Background: Idiopathic Normal Pressure Hydrocephalus (iNPH) is a disorder of the elderly with progressive worsening of gait and balance, cognition, and urinary control which requires assessment using criteria recommended by International iNPH guidelines. Methods: Adult Hydrocephalus Clinical Research Network (AHCRN) prospective registry data from 5-centers over a 50-month interval included entry criteria; demographics; comorbidities; examination findings using standard AHCRN gait and neuropsychology assessments; shunt procedures, complications of CSF drainage, complications within 30 days of surgery, and 1-year postoperative follow-up. Results: 547 patients were referred for assessment of suspected-iNPH. 123 patients(21.6%) did not meet clinical criteria to proceed with further testing. 424 patients(74.4%;mean age 76.7 ± 6.0 years;males=269) underwent an LP or lumbar drain, and 193(45.6%) underwent insertion of a ventriculoperitoneal shunt. By 8-12 months after shunt surgery, gait velocity was 0.96±0.35m/s (54% faster than pre-CSF-drainage). Mean MoCA scores increased from 21.0 ± 5.0(median=22.0) at baseline to 22.6±5.5(median=24) 12-months post-surgery. Gait and cognitive improvements were clinically significant. No deaths occurred. 8% of shunt-surgery patients experienced minor complications. The 30-day reoperation rate was 4.1%. Conclusions: This AHCRN study demonstrated that CSF-drainage testing of patients with suspected-iNPH successfully identified those who could undergo CSF-shunt surgery with a high rate of improvement and a low rate of complications.

Background: To describe preliminary results of a multi-center, randomized, blinded, placebo-controlled, pilot trial of shunt surgery in idiopathic normal pressure hydrocephalus (iNPH). Methods: Five sites of the Adult Hydrocephalus Clinical Research Network (AHCRN) randomized 18 patients scheduled for ventriculoperitoneal shunting based on CSF-drainage response. Patients were randomized to a Codman® Certas® Plus valve with SiphonGuard at either setting 4 (Active, N=9) or setting 8/”virtual off” (Placebo, N=9). Patients and assessors were blinded to the shunt setting. Outcomes included 10-meter gait velocity, cognitive function, and bladder activity scores. The prespecified primary analysis compared changes in 4-month gait velocity in the Active versus Placebo groups. Placebo-set shunts were then blindly adjusted to the active setting and all patients underwent 8 and 12-month post-surgical assessment. Results: At 4-months, gait velocity increased by 0.28±0.28m/s in the Active Group and 0.04±0.17m/s in the Placebo Group (p=0.071). Overactive Bladder (OAB-q) scores significantly improved in the Active versus Placebo groups (p=0.007). At 8 months, Placebo gait velocity increased by 0.36±0.27m/s and was comparable to the Active Group (0.40±0.20m/s; p=0.56). Conclusions: This AHCRN study shows a trend suggesting gait velocity improves more at an Active shunt setting than a Placebo shunt setting and demonstrates the feasibility of a placebo-controlled trial in iNPH.

Broad-spectrum antibiotics with once-daily dosing are often chosen for outpatient parenteral antibiotic therapy (OPAT) due to convenience even when narrower-spectrum antibiotics are appropriate. At our institution, up to 50% of select broad-spectrum OPAT regimens had potential to be narrowed, highlighting the need to re-evaluate regimens for de-escalation prior to discharge.

This paper describes a computational investigation of multimode instability growth and multimaterial mixing induced by multiple shock waves in a high-energy-density (HED) environment, where pressures exceed 1 Mbar. The simulations are based on a series of experiments performed at the National Ignition Facility (NIF) and designed as an HED analogue of non-HED shock-tube studies of the Richtmyer–Meshkov instability and turbulent mixing. A three-dimensional computational modelling framework is presented. It treats many complications absent from canonical non-HED shock-tube flows, including distinct ion and free-electron internal energies, non-ideal equations of state, radiation transport and plasma-state mass diffusivities, viscosities and thermal conductivities. The simulations are tuned to the available NIF data, and traditional statistical quantities of turbulence are analysed. Integrated measures of turbulent kinetic energy and enstrophy both increase by over an order of magnitude due to reshock. Large contributions to enstrophy production during reshock are seen from both the baroclinic source and enstrophy–dilatation terms, highlighting the significance of fluid compressibility in the HED regime. Dimensional analysis reveals that Reynolds numbers and diffusive Péclet numbers in the HED flow are similar to those in a canonical non-HED analogue, but conductive Péclet numbers are much smaller in the HED flow due to efficient thermal conduction by free electrons. It is shown that the mechanism of electron thermal conduction significantly softens local spanwise gradients of both temperature and density, which causes a minor but non-negligible decrease in enstrophy production and small-scale mixing relative to a flow without this mechanism.

Increasingly, demands are placed on healthcare systems to meet antimicrobial stewardship standards and reporting requirements. This trend, combined with reduced financial and personnel resources, has created a need to adopt information technology (IT) to help ease these burdens and facilitate action. The incorporation of IT into an antimicrobial stewardship program can help improve stewardship intervention efficiencies and facilitate the tracking and reporting of key metrics, including outcomes. This paper provides a review of the stewardship-related functionality within these IT systems, describes how these platforms can be used to improve antimicrobial use, and identifies how they can support current and potential future antimicrobial stewardship regulatory and accreditation standards. Finally, recommendations to help close the gaps in existing systems are provided and suggestions for future areas of development within these programs are delineated.

We report daptomycin minimum inhibitory concentrations (MICs) for vancomycin-resistant Enterococcus faecium isolated from bloodstream infections over a 4-year period. The daptomycin MIC increased over time hospital-wide for initial isolates and increased over time within patients, culminating in 40% of patients having daptomycin-nonsusceptible isolates in the final year of the study.

Infect Control Hosp Epidemiol 2018;39:226–228

Copper activation was used to characterize high-energy proton beam acceleration from near-critical density plasma targets. An enhancement was observed when decreasing the target density, which is indicative for an increased laser-accelerated hot electron density at the rear target-vacuum boundary. This is due to channel formation and collimation of the hot electrons inside the target. Particle-in-cell simulations support the experimental observations and show the correlation between channel depth and longitudinal electric field strength is directly correlated with the proton acceleration.

Self-modulated wakefield acceleration was investigated at densities down to ~4 × 1018 cm−3 by propagating the 50 TW 300 fs LULI laser in helium gas jets at lengths up to 1 cm. Long interaction lengths were achieved by closer matching of the initial focal spot size to the matched spot size for these densities. Electrons with energies extending to 180 MeV were observed in broad energy spectra which show some evidence for non-Maxwellian features at high energy. Two-dimensional PIC simulations indicate that the intial laser pulse breaks up into small pulselets that are eventually compressed and focused inside the first few plasma periods, leading to a ‘bubble-like’ acceleration of electron bunches.

Genetic diversity of Trypanosoma cruzi may play a role in pathogenesis of Chagas disease forms. Natural populations are classified into 6 Discrete Typing Units (DTUs) Tc I-VI with taxonomical status. This study aimed to identify T. cruzi DTUs in bloodstream and tissue samples of Argentinean patients with Chagas disease. PCR-based strategies allowed DTU identification in 256 clinical samples from 239 Argentinean patients. Tc V prevailed in blood from both asymptomatic and symptomatic cases and Tc I was more frequent in bloodstream, cardiac tissues and chagoma samples from immunosuppressed patients. Tc II and VI were identified in a minority of cases, while Tc III and Tc IV were not detected in the studied population. Interestingly, Tc I and Tc II/VI sequences were amplified from the same skin biopsy slice from a kidney transplant patient suffering Chagas disease reactivation. Further data also revealed the occurrence of mixed DTU populations in the human chronic infection. In conclusion, our findings provide evidence of the complexity of the dynamics of T. cruzi diversity in the natural history of human Chagas disease and allege the pathogenic role of DTUs I, II, V and VI in the studied population.

As the state of the art for high power laser systems increases from terawatt to petawatt level and beyond, a crucial parameter for routinely monitoring high intensity performance is laser spot size on a solid target during an intense interaction in the tight focus regime (<10 µm). Here we present a novel, simple technique for characterizing the spatial profile of such a laser focal spot by imaging the interaction region in third harmonic order (3ωlaser). Nearly linear intensity dependence of 3ωlaser generation for interactions >1019 Wcm−2 is demonstrated experimentally and shown to provide the basis for an effective focus diagnostic. Importantly, this technique is also shown to allow in-situ diagnosis of focal spot quality achieved after reflection from a double plasma mirror setup for very intense high contrast interactions (>1020 Wcm−2) an important application for the field of high laser contrast interaction science.

A 63nm Twin Flash memory cell with a size of 0.0225μm2 per 2 (or 4) bits is presented. To achieve small cell areas, a buried bit line and an aggressive gate length of 100 nm are the key features of this cell together with a minimum thermal budget processing. A novel epitaxial CoSi2 process allows the salicidation of local buried bitlines with only a few tens of nanometer width.

We report on first results of computing synthetic spectra from H/He-poor accretion disks in ultracompact LMXBs. We aim at the determination of the chemical composition of the very low-mass donor star, which is the core of a former C/O white dwarf. The abundance analysis allows to draw conclusions on gravitational settling in WDs which is an important process affecting cooling times and pulsational g-mode periods.

We have developed a new code for the calculation of synthetic spectra and vertical structures of accretion disks in cataclysmic variables and compact X-ray binaries. Here we present results for the CV system AM CVn.

AM CVn stars are a special type of cataclysmic variables, also called helium cataclysmics. They are systems of interacting binary white dwarfs, consisting of a degenerate C-O white dwarf primary and a low mass semi-degenerate secondary. The secondary loses mass, almost, pure helium, to the primary, forming an accretion disk. They have all in common a helium-rich composition, analoguous to the hydrogen-rich cataclysmic variables. They show photometric variabilities on time scales of ~ 1000s, the prototype of the class, AM CVn, e.g. exhibits a variability of ~ 18 min (Nelemans et al. 2001).

The effect of thin Ti/PbZr0.4Ti0.6O3 seed layers on the properties of PbZr0.4Ti0.6O3 (PZT) capacitors has been investigated. The seed layer is based on a bi-layer of thin Ti and thin PZT with a total thickness ranging from 10 to 25 nm, which was deposited on Ir/Pt or Ir/IrO2/Pt by sputtering. After crystallization of the seed layers the main 130-nm-thick PZT film was deposited and crystallized. As a result, a highly preferred (111)-orientation of the PZT was obtained on a 10-nm-thick seed layer, where the peak intensity ratios of (111)/{100} and (111)/{110} are about 100 and 20, respectively. The 10-nm-thick seed forms a pyrochlore phase with a very smooth surface, where the formation of the pyrochlore phase is attributed to Pb diffusion, resulting in a Pb deficient stoichiometry. The seed layer transformed to the perovskite phase during the main PZT crystallization. It is shown that an IrO2 layer beneath the Pt can prevent Pt layer degradation related to the volume expansion due to the oxidation of Ir during the main PZT crystallization. Capacitors with the 10-nm-thick seed layer fabricated on the Ir/Pt and Ir/IrO2/Pt substrates showed typical 2 Pr values of 44.0 μC/cm2 and 41.2 μC/cm2, respectively. The voltage found for 90%-polarization saturation is about 3.0 V, and the capacitors are fatigue-free at least up to 1010 switching cycles.

For high density FeRAM devices small cell sizes are essential. The combination of the capacitor on plug (COP) structure with the Chain FeRAM™ cell design is used to develop a 32Mb FeRAM. Based on a 0.2 μm standard CMOS process a silicide capped polysilicon plug is used to contact the bottom electrode of the ferroelectric capacitor to the transistor. The barrier contact to the plug is formed by IrO2/Ir and a sputter deposited PZT (40/60) is used as ferroelectric material. The function of SrRuO3 (SRO) layers at the electrode/PZT interfaces is described in more detail. Double sided SRO results in slightly lower coercive voltage and imprint behavior compared to capacitors without SRO. Double sided SRO is essential to achieve excellent fatigue behavior measured up to 1×1011 switching cycles.

Two long time series of polar motion were analysed with respect to a linear drift, decadal variations, Chandler wobble and annual wobble: the C01 series published by the International Earth Rotation Service (IERS) and the pole series which J. Vondrák, obtained by re-analysis of the classical astronomical observations using the HIPPARCOS reference frame (1899.7–1992.0). By a least-squares fit the linear drift of the pole, usually called ‘secular polar motion,’ was determined to 3.31 milliarcseconds/year (mas/yr) toward 76.1° West longitude. For this fit the a priori correlations within each pair of pole coordinates were taken into account, and the weighting function was calculated by estimation of empirical variance components. The decadal variations of the pole path were determined by Fourier analysis. Using a sliding window analysis, the variability of the periods, the amplitudes and the phases of the Chandler wobble and annual wobble was investigated. The variances of the results and the number of iterations needed to get a convergence in the nonlinear approach show that the new time series by Vondrák is more homogeneous and consistent than the IERS C01 series.