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To define the relationship of SARS-CoV-2 antigen, viral load determined by RT-qPCR, and viral culture detection. Presumptively, viral culture can provide a surrogate measure for infectivity of sampled individuals and thereby inform how and where to most appropriately deploy antigen and nucleic acid amplification-based diagnostic testing modalities. We compared the antigen testing results from three lateral flow and one microfluidics assay to viral culture detection and viral load determination performed in parallel in up to 189 nasopharyngeal swab samples positive for SARS-CoV-2. Sample viral loads, determined by RT-qPCR, were distributed across the range of viral load values observed in our testing population. Antigen tests were predictive of viral culture positivity, with the LumiraDx microfluidics method showing enhanced sensitivity (90%; 95% CI 83–94%) compared with the BD Veritor (74%, 95% CI 65–81%), CareStart (74%, 95% CI 65–81%) and Oscar Corona (74%, 95% CI 65–82%) lateral flow antigen tests. Antigen and viral culture positivity were also highly correlated with sample viral load, with areas under the receiver operator characteristic curves of 0.94 to 0.97 and 0.92, respectively. A viral load threshold of 100 000 copies/mL was 95% sensitive (95% CI, 90–98%) and 72% specific (95% CI, 60–81%) for predicting viral culture positivity. Adjusting for sample dilution inherent in our study design, sensitivities of antigen tests were ≥95% for detection of viral culture positive samples with viral loads >106 genome copies/mL, although specificity of antigen testing was imperfect. Antigen testing results and viral culture were correlated. For culture positive samples, the sensitivity of antigen tests was high at high viral loads that are likely associated with significant infectivity. Therefore, our data provides support for use of antigen testing in ruling out infectivity at the time of sampling. [ABSTRACT FROM AUTHOR]

Beamforming on the icosahedral loudspeaker (IKO), a compact, spherical loudspeaker array, was recently established and investigated as an instrument to produce auditory sculptures (i.e., 3-D sonic imagery) in electroacoustic music. Sound beams in the horizontal plane most effectively and expressively produce auditory objects via lateral reflections on sufficiently close walls and baffles. Can there be 3-D-printable arrays at drastically reduced cost and transducer count, but with similarly strong directivity in the horizontal plane? To find out, we adopt mixed-order Ambisonics schemes to control fewer, and predominantly horizontal, beam patterns, and we propose the 3|9|3 array as a suitable design, with beamforming crossing over to Ambisonics panning at high frequencies. Analytic models and measurements on hardware prototypes permit a comparison between the new design and the IKO regarding beamforming capacity. Moreover, we evaluate our 15-channel 3|9|3 prototype in listening experiments to find out whether the sculptural qualities and auditory object trajectories it produces are comparable to those of the 20-channel IKO. [ABSTRACT FROM AUTHOR]

An approach for the preparation of homogenous SrTiO3 (STO) thin films with unprecedented compositional control is presented. Nanolaminates of SrO and TiO2 were deposited at 300 °C by atomic layer deposition on bare silicon, as well as on ruthenium electrodes using metalorganic precursors [Ti(NEtMe)4 (TEMATi),Sr(iPr3Cp)2 (AbsoluteSr)]. Care was taken that the individual sublayers were grown with a number of subcycles well in the steady-state growth regime. This enabled linear composition tuning with the Sr:Ti pulse ratio, which is beneficial for process control. Still, a substrate-specific growth behavior was observed for the individual precursors leading to different cycle ratio/composition dependence for samples grown on Si as compared to Ru substrates. This could be attributed to specific nucleation conditions, which are most pronounced for the initial cycle, but also prevail throughout the film. The as-deposited layers are well separated and the sublayers are amorphous. Subsequent furnace-annealing generated polycrystalline cubic STO films, but also caused a severe distortion of the metal electrode/STO stack, due to interdiffusion. The latter was suppressed by optimized rapid thermal crystallization anneals. [ABSTRACT FROM AUTHOR]

Background: The emergence of Neisseria gonorrhoeae resistant to all currently available antimicrobial therapies poses a dire public health threat. New antimicrobial agents with activity against N. gonorrhoeae are urgently needed. Apramycin is an aminocyclitol aminoglycoside with broad-spectrum in vitro activity against MDR Gram-negative pathogens and Staphylococcus aureus. However, its activity against N. gonorrhoeae has not been described.Objectives: The activity spectrum of apramycin against a collection of MDR N. gonorrhoeae was assessed. Isolates tested included those susceptible and resistant to the structurally distinct aminocyclitol, spectinomycin.Results: The modal MICs for apramycin and spectinomycin were 16 mg/L and 32 mg/L, respectively. The epidemiological cut-off (ECOFF) for apramycin was 64 mg/L. No strains among 77 tested had an MIC above this ECOFF, suggesting very low levels of acquired apramycin resistance. In time-kill analysis, apramycin demonstrated rapid bactericidal activity comparable to that of spectinomycin.Conclusions: Apramycin has broad-spectrum, rapidly bactericidal activity against N. gonorrhoeae. Future pharmacokinetic and pharmacodynamic studies will be needed to determine whether apramycin and/or apramycin derivatives hold promise as new therapeutics for N. gonorrhoeae infection. [ABSTRACT FROM AUTHOR]

We demonstrate the deposition of Si x N y thin films using octachlorotrisilane (Si 3 Cl 8 ) and ammonia between 300 and 500 °C by an atomic layer deposition-like growth mechanism. Although there are chemical vapor deposition growth mechanisms present, which lead to an incomplete saturation, a step coverage > 80% in high aspect ratio (> 60:1) trenches could be achieved. The deposited films oxidize after contact with ambient air leading to substoichiometric N/Si ratios. Increasing the deposition temperature diminishes this oxidation. At temperatures > 390 °C a bulk N/Si ratio of ~ 1.3 is achieved. The capacitance–voltage (C–V) measurements of these films yield a k value of ~ 6 and a strong C–V hysteresis indicates significant charge trapping. [ABSTRACT FROM AUTHOR]

Abstract: Sepsis and severe sepsis cause significant morbidity and mortality among populations worldwide; the rapid diagnosis poses a considerable challenge to physicians in acute care settings. An ideal biomarker should allow, with high diagnostic accuracy, for an early and rapid recognition of sepsis. Procalcitonin (PCT) is a recently rediscovered biomarker that fulfills many of these requirements, especially in comparison to “older” and commonly used biomarkers, and that has demonstrated superior diagnostic accuracy for a variety of infections, including sepsis. While blood cultures are still considered the “gold standard” for the diagnosis of bacteremia and sepsis, and are perhaps one of the most important functions of the clinical microbiology laboratory, PCT provides important information in early stages of sepsis as well as during antimicrobial treatment. In fact, PCT can be useful for antimicrobial stewardship and its utilization may safely lead to significant reduction of unnecessary antimicrobial therapy. However, PCT is also less than a universal and perfect biomarker, as it can also be increased in noninfectious disease conditions. Laboratories and clinicians must appreciate the complexity of diagnostic algorithms for sepsis and understand the particular information that biomarkers, such as PCT, can offer. In that context, it is necessary to not only recognize the importance of critical clinical awareness and thorough physical patient examination, but also to understand traditional microbiological methods and the need for highly sensitive biomarker assays in order to facilitate an early diagnosis and goal-directed therapy in patients suspected of sepsis. This review is intended to provide additional information for clinicians and microbiologists to better understand the physiology and diagnostic utility of procalcitonin for sepsis and other infectious disease conditions. [Copyright &y& Elsevier]

Abstract: The fabrication of high aspect ratio silicon trenches (critical dimension<100nm, aspect ratio>10:1) by dry etch processing has proven to be a challenge mainly due to limited etch selectivity of conventional hardmask materials to Si. Moreover, for future technology nodes the hardmask thickness will be limited by the thickness of the photoresist. This work focuses on a concept to enable the usage of very thin resist layers (<100nm) for patterning of silicon trenches by the integration of an unconventional hardmask stack consisting of SiO2 and ZrO2. Deposition of such material films has been investigated, as well as e-beam lithography exposure and finally pattern transfer by dry etching. Using this hardmask stack and 100nm thin resist, the fabrication of 35nm wide trenches with an aspect ratio of ~20:1 is demonstrated revealing a very high selectivity (>100:1) of the ZrO2 layer to Si during the deep silicon etch. A silicon etch rate>1.5μm/min was achieved. The ZrO2 layer itself provides the main selectivity improvements of the final hardmask stack. [Copyright &y& Elsevier]

Rapid diagnosis of bloodstream infections (BSIs) in the emergency department (ED) is challenging, with turnaround times exceeding the timeline for rapid diagnosis. We studied the usefulness of procalcitonin as a marker of BSI in 367 adults admitted to our ED with symptoms of systemic infection. Serum samples obtained at the same time as blood cultures were available from 295 patients. Procalcitonin levels were compared with blood culture results and other clinical data obtained during the ED visit. Procalcitonin levels of less than 0.1 ng/mL were considered negative; all other levels were considered positive. In 16 patients, there was evidence of BSI by blood culture, and 12 (75%) of 16 patients had a procalcitonin level of more than 0.1 ng/mL. In 186 (63.1%) of 295 samples, procalcitonin values were less than 0.1 ng/mL, and all were culture negative. With a calculated threshold of 0.1475 ng/mL for procalcitonin, sensitivity and specificity for the procalcitonin assay were 75% and 79%, respectively. The positive predictive value was 17% and the negative predictive value 98% compared with blood cultures. Procalcitonin is a useful marker to rule out sepsis and systemic inflammation in the ED. [ABSTRACT FROM AUTHOR]

Bloodstream infections (BSI) cause significant morbidity and mortality among populations worldwide. Blood cultures (BCs) are regarded as the 'gold standard' for diagnosis of bacteremia and are among the most important functions of the clinical microbiology laboratory. Significant changes in the methods and techniques of obtaining BCs have occurred since the first inception of BCs into clinical practice. Aside from significant improvements of established, conventional technology, new assays for diagnosis of bacteremia and fungemia, particularly those involving molecular techniques, are now available. BCs must be collected under sterile conditions and guidelines for appropriate collection, processing, and results reporting of BCs have been established. This review provides comprehensive information on optimal BC practices for laboratories, utilizing traditional approaches and emerging technology. As laboratories and clinicians must appreciate the key factors affecting the use of these techniques, improved communication between laboratory personnel and clinicians regarding such elements as duration of incubation, workup of contaminants and critical action value reporting will greatly improve the diagnostic approach to BSI. [ABSTRACT FROM AUTHOR]

COVID-19 symptomology may overlap with other circulating respiratory viruses that may also cause severe disease and for which there are specific and potentially life-saving treatments. The Abbott Alinity m Resp-4-Plex assay is a multiplex PCR assay that simultaneously detects and differentiates infection with SARS-CoV-2, influenza A, influenza B, and respiratory syncytial virus (RSV). We characterized its accuracy, precision, and analytical sensitivity. All were found to be robust for measures examined. In the context of sample-to-answer, near random access automation on the Alinity m platform, we believe that the Resp-4-Plex assay offers significant utility in addressing the current needs of the SARS-CoV-2 pandemic and future needs during anticipated endemic circulation of SARS-CoV-2 with other respiratory viruses. [ABSTRACT FROM AUTHOR]

Urinary tract infections are leading causes of hospital admissions. Accurate and timely diagnosis is important due to increasing morbidity and mortality from antimicrobial resistance. We evaluated a polymerase chain reaction test (Acuitas AMR Gene Panel with the Acuitas Lighthouse Software) for detection of 5 common uropathogens (Escherichia coli, Klebsiella pneumoniae, Proteus mirabilis, Pseudomonas aeruginosa, Enterococcus faecalis) and antibiotic resistance genes directly from urine for prediction of phenotypic resistance. Overall percent agreement was 97% for semiquantitative detection of uropathogens versus urine culture using a cut-off of 104 colony forming units per mL urine. Overall accuracy was 91% to 93% for genotypic prediction of common antibiotic resistance harbored by E. coli, K. pneumoniae, and P. mirabilis. [ABSTRACT FROM AUTHOR]

• SARS-CoV-2 patient samples covered the range of cycle threshold values. • Split samples were cultured fresh and after storage at 80 °C for 7 or 17-18 days. • Freeze-thaw did not significantly affect SARS-CoV-2 viral culture isolation. • Therefore, frozen samples may be used to assess SARS-CoV-2 infectiousness. The effect of freeze-thaw on SARS-CoV-2 viral viability is not well established. We isolated virus from 31 split clinical samples cultured fresh or after a 7- or 17/18-day freeze. We found that freeze-thaw did not significantly affect viral culture isolation. Therefore, frozen samples may be used to assess SARS-CoV-2 infectiousness. [ABSTRACT FROM AUTHOR]

Abstract. We report on semi‐metallic cobalt monosilicide (CoSi) as a CMOS‐compatible thermoelectric (TE) material and discuss the effect of n‐ and p‐type dopants on its transport properties. Thin films of CoSi are developed using chemical vapor deposition tools and subsequent rapid thermal processing. Film properties such as microstructure, crystallinity and elemental distribution are studied via electron microscopy, X‐ray diffraction and time‐of‐flight secondary ion mass spectroscopy. Doping silicon with boron prior to silicidation impedes the Co‐Si diffusion process, while phosphorus atoms distribute uniformly in silicides with no voids or agglomerations. CoSi makes a suitable n‐type TE candidate and provides an alternative to Si or SiGe materials. Transport properties of undoped CoSi exhibit a linear dependence within the investigated temperature window, whereas dopants in CoSi increase the number of electron carriers that contribute to charge transport and thereby influence the Seebeck coefficient. Thus, TE characteristics of thin CoSi films can be tuned via (i) the type of dopants used and/or (ii) varying the residual silicon thickness post silicidation. [ABSTRACT FROM AUTHOR]

Methylotrophic bacteria use methanol and related C1 compounds as carbon and energy sources. Methanol dehydrogenases are essential for methanol oxidation, while lanthanides are important cofactors of many pyrroloquinoline quinone-dependent methanol dehydrogenases and related alcohol dehydrogenases. We describe here the physiological and genomic characterization of newly isolated Beijerinckiaceae bacteria that rely on lanthanides for methanol oxidation. A broad physiological diversity was indicated by the ability to metabolize a wide range of multicarbon substrates, including various sugars, and organic acids, as well as diverse C1 substrates such as methylated amines and methylated sulfur compounds. Methanol oxidation was possible only in the presence of low-mass lanthanides (La, Ce, and Nd) at submicromolar concentrations (-100 nM). In a comparison with other Beijerinckiaceae, genomic and transcriptomic analyses revealed the usage of a glutathione- and tetrahydrofolate-dependent pathway for formaldehyde oxidation and channeling methyl groups into the serine cycle for carbon assimilation. Besides a single xoxF gene, we identified two additional genes for lanthanide-dependent alcohol dehydrogenases, including one coding for an ExaF-type alcohol dehydrogenase, which was so far not known in Beijerinckiaceae. Homologs for most of the gene products of the recently postulated gene cluster linked to lanthanide utilization and transport could be detected, but for now it remains unanswered how lanthanides are sensed and taken up by our strains. Studying physiological responses to lanthanides under nonmethylotrophic conditions in these isolates as well as other organisms is necessary to gain a more complete understanding of lanthanide-dependent metabolism as a whole. [ABSTRACT FROM AUTHOR]

The author discusses a study which investigated the use of procalcitonin (PCT) to reduce antibiotic utilization in intensive care units (ICU), by Layios and colleagues, published within the issue. He says that the study is very interesting since it showed that PCT did not significantly reduced antibiotics usage in ICU patients. He also commends the study authors for showing the dilemma of assessing the clinical utility of a biomarker in the context of complex, acute and critical care settings.

Sarcina ventriculi , also known as Zymosarcina ventriculi and, incorrectly, as Clostridium ventriculi , is rarely encountered in clinical settings. A patient with a complicated gastrointestinal (GI) history, who was acutely presenting with small-bowel obstruction, was found to be colonized by S. ventriculi. The distinctive morphology of this species, with large Gram-variable cocci (up to 3 µm) arranged in two-by-two cuboid clusters reaching up to 20 µm, was key in identifying this bacterium in a stomach biopsy specimen. Sarcina ventriculi appears to be ubiquitously found in nature, and related bacterial species can cause GI-related disease in various animals. Clinical manifestations in humans are broad and often related to other underlying comorbidities. Isolation of S. ventriculi in the laboratory requires anaerobic culture on select media but its absence from standard MALDI-TOF databases complicates identification. Susceptibility data do not exist, so empiric treatment is the only option for this rare pathogen. [ABSTRACT FROM AUTHOR]

Highlights • We study annealing effect on memory states stability in CoFeB/MgO/CoFeB based perpendicular MTJs. • Our study indicates a ferromagnetic coupling between the storage and reference layers. • Enhance pMTJs stability by playing perpendicular magnetic anisotropy and interlayer coupling. Abstract Perpendicular magnetic tunnel junctions (p-MTJs) attract great interest because of their excellent performance in spin-transfer-torque magnetic random access memories (STT-MRAMs). The annealing process is critical to achieve the required structural and magnetic properties, therefore obtaining high perpendicular tunneling magnetoresistance (p-TMR) and lower switching current. In this work, the CoFeB/MgO/CoFeB-based p-TMR stack was prepared and a high p-TMR value of 155.9% was obtained from CIPT. The p-MTJs were patterned with pillar sizes ranging from 50 nm to 1000 nm and were annealed upon different annealing temperatures (T A) of 300 and 340 °C. The resistance at parallel (R P) and antiparallel (R AP) state in p-MTJs was obtained upon the application of a ±30 mT perpendicular magnetic field, where the angle of magnetization between storage and reference layer at memory state, θ P and θ AP , were derived from the P and AP resistance ratios with and without magnetic field. The condition θ P = θ AP of about 63.5° was found in as-deposited samples, indicating a ferromagnetic interlayer coupling between storage and reference layers, where θ P = 0° and θ AP = 180° at T A = 300 °C and 340 °C demonstrate a stable memory state. The stability of the resistance state was modeled by considering the evolution of effective perpendicular magnetic anisotropy (K eff) and interlayer coupling constant (J), showing a method to evaluate the ratio of K eff / J via the memory state resistance characterization, where the K eff / J of about −1.26 was obtained in our as-deposited samples. Our study assesses the effect of T A on the θ P and θ AP and supplies the method to enhance the stability through the optimization of perpendicular magnetic anisotropy and interlayer coupling, so to better control the performance of p-MTJ-based STT-MRAMs. [ABSTRACT FROM AUTHOR]

Perpendicular magnetic tunnel junctions (p-MTJs) have been explored for spin transfer torque magnetic random access memory devices (STT-MRAMs). The current-induced switching (CIS) of the p-MTJs requires a relatively high current density (J); thereby, very thin insulating barriers are required, consequently increasing the risk of non-tunneling conduction mechanisms through the MgO film. In this work, we fabricated CoFeB/MgO/CoFeB p-MTJs and studied the CIS characteristics, with the obtained switching current densities of about 2 × 1010 A/m2. The filament conduction through the MgO film was induced by applying a high set current (Iset) until a significant decrease in the resistance (R) is observed. A decrease in R with increasing current (I) for parallel (P) and antiparallel (AP) states was observed. In contrast, an increase in R with the increasing I value was observed for filament p-MTJs. We used a two-channel model to extract the filament resistance (Rf) and filament current (If). The Rf dependence on the electrical power (Pf) was linearly fitted, and a heating coefficient β of about 6%/mW was obtained, which was much higher than 0.15%/mW obtained from the bulk metallic multilayers of the top electrode. The CIS for filament p-MTJs was modeled by considering the bias dependence of the tunneling and the thermal dependence of Rf, showing a significant change in the CIS curves and switching currents. Our study addresses the effect of filament conduction on the tunneling current of CoFeB/MgO/CoFeB p-MTJs, critical for the design and control of the p-MTJ based devices, such as STT-MRAMs. [ABSTRACT FROM AUTHOR]

Background: Aerobic exercise can improve cognitive performance in healthy elderly people. Objective: The aim of this study was to investigate the influence of a 3-week high-intensity aerobic exercise programme (high-intensity training group (HIT)) on cognitive performance in persons with multiple sclerosis (MS) compared with a standard exercise programme (control training (CT)). Methods: A total of 60 persons with MS (Expanded Disability Status Scale (EDSS): 1.0–6.5) were randomized to a HIT group (3×/week for 20 minutes, including five 3-minute exercise intervals at 80% of peak oxygen uptake (VO2-peak)) or a CT group (continuously 5×/week for 30 minutes/session at 65% of VO2-peak). Cognitive performance was assessed using the Brief International Cognitive Assessment for MS at entry (t0) and discharge (t1). Furthermore, VO2-peak, brain-derived neurotrophic factor, serotonin and matrix metalloproteinases (MMP)-2 and -9 were measured. Results: Compared to CT, HIT significantly improved verbal memory. Significant improvements over time in executive functions were found in both groups. Secondary outcomes indicated significant improvements in VO2-peak and a significant reduction in MMP-2 in the HIT group only. Conclusion: HIT represents a promising strategy to improve verbal memory and physical fitness in persons with MS. Further research is needed to determine the impact of exercise on biomarkers in MS. [ABSTRACT FROM AUTHOR]

We investigated whether outpatient antimicrobial drug prescribing is associated with Neisseria gonorrhoeae antimicrobial drug susceptibility in the United States. Using susceptibility data from the Gonococcal Isolate Surveillance Project during 2005-2013 and QuintilesIMS data on outpatient cephalosporin, macrolide, and fluoroquinolone prescribing, we constructed multivariable linear mixed models for each antimicrobial agent with 1-year lagged annual prescribing per 1,000 persons as the exposure and geometric mean MIC as the outcome of interest. Multivariable models did not demonstrate associations between antimicrobial drug prescribing and N. gonorrhoeae susceptibility for any of the studied antimicrobial drugs during 2005-2013. Elucidation of epidemiologic factors contributing to resistance, including further investigation of the potential role of antimicrobial drug use, is needed. [ABSTRACT FROM AUTHOR]

Ice is defined as a food and is frequently used in direct contact with food and beverages. Packaged ice is commercially produced and can be easily found in grocery and convenience stores. However, the quality and safety of packaged ice products is not consistent. The Packaged Ice Quality Control Standards manual (PIQCS) published by the International Packaged Ice Association provides the quality and processing standards for packaged ice produced by its members. Packaged ice produced on the premise of stores (on-site packaged ice) is not required to be in compliance with these standards. In this study, packaged ice produced by manufacturing plants or by in-store bagger (ISB) machines and on-site packaged ice were compared for their microbiological quality and microbial diversity. Our results revealed that 19% of the 120 on-site packaged ice samples did not meet the PIQCS microbial limit of 500 CFU/mL (or g) and also the absence of coliforms and Escherichia coli. Staphylococci were found in 34% of the on-site packaged ice samples, most likely through contamination from the packaging workers. None of the ISB and manufactured packaged ice samples had unacceptable microbial levels, and all were devoid of staphylococci. Salmonella was absent in all samples analyzed in this study. Microbial community analysis of ice based on 16S/18S rRNA targeted sequencing revealed a much higher microbial diversity and abundance in the on-site packaged ice than in the ISB ice. Proteobacteria, especially Alphaproteobacteria and Betaproteobacteria, were the dominant bacterial groups in all samples tested. Most of these bacteria were oligotrophic; however, a few opportunistic or potential pathogens were found at low levels in the on-site packaged ice but not in the ISB packaged ice. The types of microbes identified may provide information needed to investigate potential sources of contamination. Our data also suggest a need for enforcement of processing standards during the on-site packaging of ice. [ABSTRACT FROM AUTHOR]

Objectives: During hospitalizations, blood is drawn for diagnostic laboratory tests to help guide patient care. Often, blood tests continue to be ordered even in the face of clinical and laboratory stability. Blood draws are painful and costly, and they may be associated with anemia. We hypothesized that provider education could reduce the frequency of daily blood tests ordered for hospitalized patients. Methods: During a 2-month intervention period, internal medicine providers were educated through flyers displayed in providers' offices and periodic email communications reminding them to order daily blood tests only if the results would change patient care. Two-month preintervention data from 982 patients and 2-month postintervention data from 988 patients were analyzed. The primary outcome measured was the number of daily blood tests ordered per patient per day. Results: Mean orders of CBC decreased from 1.46 to 1.37 tests per patient per day (P < .05) after the intervention. Basic metabolic panel orders were reduced from 0.91 to 0.83 tests per patient per day (P < .05). Cost analyses showed a reduction of $6.33 per patient day based on the decrease in the number of daily laboratory tests ordered. Conclusions: Provider education and reminders can reduce the frequency of daily blood tests ordered by providers for hospitalized patients. This can decrease health care costs and may reduce the risk of complications such as anemia. [ABSTRACT FROM AUTHOR]

BACKGROUND: Elimination of wasteful diagnostic testing will improve value for the United States health care system. OBJECTIVE: Design and implement a multimodal intervention to improve evidence-based ordering of cardiac biomarkers for the diagnosis of acute coronary syndrome (ACS). DESIGN: Interrupted times series. SUBJECTS: A total of 60,494 adult inpatient admissions from January 2009 through July 2011 (pre-intervention) and 24,341 admissions from November 2011 through October 2012 (post-intervention) at an academic medical center in Baltimore, Maryland. INTERVENTION: Multimodal intervention introduced August through October 2011 that included dissemination of an institutional guideline and changes to the computerized provider order entry system. MAIN MEASURES: The primary outcome was percentage of patients with guideline-concordant ordering of cardiac biomarkers, defined as three or fewer troponin tests and zero CK-MB tests in patients without a diagnosis of ACS. Secondary outcomes included counts of tests ordered per patient, incidence of diagnosis of ACS, and estimated change in charges for cardiac biomarker tests in the post-intervention period. KEY RESULTS: Twelve months following the intervention, we estimated that guideline-concordant ordering of cardiac biomarkers increased from 57.1 % to 95.5 %, an absolute increase of 38.4 % (95 % CI, 36.4 % to 40.4 %). We estimated that the intervention led to a 66 % reduction in the number of tests ordered, and a $1.25 million decrease in charges over the first year. At 12 months, there was an estimated absolute increase in incidence of primary diagnosis of ACS of 0.3 % (95 % CI, 0.0 % to 0.5 %) compared with the expected baseline rate. CONCLUSIONS: We implemented a multimodal intervention that significantly increased guideline-concordant ordering of cardiac biomarker testing, leading to substantial reductions in tests ordered without impacting diagnostic yield. A trial of this approach at other institutions and for other diagnostic tests is warranted and if successful, would represent a framework for eliminating wasteful diagnostic testing. [ABSTRACT FROM AUTHOR]

Privacy curtains, frequently used in hospitals to separate patient care areas may have an important role in the transmission of healthcare-associated pathogens. In this pilot study, we inoculated curtain swatches with suspensions of clinical specimens of meticillin resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococcus (VRE), and Clostridium difficile before using a gloved hand to touch the inoculated curtain swatch and transfer to clean agar plates. Three different commonly used disinfectants were then sprayed onto these swatches before using a clean gloved hand to touch the swatch and transfer onto new agar plates. All plates were incubated at 35°C for 24 and 72 h. Bacterial growth before and after disinfection was assessed and compared. 3.1% hydrogen peroxide effectively eliminated transfer of C. difficile, MRSA and VRE from inoculated curtains. [ABSTRACT FROM PUBLISHER]

The long-term use of proton pump inhibitors has been linked to an increased risk for the development of gastric polyps, hip fractures, pneumonia, and Clostridium difficile colitis. There is evidence that chronic acid suppression from long-term use of proton pump inhibitors poses some risk for the development of C difficile–associated diarrhea by decreasing the elimination of pathogenic microbes before reaching the lower gastrointestinal tract. Here we present a case of a 51-year-old woman with a recent history of abdominal pain and fever who presented to the emergency department with rapidly progressive spontaneous necrotizing fasciitis and gas gangrene and died within hours of presentation. Postmortem examination confirmed spreading tissue gas gangrene and myonecrosis. In addition, multiple intestinal ulcers containing Clostridium septicum were present at autopsy. This case illustrates a possible association between proton pump inhibitor therapy and fatal C septicum infection. [ABSTRACT FROM AUTHOR]

Objectives: The stability of urine specimens submitted for culture remains a challenge for many laboratories because of delays in specimen transport. We evaluated the usefulness of BD Vacutainer Plus Urine C&S Preservative Tube in ensuring specimen stability. Methods: Clinical urine specimens collected in sterile collection cups (n = 110) were plated onto sheep blood and MacConkey agar following standard laboratory procedures guidelines. Thereafter, specimens were divided into 3 storage conditions: nonpreservative, refrigerated; nonpreservative, room temperature (RT); BD Vacutainer Plus Urine C&S Preservative Tube, RT. For each sample type, additional cultures were set up at 2, 4, 24, and 48 hours. Results: Initially, 18 specimens had no growth, 32 showed mixed skin flora, and 60 yielded at least 1 uropathogen. Increased colony counts of uropathogens were observed for nonpreserved urine samples stored at RT; these changes were statistically significant. Minor differences between refrigerated urine samples and BD Vacutainer Plus Urine C&S Preservative Tube samples were seen but were not statistically significant. Conclusions: The use of preservative-containing collection tubes is desirable to ensure specimen stability when prompt processing or refrigeration is not feasible. [ABSTRACT FROM AUTHOR]

Highlights: [•] Lowering top electrode deposition temperature improves MIM-capacitor performance. [•] Substrate pre-treatment with chemical oxide improves reliability of MIM-capacitor. [•] Poole–Frenkel conduction was fitted for higher voltage regions. [Copyright &y& Elsevier]

Abstract: German Environmental Surveys (GerESs) are large scale population studies which have been carried out on adults in 1985/86, 1990/92 and 1998 and on children aged 6–14 years in 1990/92. GerES IV is the first survey focussing exclusively on children [Becker, K., Schulz, C., Babisch, W., Dürkop, J., Roskamp, E., Seiwert, M., Szewzyk, R., Ullrich, D., Seifert, B., 2005. German Environmental Survey for Children (GerES IV) 2003–2006. Pullut. Atmos. 188, 475–479]. GerES IV included a representative sample of 1790 children aged 3–14 of the participants of the National Health Interview and Examination Survey on Children and Adolescents. The primary goal of GerES IV is not only to analyse and document the extent, distribution and determinants of German children''s exposure to environmental pollutants but to discover links between environmental exposure and health. Results will help develop preventive measures and advance further research. They might provide the basis for environmental and public health policy decisions. Precondition to achieve this task is a description of the data on exposures and the data on health outcomes. This work is currently performed at the Federal Environment Agency. First results show a remarkable decrease of the blood lead level of German children aged 6–14 years from 32.3μg/l in 1990/92 (GerES II) to 16.3μg/l in GerES IV which is the lowest mean lead concentration determined in German studies so far. None of the children had a value exceeding 100μg/l. In GerES IV, the following health-related issues will be primarily examined: the relationship between sensitisation against mould spores and the occurrence of mould in households, irritation of eyes and respiratory system caused by formaldehyde, other aldehydes, or total volatile organic compounds (TVOC); the impact of non-occupational noise on hearing loss, stress and sleep disturbances, and the connection between contact allergies, nickel and scents. 9.5% of the children showed a sensitisation to at least one of the moulds examined (Penicillium (notatum) chrysogenum, Aspergillus versicolor, Wallemia sebi, Eurotium spp., Alternaria alternata). The most frequent sensitisation was against Penicillium chrysogenum. GerES IV might broaden the knowledge in terms of environmental causes of health outcomes. Children of smoking mothers showed higher mean cotinine concentrations than children living with a smoking father, regardless whether they smoked daily or occasionally. Results from the GerES IV pilot study showed a relation between environmental tobacco smoke (ETS) exposure and an increased susceptibility to infections and inflammations of the middle ear. [Copyright &y& Elsevier]

We compared a lateral flow immunoassay (LFA) to a currently used enzyme immunoassay for detection of cryptococcal antigen in 396 sera and 651 cerebrospinal fluid specimens. We found 97% concordance between the 2 assays. The LFA detected an additional 22 positives. Overall, the LFA had sensitivity of 100% and specificity of 99.6% for the diagnosis of cryptococcosis. The LFA is rapid, accurate, and easy to perform, and it is suitable for routine patient care testing. [ABSTRACT FROM AUTHOR]

The analytical performance of the FDA-cleared AIX1000 automated RPR testing platform was evaluated in comparison to manual RPR card testing. Eight hundred thirty-three patient serum samples were analyzed, 87 samples were positive by the AIX1000, 108 were positive by the manual test method; overall agreement between methods was 96.5% (κ = 0.83). Cases were further classified by clinical and laboratory-based confirmation of disease, to which reactivity rates were compared, yielding sensitivities of 96.4% and 100%, and specificities of 99.2% and 96.8% for the automated and manual RPR methods, respectively. The difference in specificity between methods was statistically significant (P < 0.001). Twenty-five of 29 samples with discordant results were reactive by manual testing (titers of 1:1 or 1:2); 21 of 25 patients with negative AIX100 results were identified to have histories of remote, treated syphilis. Overall, the AIX1000 platform demonstrated excellent agreement with the manual RPR method; discrepancies occurred with specimens at the threshold of reactivity. [ABSTRACT FROM AUTHOR]

The airway fluids of cystic fibrosis (CF) patients contain local pH gradients and are more acidic than those of healthy individuals. pH is a critical factor that is often overlooked in studies seeking to recapitulate the infection microenvironment. We sought to determine the impact of pH on the physiology of a ubiqituous yet understudied microbe, Stenotrophomonas maltophilia. Phylogenomics was first used to reconstruct evolutionary relationships between 74 strains of S. maltophilia (59 from CF patients). Neither the core genome (2,158 genes) nor the accessory genome (11,978 genes) distinguish the CF and non-CF isolates; however, strains from similar isolation sources grouped into the same subclades. We grew two human and six CF S. maltophilia isolates from different subclades at a range of pH values and observed impaired growth and altered antibiotic tolerances at pH 5. Transcriptomes revealed increased expression of both antibiotic resistance and DNA repair genes in acidic conditions. Although the gene expression profiles of S. maltophilia in lab cultures and CF sputum were distinct, we found that the same genes associated with low pH were also expressed during infection, and the higher pH cultures were more similar to sputum metatranscriptomes. Our findings suggest that S. maltophilia is not well adapted to acidity and may cope with low pH by expressing stress response genes and colonizing less acidic microenvironments. As a whole, our study underlines the impact of microenvironments on bacterial colonization and adaptation in CF infections. [ABSTRACT FROM AUTHOR]