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IMPORTANCE: Febrile infants at low risk of invasive bacterial infections are unlikely to benefit from lumbar puncture, antibiotics, or hospitalization, yet these are commonly performed. It is not known if there are differences in management by race, ethnicity, or language. OBJECTIVE: To investigate associations between race, ethnicity, and language and additional interventions (lumbar puncture, empirical antibiotics, and hospitalization) in well-appearing febrile infants at low risk of invasive bacterial infection. DESIGN, SETTING, AND PARTICIPANTS: This was a multicenter retrospective cross-sectional analysis of infants receiving emergency department care between January 1, 2018, and December 31, 2019. Data were analyzed from December 2022 to July 2023. Pediatric emergency departments were determined through the Pediatric Emergency Medicine Collaborative Research Committee. Well-appearing febrile infants aged 29 to 60 days at low risk of invasive bacterial infection based on blood and urine testing were included. Data were available for 9847 infants, and 4042 were included following exclusions for ill appearance, medical history, and diagnosis of a focal infectious source. EXPOSURES: Infant race and ethnicity (non-Hispanic Black, Hispanic, non-Hispanic White, and other race or ethnicity) and language used for medical care (English and language other than English). MAIN OUTCOMES AND MEASURES: The primary outcome was receipt of at least 1 of lumbar puncture, empirical antibiotics, or hospitalization. We performed bivariate and multivariable logistic regression with sum contrasts for comparisons. Individual components were assessed as secondary outcomes. RESULTS: Across 34 sites, 4042 infants (median [IQR] age, 45 [38-53] days; 1561 [44.4% of the 3516 without missing sex] female; 612 [15.1%] non-Hispanic Black, 1054 [26.1%] Hispanic, 1741 [43.1%] non-Hispanic White, and 352 [9.1%] other race or ethnicity; 3555 [88.0%] English and 463 [12.0%] language other than English) met inclusion criteria. The primary outcome occurred in 969 infants (24%). Race and ethnicity were not associated with the primary composite outcome. Compared to the grand mean, infants of families that use a language other than English had higher odds of the primary outcome (adjusted odds ratio [aOR]; 1.16; 95% CI, 1.01-1.33). In secondary analyses, Hispanic infants, compared to the grand mean, had lower odds of hospital admission (aOR, 0.76; 95% CI, 0.63-0.93). Compared to the grand mean, infants of families that use a language other than English had higher odds of hospital admission (aOR, 1.08; 95% CI, 1.08-1.46). CONCLUSIONS AND RELEVANCE: Among low-risk febrile infants, language used for medical care was associated with the use of at least 1 nonindicated intervention, but race and ethnicity were not. Secondary analyses highlight the complex intersectionality of race, ethnicity, language, and health inequity. As inequitable care may be influenced by communication barriers, new guidelines that emphasize patient-centered communication may create disparities if not implemented with specific attention to equity.

Background: Racialized communities, including Black Canadians, have disproportionately higher COVID-19 cases. We examined the extent to which SARS-CoV-2 infection has affected the Black Canadian community and the factors associated with the infection. Methods: We conducted a cross-sectional survey in an area of Ontario (northwest Toronto/Peel Region) with a high proportion of Black residents along with 2 areas that have lower proportions of Black residents (Oakville and London, Ontario). SARS-CoV-2 IgG antibodies were determined using the EUROIMMUN assay. The study was conducted between August 15, 2020, and December 15, 2020. Results: Among 387 evaluable subjects, the majority, 273 (70.5%), were enrolled from northwest Toronto and adjoining suburban areas of Peel, Ontario. The seropositivity values for Oakville and London were comparable (3.3% (2/60; 95% CI 0.4–11.5) and 3.9% (2/51; 95% CI 0.5–13.5), respectively). Relative to these areas, the seropositivity was higher for the northwest Toronto/Peel area at 12.1% (33/273), relative risk (RR) 3.35 (1.22–9.25). Persons 19 years of age or less had the highest seropositivity (10/50; 20.0%, 95% CI 10.3–33.7%), RR 2.27 (1.23–3.59). There was a trend for an interaction effect between race and location of residence as this relates to the relative risk of seropositivity. Interpretation: During the early phases of the pandemic, the seropositivity within a COVID-19 high-prevalence zone was threefold greater than lower prevalence areas of Ontario. Black individuals were among those with the highest seroprevalence of SARS-CoV-2.

AbstractObjective:Although needleless connectors (NCs) are widely used in clinical practice, they carry significant risk of bloodstream infection (BSI). In this study, we quantified differences in bacterial transfer and biofilm formation between various NCs.Design:Prospective, clinically simulated in vitro experimental study.Methods:We tested 20 NCs in a 5-day clinical simulation of Staphylococcus aureusinoculations onto NC septum surfaces, which were then flushed with saline and cultured for bacterial transfer. Biofilm formation was measured through destructive sampling of the connector-catheter system. Moreover, 8 NC design factors were evaluated for their influence on bacterial transfer and biofilm formation. This study was designed without a disinfection protocol to ascertain the intrinsic risk of each NC.Results:Clave Neutron and MicroClave had the lowest overall mean log density of bacteria in the flush compared to other NCs (P< .05), except there were no statistically significant differences between Clave Neutron, Microclave, SafeTouch, and SafeAccess (P≥ .05). The amount of biofilm in the NC was positively associated with bacteria in the flush (P <.0005). Among 8 design factors, flow path was most important, with the internal cannula associated with a statistically significant 1 log reduction (LR) in bacteria in the flush (R2= 49%) and 0.5–2 LR in the connector (R2= 34%). All factors together best explained bacteria in the flush (R2= 65%) and biofilm in the connector (R2= 48%).Conclusions:Bacterial transfer and biofilm formation in the connector-catheter system varied statistically significantly between the 20 NCs, suggesting that NC choice can lower the risk of developing catheter-related BSIs.

The genus Phytophthoraincludes phytopathogens of relevant socio-economic importance. Among these, the species Phytophthora infestansand Phytophthora capsicithreat several crops and, in particular, Solanaceae and cucurbits. In order to support the searching for sustainable means for the management of plant diseases, this study evaluated several safe natural products (botanicals, inorganics, and vitamins) for the control of P. infestansand P. capsici. In vitrotests on P. infestanshighlighted that Tagetes minuta-, Lavandula angustifolia- and ascorbic acid-based formulas, at the highest concentration, were the most effectives; they determined 91.1, 91.3 and 100.0% of radial growth inhibition and 21.3, 6.0 and 9.3% of sporangial germination, respectively; the negative control (Cuprostar–copper-based formula) totally inhibited the mycelial growth and determined the 18.0% of sporangial germination. Among products tested in vitroon P. capsicithe most effectives were Armicarb 85 (a potassium hydrogen carbonate-based formula) and ascorbic acid; at the highest concentration they determined the total inhibition of mycelial growth and the 28.0 and 19.3% of sporangia germination, respectively; the Abies sibirica-based formula also significantly affected P. capsici, determining the 97.6% of radial growth inhibition and 38.0% of sporangia germination; the negative control (Cupravit Blu 35–copper-based formula) totally inhibited the mycelial growth and determined the 27.7% of sporangial germination. Natural products were also tested in vivoon artificially P. infestans-infested tomato plants; results highlighted a significant reduction of disease severity by treatments with Tagetes minuta, Lavandula angustifoliaand Adigor formulation (a rapeseed oil-based formulation) at the concentrations of 1.0, 0.5 and 0.5%, respectively. In conclusion, this study provided new evidence supporting the employment of safe natural products for the management of Phytophthoradiseases.

Research has led to major achievements in public policy and child health. Despite the gains, the need for research to inform policy remains paramount against a backdrop of inadequate public health investments, health inequities, and public skepticism toward science. However, the translation of research into child health policy has often been slow due to misalignments in incentives between researchers and policy makers and a paucity of conceptual models to inform translation. This article outlines barriers to translation, provides examples of discordance between evidence and policy, summarizes models to inform translation, and offers strategies to improve translation of research to policy.

Despite being reduced by treatment, natural organic matter (NOM) is ubiquitous in drinking water distribution systems (DWDSs) from sources to consumers' taps where it can potentially have negative impacts on drinking water quality. While a few studies have investigated its behaviour in disinfected and NOM-rich DWDSs, its dynamics in non-disinfected systems, characterized by low NOM content, have not yet been explored. In this study, we monitored the NOM variations occurring between groundwater sources and consumers' taps of a non-disinfected DWDS, including three drinking water treatment plants, using both fluorescence and absorbance, selected due to their increasing adoption by water utilities. PARAFAC analysis of fluorescence data, combined with absorbance indices, highlighted how NOM characteristics in groundwater vary due to the combination of multiple factors (e.g., well depth, pumping rate), especially in the case of shallower aquifers. The treatment processes display different effects on NOM when monitored by fluorescence and absorbance, due to the differences among fluorophores and between fluorescent and chromophoric molecules. Variations of the NOM characteristics between the treatment plant outlets and sampling locations within the network were detected only in few locations, suggesting the importance of the processes occurring in specific sections of the network and the last meter before consumption. These findings highlight the overall stability of water quality within non-disinfected NOM-poor DWDSs, but they stress the importance of (i) properly selecting the analytical method to be used for monitoring and (ii) localized water quality variations mainly related to pipe materials, suggesting several implications for DWDS monitoring and management.

The study focused on investigating the phytochemical composition and bio-pharmacological properties of a water extract obtained from industrial hemp by-products, after trimming female inflorescences of Cannabis sativaL., cultivar Kompolti. The extract was found to be rich in phenolic compounds, particularly gallic acid, catechin, coumaric acid, ferulic acid, and benzoic acid. It also contained significant amounts of cannabidiolic acid and cannabigerolic acid as the main terpenophenols. To assess the biological potential of the extract, various ecotoxicological assays were conducted. The extract did not show significant phytotoxic effects on seedling germination in the allelopathic assay. In the brine shrimp (Artemia salina) lethality test, the LC50value was 1.726 mg/mL, and in the Daphnia magnatest, the extract showed no cardiotoxicity effects at the same concentration; thus, confirming its biocompatibility with these eukaryotic organisms. Additionally, the extract did not induce cytotoxicity in the murine C2C12 cell line till to the concentration of 1000 μg/mL. In isolated mouse prostate specimens, the extract (10–1000 μg/mL) also prevented LPS-induced gene expression of pro-inflammatory cytokines, namely tumor necrosis factor (TNF)α, interleukin (IL)-6, and IL-1β. Furthermore, the extract exhibited inhibitory effects on the growth of pathogenic bacterial, fungal, and dermatophyte species commonly associated with prostatitis. These results suggest that the residual powder from female inflorescence trimming can be considered an innovative plant material from the industrial hemp supply chain that deserves to be valorised in terms of recycling and upcycling; thus, reducing the environmental impact of the by-products and also opening the way for innovative health-promoting agents.

THE CASE A 17-year-old white female is transferred from an outside hospital with the chief complaint being painful oral ulcers. Over the last 72 hours, the pain from her ulcers [...]

Introduction: There is no consensus regarding optimal duration of antibiotic therapy for Pseudomonas aeruginosabacteremia. We aimed to evaluate the impact of short antibiotic course. Methods: We present a retrospective multicenter study including patients with P. aeruginosabacteremia during 2009–2015. We evaluated outcomes of patients treated with short (6–10 days) versus long (11–15 days) antibiotic courses. The primary outcome was a composite of 30-day mortality or bacteremia recurrence and/or persistence. Univariate and inverse probability treatment-weighted (IPTW) adjusted multivariate analysis for the primary outcome was performed. To avoid immortal time bias, the landmark method was used. Results: We included 657 patients; 273 received a short antibiotic course and 384 a long course. There was no significant difference in baseline characteristics of patients. The composite primary outcome occurred in 61/384 patients in the long-treatment group (16%) versus 32/273 in the short-treatment group (12%) (p= 0.131). Mortality accounted for 41/384 (11%) versus 25/273 (9%) of cases, respectively. Length of hospital stay was significantly shorter in the short group [median 13 days, interquartile range (IQR) 9–21 days, versus median 15 days, IQR 11–26 days, p= 0.002]. Ten patients in the long group discontinued antibiotic therapy owing to adverse events, compared with none in the short group. On univariate and multivariate analyses, duration of therapy was not associated with the primary outcome. Conclusions: In this retrospective study, 6–10 days of antibiotic course for P. aeruginosabacteremia were as effective as longer courses in terms of survival and recurrence. Shorter therapy was associated with reduced length of stay and less drug discontinuation.

The literature shows that the prescription of antibiotics in dental care is often unnecessary or inappropriate. Indicators estimating the appropriateness of antibiotics prescribed by dentists based on routine databases are, however, not available in the literature.

ObjectivesWith improved access to intrauterine transfusion (IUT), more fetuses with haemoglobin Bart’s hydrops fetalis (HBHF; homozygous α0-thalassaemia) will survive.DesignTo evaluate the long-term outcome of affected fetuses with and without IUT in Ontario, Canada, we retrospectively collected data on IUTs and pregnancy outcomes in all cases of HBHF, from 1989 to 2014. Clinical outcome and neurocognitive profiles of long-term survivors were also collected and compared with data from 24 patients with transfusion-dependent β-thalassaemia (TDT-β).ResultsOf the 99 affected pregnancies (93 prenatally diagnosed), 68 resulted in miscarriage or elective termination of pregnancy. Twelve mothers (12%) continued their pregnancies without IUT, and none of those newborns survived the first week of life. All 13 fetuses that received IUT(s) were live-born, but 3 died due to severe hydrops at birth and 1 died due to infection. The remaining nine survivors, in comparison with TDT-β patients, had earlier iron overload requiring iron chelation therapy. Endocrinopathies and short stature were more frequent in these patients. Neurocognitive outcome was not significantly affected in five patients who were assessed, and none were diagnosed with intellectual impairment. In three patients, MRI studies demonstrated brain white matter changes in keeping with ‘silent’ ischaemic infarcts.ConclusionsIn patients with HBHF, IUT is associated with improved survival. While acceptable neurocognitive outcome can be expected, these patients have more clinical complications compared with their TDT-β counterparts. The clinical and neurocognitive outcomes of HBHF should be discussed in detail when counselling and offering IUT for patients.

Huanglonbing, or citrus greening, is the most serious disease of citrus which cause large economic losses. One of the strategies to avoid the spread of the disease is the control of Diaphorina citripsyllid, its insect vector, by the application of insecticides. Development of nanoinsecticides, which are less harmful to the environment and more efficient (in terms of cost and performance) than the existing formulations, is a current challenge. In this work, nanocarriers composed of chitosan–tripolyphosphate (by ionic gelification approach) and poly-ε-caprolactone (PCL)–chitosan (by double-emulsion–solvent evaporation method) for thiametoxam insecticide were developed and characterized. Toxicological assessments using Raphidocelis subcapta, Artemia salinaand Caernohabditis eleganswere performed comparing PCL–chitosan nanoparticle and PCL–chitosan loaded thiamethoxam in comparison to commercial pesticide. The nanoparticles obtained from optimized conditions resulted in positive charged nanoparticles, with medium dispersity. The double-emulsion method resulted in smaller nanoparticles (313.5 ± 7 nm) and increased encapsulation efficiency (36.6 ± 0.2%) in comparison to chitosan–tripolyphosphate nanoparticles. The lower encapsulation efficiency was observed in chitosan–tripolyphosphate, impairing agricultural applications. The EC50 values (mg L−1) of Raphidocelis subcapitataand C. elegansobtained for poly-ε-caprolactone with thiamethoxam were 56.15 (18.91–131.21) and 66.07 (1.20–274.14), respectively, and poly-ε-caprolactone without thiamethoxam 94.26 (22.42–166.10) and 214.63 (139.08–494.3), respectively. No toxicity was found in Artemia salina. Our results indicate that nanoparticles (with and without thiamethoxam) were more toxic to soil organisms (C. elegan) than commercial formulations.

L’objectif de notre étude était d’évaluer la qualité des prescriptions antibiotiques d’un échantillon de médecins généralistes-maîtres de stage (MG), quel que soit le motif de la prescription.

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.ajog.2007.11.070 Byline: Caela Miller (a), Michael A. Bidus (b), Joseph P. Pulcini (c), G. Larry Maxwell (b)(c), Jonathan A. Cosin (d), G. Scott Rose (b) Keywords: atypical hyperplasia; endometrial cancer; endometrial hyperplasia Abstract: This study was undertaken to determine the clinical relevance of 'qualifying comments' on pathology reports of complex atypical endometrial hyperplasia. Author Affiliation: (a) Department of Obstetrics and Gynecology, National Naval Medical Center, Bethesda, MD (b) Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, and the United States Military Cancer Institute, Walter Reed Army Medical Center, Washington, DC (c) Department of Pathology, Brook Army Medical Center, San Antonio, TX (d) Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington Hospital Center, Washington, DC. Article History: Received 22 June 2007; Revised 26 September 2007; Accepted 27 November 2007 Article Note: (footnote) Cite this article as: Miller C, Bidus MA, Pulcini JP, et al. The ability of endometrial biopsies with atypical complex hyperplasia to guide surgical management. Am J Obstet Gynecol 2008;199:69.e1-69.e4. The opinions or assertions expressed in this article represent the private views of the authors and are not to be construed as official or as reflecting the views of the US Departments of the Army, Navy, or Defense. Reprints not available from the authors.

Una de las principales herramientas para optimizar el uso de los antibióticos es la formación de los prescriptores. El objetivo de este trabajo es conocer la opinión de los estudiantes de Medicina españoles sobre la formación en enfermedades infecciosas.

L’objectif de ce travail était d’émettre des recommandations de bonne pratique concernant l’antibioprophylaxie dans le cadre d’un BUD.

'The challenge now is to educate nurses to adapt their political and policy strategies to the new health care milieu.' During the past two decades, the drive to rein in [...]

ABSTRACTThis paper argues that between 1969 and 1976 US policy-makers actively sought to transcend nuclear parity. The Nixon and Ford administrations demonstrated increasing uneasiness toward nuclear parity and yet, proved unwilling to match the Soviet Union quantitatively. In the search for an answer to the question of what strategic superiority was in the age of parity, they came to understand it in distinctly qualitative terms, adopting a number of decisions related to nuclear planning, intelligence analysis of the nuclear balance, and nuclear weapons innovation and modernization, aimed at securing a qualitative edge over the USSR.

ABSTRACTCommunity colleges continue to operate in a society of accountability and efficiencies. Throughout the country, states have implemented performance-based funding and completion agendas while also tightening or restricting funding for higher education. The state of Ohio has implemented one of the boldest performance funding plans in the country while also mandating that higher education institutions limit spending and lower costs to students. This article explores how Central Ohio Technical College has implemented the flipped classroom and one-room school house models in college-level mathematics courses and how both models of instruction can help community colleges increase successful completion rates to meet performance-based funding completion metrics while also limiting instructional cost.

Supplemental Digital Content is available in the text.

Indirect signal analysis (pH, ORP and DO) are often used in monitoring and control of SBRs (Sequencing Batch Reactors), where operating conditions can be clearly identified during the various cyclic phases. Only few studies applied this methodology to control continuous flow plants, as it is much more difficult to identify operating conditions because of continually variable inflow characteristics. This work applied indirect signal analysis to control pre-denitrification in continuous-flow activated sludge processes: (i) a laboratory-scale plant, fed with synthetic wastewater, simulating real municipal wastewater and (ii) a pilot-scale plant, fed with real sewage. Three different ranges of ORP values identify three operational conditions of the denitrification process. (1) ORP > 0 mV means that nitrates and/or nitrites are present, possibly due to a low C/N ratio. (2) –50 < ORP < –200 mV is typical of normal operating conditions, that is with a balanced C/N ratio. (3) ORP < –350 mV means that oxidized nitrogen load is too low or that C/N exceeds the stoichiometric ratio. The trend of pH, instead, points out if and how the process is evolving from one to another operating condition. The correlation between pH and ORP signals (as well as their derivatives) allows to restore normal operating conditions by acting on the internal recycle flow-rate. Improved denitrification process ensures lower effluent nitrate concentration, and reduce external carbon dosage to achieve stricter nitrogen limits.

Antibiotic resistance is a global health crisis. Ensuring responsible, appropriate use (stewardship) is an important for keeping antibiotics working as long as possible. Around 10% of antibiotics across healthcare are prescribed by oral healthcare professionals, with high rates of unnecessary use. To maximise the value from research to optimise antibiotic use in dentistry, this study developed international consensus on a core outcome set for dental antibiotic stewardship.

Contexte :La médecine d’urgence est sur le point de devenir une spécialité en France, ce qui implique l’utilisation d’outils de certification adaptés. Buts :Comparer l’aptitude des tests de concordance des scripts (TCS) et des questions à choix multiples à contexte riche (QCM) à identifier le niveau d’expérience des cliniciens en matière de raisonnement clinique en médecine d’urgence. Méthode :60 QCM et 30 TCS ont été rédigés selon les recommandations publiées et administrées à 20 résidents de première année, 16 étudiants de fin de sixième année, et à neuf médecins seniors en poste dans des services d’urgences. L’analyse d’item des QCM a inclus la détermination des indices de difficulté et de discrimination. La fidélité des QCM et des TCS a été mesurée par le coefficient alpha de Cronbach. Les scores obtenus aux deux épreuves par les trois groupes ont été comparés (ANOVA avec correction de Bonferoni-Dunn après vérification de l‘homogénéité des variances par un test de Levene). Ils ont été corrélés (test de Pearson) dans le groupe des résidents. Résultats :QCM et TCS ont obtenu des coefficients de fidélité corrects (respectivement 0,85 à 0,95 et 0,92 à 0,96 selon les groupes étudiés). Seuls, les TCS ont pu identifier le niveau d’expérience des différents cliniciens. Les scores des TCS et des QCM variaient dans le même sens, sans corrélation significative. Ce point suggère que QCM et TCS explorent deux aspects complémentaires de la compétence médicale. Conclusion :Le TCS paraît être un outil d’évaluation intéressant en médecine d’urgence, complémentaire d’autres tests d’évaluation.

La diffusion des résistances bactériennes aux antibiotiques menace l’efficacité des antibiotiques. Cependant, la consommation antibiotique reste fréquemment inadaptée en termes quantitatifs et qualitatifs. L’antimicrobial stewardship(AMS) renvoie aux actions et stratégies visant à promouvoir le bon usage des antibiotiques et ces programmes ont démontré leur efficacité dans la littérature. Néanmoins, beaucoup reste à faire dans différents domaines, qui s’étendent de la définition même du bon usage et des indicateurs pour l’évaluer, à l’identification des déterminants comportementaux associés à la prescription, à la mise en place d’interventions efficaces, ainsi qu’au développement de méthodologies adaptées pour évaluer l’impact de ces interventions. L’objet de cet article est de discuter des points les plus importants et novateurs de l’AMS dans les établissements de santé.

ABSTRACTContext: General practitioners and family physicians (GP/FPs) play a key role in the vaccination of the public in many countries and serve as role models for their patients through their own health behaviors. Objectives and Methods: a) To search for and document recommended/mandated vaccines for GP/FPs in high-income countries; b) To systematically search and review the literature on these physicians' knowledge, attitudes, beliefs, and behaviors (KABB) toward their own vaccination with the recommended/mandated vaccines and the factors determining it. Results: a) The 14 countries included recommended or mandated as many as 12 vaccines; b) The systematic review identified 11 studies published in the last 10 y. All considered seasonal influenza vaccination but differed in the variables investigated. Discussion/Conclusions: This review highlights the need for further studies on this topic, including qualitative and interventional studies (based on behavior change theories). These should cover occupational vaccines and determinants known to be associated with vaccine hesitancy.

The aim of this paper is to argue that logic can play an important role in the “toolbox” of molecular biology. We show how biochemical pathways, i.e., transitions from a molecular aggregate to another molecular aggregate, can be viewed as deductive processes. In particular, our logical approach to molecular biology — developed in the form of a natural deduction system — is centered on the notion of Curry-Howard isomorphism, a cornerstone in nineteenth-century proof-theory.

Existen numerosas patologías adquiridas del oído externo, que además son muy diversas, debido a sus particularidades anatómicas. El médico otorrinolaringólogo, que suele ser el primero en atenderlas, no debe pasarlas por alto. En este artículo se presenta una reseña anatómica y fisiológica, seguida por los principios básicos de la exploración física del conducto auditivo externo, así como de las principales pruebas complementarias útiles. A continuación, se describen todas las patologías, haciendo hincapié tanto en los procesos frecuentes como en las otitis externas, pero también en una patología potencialmente grave: la otitis externa necrosante, con la que siempre hay que ser muy cauteloso. Además de las patologías infecciosas, también se expondrán las patologías dermatológicas, tumorales y traumáticas. Se dedica un apartado específico a las complicaciones de la radioterapia externa y a las estenosis del conducto.

To examine the prevalence trends and coexisting conditions in attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorder (ASD), and intellectual disability (ID) in the pediatric Supplemental Security Income (SSI) population and general population.

Le patologie acquisite dell’orecchio esterno sono numerose e molto diverse, in rapporto con le sue particolarità anatomiche, e non devono essere sottovalutate dal medico ORL, che è spesso in prima linea. Dopo un richiamo anatomico e fisiologico, sono precisati i principi di base dell’esame clinico del condotto uditivo esterno così come i principali esami complementari utili. In seguito, viene trattato l’insieme delle patologie, ponendo l’accento, allo stesso tempo, sulle patologie frequenti, come le otiti esterne, ma anche, particolarmente, su una patologia potenzialmente grave: l’otite esterna necrotizzante, di cui occorre diffidare. Al di fuori delle patologie infettive, sono anche esposte dettagliatamente le patologie dermatologiche, tumorali e traumatiche, e un capitolo distinto è riservato alle complicanze della radioterapia esterna e alle stenosi del condotto.

Burn-in is a method of ‘elimination’ of initial failures (infant mortality). In the conventional burn-in procedures, to burn-in a component or a system means to subject it to a fixed time period of simulated use prior to actual operation. Then those which fail during the burn-in procedure are scrapped and only those which survived the burn-in procedure are considered to be of satisfactory quality. Thus, in this case, the only information used for the elimination procedure is the lifetime of the corresponding item. In this paper we consider a new burn-in procedure which additionally employs a dependent covariate process in the elimination procedure. Through the comparison with the conventional burn-in procedure, we show that the new burn-in procedure is preferable under commonly satisfied conditions. The problem of determining the optimal burn-in parameters is also considered and the properties of the optimal parameters are derived. A numerical example is provided to illustrate the theoretical results obtained in this paper.

Purpose – This paper aims the application of a novel hybrid algorithm, called MeTEO, based on the combination of three heuristics inspired by artificial life to the optimization of electrodes voltages of multistage depressed collector. Design/methodology/approach – The flock-of-starlings optimization (FSO), the particle swarm optimization (PSO) and the bacterial chemotaxis algorithm (BCA) were adapted to implement a hybrid and parallel algorithm: the FSO has been powerfully employed for exploring the whole space of solutions, whereas the PSO+BCA has been used to refine the FSO-found solutions, exploiting their better performances in local search. Findings – The optimization of the voltage of the electrodes of multistage depressed collector are efficiently handled with a moderate computational effort. Practical implication – The development of an efficient method for the solution of a complicated electromagnetic optimization problem, exploiting the different characteristic of different approaches based on evolutionary computation algorithm. Originality/value – The paper shows that the combination of stochastic methods having different exploration properties with appositely developed FE electromagnetic simulator allows us to produce effective solutions of multimodal electromagnetic optimization problems, with an acceptable computational cost. [ABSTRACT FROM AUTHOR]

To carry out a systematic review of scientific evidence available about necrotizing otitis externa, emphasizing epidemiologic data, diagnosis criteria, treatment protocols, follow-up criteria, prognosis factors, and chronologic evolution.

Widespread antimicrobial use has compromised its value, leading to a crisis of antimicrobial resistance. A major cause of misuse is insufficient knowledge of prescribing of antimicrobials in many categories of professionals. An important principle of antimicrobial stewardship is avoiding selection pressure in the patient, both on pathogen and commensal by avoiding unnecessary use, choosing the least broad-spectrum antibiotic, adequate doses, a good timing and the shortest possible duration. Up to now, most educational efforts have been targeted at professionals (mostly medical doctors) after their training and at the adult public. In the past few years, progress has been made in educating children. It is now crucial that academia and ministries of Health and Education jointly focus on an adapted undergraduate medical/professional curriculum that teaches all necessary principles of microbiology, infectious diseases and clinical pharmacology, with emphasis on the principles of prudent prescribing.

Information on the conference titled English in Europe: Debates and Discourses held at the University of Sheffield in England on April 20-22, 2012 is presented. Topics include English in the European language, the role of English in the international communication and world affairs, and English language as opportunity for professional and economic growth. The event featured several speakers, including David Block, Marcin Zabawa, and Geoff Sockett.

To compare the costs of redetermining disability to potential savings in Supplemental Security Income payments associated with different strategies for implementing Continuing Disability Reviews (CDRs) among children potentially enrolled in SSI from 2012 to 2021.

Purpose |!|#8211; The purpose of this paper is to present the application of a novel hybrid algorithm, called MeTEO (Metric-Topological-Evolutionary-Optimization), based on the combination of three heuristics inspired by artificial life to the solution of optimization problems of a real electronic vacuum device. Design/methodology/approach |!|#8211; The Particle Swarm Optimization (PSO), the Flock-of-Starlings Optimization (FSO) and the Bacterial Chemotaxis Algorithm (BCA) were adapted to implement a novel meta-heuristic MeTEO the FSO has been powerfully employed for exploring the whole space of solutions, whereas the PSO is used to explore local regions where FSO had found solutions, and BCA to refine the solutions found by PSO, thanks its better performances in local search. Findings |!|#8211; The optimization of the focusing magnetic field of a Travelling Wave Tubes (TWT) collector is presented in order to show the effectiveness of MeTEO, in combination with COLLGUN FE simulator and equivalent source representation. The optimization of the focusing magnetic structure is obtained by using a maximum of 100 steps for each heuristic. Practical implications |!|#8211; The paper describes the development of a novel efficient parallel method for the solution of electromagnetic device optimization problems. Originality/value |!|#8211; The paper shows the capabilities of a novel combination of optimization methods inspired by |!|#34;artificial life|!|#34; which allows us to achieve effective solutions of multimodal optimization problems, typical of the electromagnetic device optimization, with an acceptable computational cost, thanks also to its natural parallel implementation. [ABSTRACT FROM AUTHOR]

Multiple national, state, and local organizations recommend that emergency action plans (EAPs) direct therapy of allergic reactions in schoolchildren.