIUFD, and one which concerns parents and may be the basis for terminating the pregnancy. We will outline how these brain injuries are thought to occur and describe potential pathophysiological mechanisms. We will discuss risk factors for brain injury in cases of sIUFD, including: chorionicity, cause of the sIUFD (spontaneous or secondary to an underlying pathological process such as twin-to-twin transfusion syndrome), gestation of delivery and how to prevent brain injury in the co-twin. We also review modes of imaging, discuss the difficulties in predicting the long-term outcome for co-twin survivors, and highlight the dearth of research in this area.