We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.
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 coreplatform@cambridge.org
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.
To describe the incidence of systemic overlap and typical coronavirus disease 2019 (COVID-19) symptoms in healthcare personnel (HCP) following COVID-19 vaccination and association of reported symptoms with diagnosis of severe acute respiratory coronavirus virus 2 (SARS-CoV-2) infection in the context of public health recommendations regarding work exclusion.
Design:
This prospective cohort study was conducted between December 16, 2020, and March 14, 2021, with HCP who had received at least 1 dose of either the Pfizer-BioNTech or Moderna COVID-19 vaccine.
Setting:
Large healthcare system in New England.
Interventions:
HCP were prompted to complete a symptom survey for 3 days after each vaccination. Reported symptoms generated automated guidance regarding symptom management, SARS-CoV-2 testing requirements, and work restrictions. Overlap symptoms (ie, fever, fatigue, myalgias, arthralgias, or headache) were categorized as either lower or higher severity. Typical COVID-19 symptoms included sore throat, cough, nasal congestion or rhinorrhea, shortness of breath, ageusia and anosmia.
Results:
Among 64,187 HCP, a postvaccination electronic survey had response rates of 83% after dose 1 and 77% after dose 2. Report of ≥3 lower-severity overlap symptoms, ≥1 higher-severity overlap symptoms, or at least 1 typical COVID-19 symptom after dose 1 was associated with increased likelihood of testing positive. HCP with prior COVID-19 infection were significantly more likely to report severe overlap symptoms after dose 1.
Conclusions:
Reported overlap symptoms were common; however, only report of ≥3 low-severity overlap symptoms, at least 1 higher-severity overlap symptom, or any typical COVID-19 symptom were associated with infection. Work-related restrictions for overlap symptoms should be reconsidered.
Antimicrobial resistance is an urgent public health threat. Identifying trends in antimicrobial susceptibility can inform public health policy at the state and local levels.
Objective:
To determine the ability of statewide antibiogram aggregation for public health surveillance to identify changes in antimicrobial resistance trends.
Design:
Facility-level trend analysis.
Methods:
Crude and adjusted trend analyses of the susceptibility of Escherichia coli and Klebsiella pneumoniae to particular antibiotics, as reported by aggregated antibiograms, were examined from 2008 through 2018. Multivariable regression analyses via generalized linear mixed models were used to examine associations between hospital characteristics and trends of E. coli and K. pneumoniae susceptibility to ciprofloxacin and ceftriaxone.
Results:
E. coli and K. pneumoniae showed inverse trends in drug susceptibility over time. K. pneumoniae susceptibility to fluoroquinolones increased by 5% between 2008 and 2018 (P < .05). In contrast, E. coli susceptibility declined during the same period to ceftriaxone (6%), gentamicin (4%), and fluoroquinolones (4%) (P < .05). When compared to Boston hospitals, E. coli isolates from hospitals in other regions had a >4% higher proportion of susceptibility to ciprofloxacin and a >3% higher proportion of susceptibility to ceftriaxone (P < .05). Isolates of K. pneumoniae had higher susceptibility to ciprofloxacin (>3%) and ceftriaxone (>1.5%) in all regions when compared to Boston hospitals (P < .05).
Conclusions:
Cumulative antibiograms can be used to monitor antimicrobial resistance, to discern regional and facility differences, and to detect changes in trends. Furthermore, because the number of years that hospitals contributed reports to the state-level aggregate had no significant influence on susceptibility trends, other states should not be discouraged by incomplete hospital compliance.
To assess the safety of, and subsequent allergy documentation associated with, an antimicrobial stewardship intervention consisting of test-dose challenge procedures prompted by an electronic guideline for hospitalized patients with reported β-lactam allergies.
Design:
Retrospective cohort study.
Setting:
Large healthcare system consisting of 2 academic and 3 community acute-care hospitals between April 2016 and December 2017.
Methods:
We evaluated β-lactam antibiotic test-dose outcomes, including adverse drug reactions (ADRs), hypersensitivity reactions (HSRs), and electronic health record (EHR) allergy record updates. HSR predictors were examined using a multivariable logistic regression model. Modification of the EHR allergy record after test doses considered relevant allergy entries added, deleted, and/or specified.
Results:
We identified 1,046 test-doses: 809 (77%) to cephalosporins, 148 (14%) to penicillins, and 89 (9%) to carbapenems. Overall, 78 patients (7.5%; 95% confidence interval [CI], 5.9%–9.2%) had signs or symptoms of an ADR, and 40 (3.8%; 95% CI, 2.8%–5.2%) had confirmed HSRs. Most HSRs occurred at the second (ie, full-dose) step (68%) and required no treatment beyond drug discontinuation (58%); 3 HSR patients were treated with intramuscular epinephrine. Reported cephalosporin allergy history was associated with an increased odds of HSR (odds ratio [OR], 2.96; 95% CI, 1.34–6.58). Allergies were updated for 474 patients (45%), with records specified (82%), deleted (16%), and added (8%).
Conclusion:
This antimicrobial stewardship intervention using β-lactam test-dose procedures was safe. Overall, 3.8% of patients with β-lactam allergy histories had an HSR; cephalosporin allergy histories conferred a 3-fold increased risk. Encouraging EHR documentation might improve this safe, effective, and practical acute-care antibiotic stewardship tool.
Magnetic resonance imaging (MRI) provides unprecedented access to the anatomy and physiology of the human brain and has launched a new era of pediatric neuroscience. Because it does not use ionizing radiation, it is safe not only for single scans of children, but for repeated scans throughout the course of maturation. In this chapter, we will summarize results to date from an ongoing longitudinal brain MRI project that has been underway at the Child Psychiatry Branch (CPB) of the National Institute of Mental Health (NIMH) since being initiated by Dr. Markus Krusei in 1989. The design of the study is for volunteers to visit the NIMH at approximately two-year intervals for (1) genetic analysis; (2) cognitive/emotional/behavioral assessment; and (3) brain imaging.
The data presented here are the quantitative morphology (i.e., size and shape) results from our typically developing participants between the ages of three and twenty-seven years. The findings will be grouped by tissue type (i.e., gray matter, white matter, cerebrospinal fluid) or structure/region (i.e. total and lobar volumes, caudate, ventricles, etc.) and shown as a function of age separately for boys and girls. To promote independence of the sample data points for the non-twin analyses, only one subject was chosen per family. The particular person chosen from a given family was based on an attempt to optimize the age and gender distribution of the sample and was done blind to knowledge of their imaging results. Unless otherwise indicated, the results in the following sections are from the most recent analyses of the CPB data consisting of 829 scans from 387 subjects, ages 3 to 27 years.
By
Jay N. Giedd, Child Psychiatry Branch, National Institute of Mental Health, Bethesda, USA,
Michael A. Rosenthal, Child Psychiatry Branch, National Institute of Mental Health, Bethesda, USA,
A. Blythe Rose, Child Psychiatry Branch, National Institute of Mental Health, Bethesda, USA,
Jonathan D. Blumenthal, Child Psychiatry Branch, National Institute of Mental Health, Bethesda, USA,
Elizabeth Molloy, Child Psychiatry Branch, National Institute of Mental Health, Bethesda, USA,
Richard R. Dopp, Child Psychiatry Branch, National Institute of Mental Health, Bethesda, USA,
Liv S. Clasen, Child Psychiatry Branch, National Institute of Mental Health, Bethesda, USA,
Daniel J. Fridberg, Child Psychiatry Branch, National Institute of Mental Health, Bethesda, USA,
Nitin Gogtay, Child Psychiatry Branch, National Institute of Mental Health, Bethesda, USA
Using Magnetic resonance imaging (MRI), the team at the Child Psychiatry Branch of the National Institute of Mental Health has been collecting brain MRI scans on healthy children and adolescents since 1989. As of 2003, over 300 scans from 150 healthy subjects are acquired. The data presented in this chapter is largely drawn from this cohort unless otherwise stated. MRI is adept at discerning gray matter, white matter, and fluid on brain images. These boundaries are used to define the size and shape of brain structures or regions. Characterization of normal brain development is imperative to assess the hypothesis that many of the most severe neuropsychiatric disorders of childhood onset are manifestations of deviations from that normative path. Sexual dimorphism in healthy brain development may lead to differential vulnerability, which would account for some of the clinical differences in childhood neuropsychiatric disorders.
The recent introduction of dual inlaid Cu and oxide based interconnects within sub-0.25μm CMOS technology has delivered higher performance and lower power devices. Further speed improvements and power reduction may be achieved by reducing the interconnect parasitic capacitance through integration of low-k interlevel dielectric (ILD) materials with Cu. This paper demonstrates successful multi-level dual inlaid Cu/low-k interconnects with ILD permittivities ranging from 2.0 to 2.5. Integration challenges specific to inorganic low-k and Cu based structures are discussed. Through advanced CMP process development, multi-level integration of porous oxide materials with moduli less than 0.5 GPa is demonstrated. Parametric data and isothermal annealing of these Cu/ low-k structures show results with yield comparable to Cu/oxide based interconnects.
The recent introduction of dual inlaid Cu and oxide based interconnects within sub-0.25μm CMOS technology has delivered higher performance and lower power devices. Further speed improvements and power reduction may be achieved by reducing the interconnect parasitic capacitance through integration of low-k interlevel dielectric (ILD) materials with Cu. This paper demonstrates successful multi-level dual inlaid Cu/low-k interconnects with ILD permittivities ranging from 2.0 to 2.5. Integration challenges specific to inorganic low-k and Cu based structures are discussed. Through advanced CMP process development, multi-level integration of porous oxide materials with moduli less than 0.5 GPa is demonstrated. Parametric data and isothermal annealing of these Cu/ low-k structures show results with yield comparable to Cu/oxide based interconnects.
Powder metallurgy (P/M) involves a multiple-step process to prepare and consolidate granulated metal and composites into near-net-shaped components. The modern P/M method starts with a precisely defined final geometry and a set of properties for a desired component. Decisions are then made about a variety of processing variables, recognizing that many variables strongly interact counter to the desired properties. Finally preproduction fabrication trials are conducted to optimize key variables until he specifications are achieved, and the processing conditions are established. A critical step in the overall process is the compaction of powder into a sufficiently strong, low-porosity, properly shaped part with uniform microstructure that can be sintered, or alternately heated and pressed to the final dimensions and properties.
The technique of microscope examination and hot wire cautery in a prospective study of 100 consecutive patients with acute epistaxis is described. The method was successful in arresting haemorrhage in 94 per cent of patients bleeding at the time of examination, and in 86 per cent, discharge home within one hour was possible. Due to improved illumination, magnification and control of the cautery instrument, nasal packing was required in only nine per cent of cases. By achieving this and by reducing the overall need for admission to 20 per cent, we recommend this method of treatment both as a successful cost saving measure, as well as advantageous to the patient.
The γ-ray burst brightness distribution is inhomogeneous and the distribution on the sky is nearly isotropic. These features argue against an association of γ-ray bursts with those Galactic objects that are known to exhibit a strong concentration toward the Galactic center or plane. The observed statistical properties indicate a cosmological origin. Circumstantial evidence suggests that neutron stars are involved in the burst phenomenon. Here we consider Population II neutron stars in an extended Galactic Halo (EGH) as an alternative to cosmological scenarios. The BATSE data indicate a small deviation from isotropy near the 2 σ level of statistical significance. If confirmed for an increasing number of bursts, these anisotropies could rule out cosmological scenarios. On the other hand, EGH models require small anisotropies like those observed by BATSE. We consider simple distribution models to determine the generic properties such halos must have to be consistent with the observations and discuss the implications of the corresponding distance scale on burst models.
Subject headings: gamma rays: bursts — stars: neutron — stars: Population II — stars: statistics
A strong correlation has been established between TiN substrate anneal ambient and electromigration performance of Al-based alloys. Excellent electromigration lifetimes were measured for AlSiCu (and AlCu) films on sputtered TiN substrates annealed in N2 and slowly cooled down in furnace. The films annealed in N2-O2 and N2-H2 showed poorer electromigration performance, in that order. Stronger Al (111) texture, larger median grain size and uniform grain size distribution have been responsible for the improved electromigration performance of the N2-annealed (furnace-cooled) films. On the contrary, Al alloy films on TiN substrates annealed in N2 (but air-cooled), N2-O2, or N2-H2 ambient showed weaker Al (111) textures and smaller median grain sizes.
When protogalaxies collapse, the cooling and infall of what will become the visible galactic component affects the mass distribution of dissipationless dark matter particles which constitute the halo. For spiral galaxies, the reaction of the dissipationless halo can have a striking effect on the resulting rotation curves [1–5].