Search

BACKGROUND: There is a paucity of literature examining surgical trends and outcomes in both child and adult cerebral palsy (CP) patients. We aimed to evaluate surgical trends, complications, length of stay, and charges for spinal deformity surgery in CP patients. METHODS: Using the Nationwide Inpatient Sample (NIS) from 2001 to 2013, patients with CP scoliosis who underwent spinal fusion surgery were identified. Patient characteristics and comorbidities were recorded. Trends in spinal fusion approaches were grouped as anterior (ASF), posterior (PSF), or combined anterior-posterior (ASF/PSF). Complication rates, length of stay, and charges for each approach were analyzed. Bivariate analyses using adjusted Wald tests and multivariate analyses using linear (logarithmic transformation) and logistic regressions were performed. RESULTS: Of the 5191 adult CP patients who underwent spinal fusion the majority underwent PSF (86.5%), followed by the ASF/PSF approach (9.3%). The rate of PSF for cerebral palsy patients with spinal deformity increased significantly per 1 million people in the US population (0.90 to 1.30; P = .048). Complication rate, hospital length of stay, and charges were higher for patients undergoing ASF/PSF (P

The purpose of this study was to determine the variability in clinical management of tibial tubercle fractures among a group of pediatric orthopedic surgeons. Nine fellowship-trained academic pediatric orthopedic surgeons reviewed 51 anteroposterior and lateral knee radiographs with associated case age. Respondents were asked to describe each fracture using the Ogden classification (type 1-5 with A/B modifiers), desired radiographic workup, operative vs. nonoperative treatment strategy and plans for post-treatment follow-up. Fair agreement was reached when classifying the fracture type using the Ogden classification (k = 0.39; P

Background: Human growth is susceptible to damage from insults, particularly during periods of rapid growth. Identifying those periods and the normative limits that are compatible with adequate growth and development are the first key steps toward preventing impaired growth. Objective: This study aimed to construct international fetal growth velocity increment and conditional velocity standards from 14 to 40 weeks’ gestation based on the same cohort that contributed to the INTERGROWTH-21st Fetal Growth Standards. Study Design: This study was a prospective, longitudinal study of 4321 low-risk pregnancies from 8 geographically diverse populations in the INTERGROWTH-21st Project with rigorous standardization of all study procedures, equipment, and measurements that were performed by trained ultrasonographers. Gestational age was accurately determined clinically and confirmed by ultrasound measurement of crown-rump length at Results: Peak velocity was observed at a similar gestational age: 16 and 17 weeks’ gestation for head circumference (12.2 mm/wk), and 16 weeks’ gestation for abdominal circumference (11.8 mm/wk) and femur length (3.2 mm/wk). However, velocity growth slowed down rapidly for head circumference, biparietal diameter, occipitofrontal diameter, and femur length, with an almost linear reduction toward term that was more marked for femur length. Conversely, abdominal circumference velocity remained relatively steady throughout pregnancy. The change in velocity with gestational age was more evident for head circumference, biparietal diameter, occipitofrontal diameter, and femur length than for abdominal circumference when the change was expressed as a percentage of fetal size at 40 weeks’ gestation. We have also shown how to obtain accurate conditional fetal velocity based on our previous methodological work. Conclusion: The fetal skeleton and abdomen have different velocity growth patterns during intrauterine life. Accordingly, we have produced international Fetal Growth Velocity Increment Standards to complement the INTERGROWTH-21st Fetal Growth Standards so as to monitor fetal well-being comprehensively worldwide. Fetal growth velocity curves may be valuable if one wants to study the pathophysiology of fetal growth. We provide an application that can be used easily in clinical practice to evaluate changes in fetal size as conditional velocity for a more refined assessment of fetal growth than is possible at present (https://lxiao5.shinyapps.io/fetal_growth/). The application is freely available with the other INTERGROWTH-21st tools at https://intergrowth21.tghn.org/standards-tools/.

ObjectivesInforming research participants of the results of studies in which they took part is viewed as an ethical imperative. However, there is little guidance in the literature about how to do this. The Fluoxetine Or Control Under Supervision trial randomised 3127 patients with a recent acute stroke to 6 months of fluoxetine or placebo and was published in the Lancet on 5 December 2018. The trial team decided to inform the participants of the results at exactly the same time as the Lancet publication, and also whether they had been allocated fluoxetine or placebo. In this report, we describe how we informed participants of the results.DesignIn the 6-month and 12-month follow-up questionnaires, we invited participants to provide an email address if they wished to be informed of the results of the trial. We re-opened our trial telephone helpline between 5 December 2018 and 31 March 2019.SettingUK stroke services.Participants3127 participants were randomised. 2847 returned 6-month follow-up forms and 2703 returned 12-month follow-up forms; the remaining participants had died (380), withdrawn consent or did not respond.ResultsOf those returning follow-up questionnaires, a total of 1845 email addresses were provided and a further 50 people requested results to be sent by post. Results were sent to all email and postal addresses provided; 309 emails were returned unrecognised. Seventeen people replied, of whom three called the helpline and the rest responded by email.ConclusionIt is feasible to disseminate results of large trials to research participants, though only around 60% of those randomised wanted to receive the results. The system we developed was efficient and required very little resource, and could be replicated by trialists in the future.Trial registration numberISRCTN83290762; Post-results.

Summary Background Preterm birth is a major global health challenge, the leading cause of death in children under 5 years of age, and a key measure of a population's general health and nutritional status. Current clinical methods of estimating fetal gestational age are often inaccurate. For example, between 20 and 30 weeks of gestation, the width of the 95% prediction interval around the actual gestational age is estimated to be 18–36 days, even when the best ultrasound estimates are used. The aims of this study are to improve estimates of fetal gestational age and provide personalised predictions of future growth. Methods Using ultrasound-derived, fetal biometric data, we developed a machine learning approach to accurately estimate gestational age. The accuracy of the method is determined by reference to exactly known facts pertaining to each fetus—specifically, intervals between ultrasound visits—rather than the date of the mother's last menstrual period. The data stem from a sample of healthy, well-nourished participants in a large, multicentre, population-based study, the International Fetal and Newborn Growth Consortium for the 21st Century (INTERGROWTH-21st). The generalisability of the algorithm is shown with data from a different and more heterogeneous population (INTERBIO-21st Fetal Study). Findings In the context of two large datasets, we estimated gestational age between 20 and 30 weeks of gestation with 95% confidence to within 3 days, using measurements made in a 10-week window spanning the second and third trimesters. Fetal gestational age can thus be estimated in the 20–30 weeks gestational age window with a prediction interval 3–5 times better than with any previous algorithm. This will enable improved management of individual pregnancies. 6-week forecasts of the growth trajectory for a given fetus are accurate to within 7 days. This will help identify at-risk fetuses more accurately than currently possible. At population level, the higher accuracy is expected to improve fetal growth charts and population health assessments. Interpretation Machine learning can circumvent long-standing limitations in determining fetal gestational age and future growth trajectory, without recourse to often inaccurately known information, such as the date of the mother's last menstrual period. Using this algorithm in clinical practice could facilitate the management of individual pregnancies and improve population-level health. Upon publication of this study, the algorithm for gestational age estimates will be provided for research purposes free of charge via a web portal. Funding Bill & Melinda Gates Foundation, Office of Science (US Department of Energy), US National Science Foundation, and National Institute for Health Research Oxford Biomedical Research Centre.

Symbioses are ubiquitous in nature and influence individual plants and populations. Orchids have life history stages that depend fully or partially on fungi for carbon and other essential resources. As a result, orchid populations depend on the distribution of orchid mycorrhizal fungi (OMFs). We focused on evidence that local-scale distribution and population dynamics of orchids can be limited by the patchy distribution and abundance of OMFs, after an update of an earlier review confirmed that orchids are rarely limited by OMF distribution at geographic scales. Recent evidence points to a relationship between OMF abundance and orchid density and dormancy, which results in apparent density differences. Orchids were more abundant, less likely to enter dormancy, and more likely to re-emerge when OMF were abundant. We highlight the need for additional studies on OMF quantity, more emphasis on tropical species, and development and application of next-generation sequencing techniques to quantify OMF abundance in substrates and determine their function in association with orchids. Research is also needed to distinguish between OMFs and endophytic fungi and to determine the function of nonmycorrhizal endophytes in orchid roots. These studies will be especially important if we are to link orchids and OMFs in efforts to inform conservation.

Learn the value of having students create their own stories and pictures to represent number sentences as classroom assessments.

BACKGROUND: Syphilis transmission can be prevented by prompt diagnosis and treatment of primary and secondary infection. We evaluated the performance of a point-of-care rapid syphilis treponemal (RST) test in an emergency department (ED) setting. METHODS: Between June 2015 and April 2016, men aged 18 to 34 years seeking services in a Detroit ED, and with no history of syphilis, were screened for syphilis with the RST test, rapid plasma reagin (RPR) test, and Treponema pallidum particle agglutination assay (TP-PA). A positive reference standard was both a reactive RPR and a reactive TP-PA. We compared test results in self-reported men who have sex with men (MSM) to non-MSM. RESULTS: Among 965 participants, 10.9% of RST tests were reactive in MSM and only 1.5% in non-MSM (P < 0.001). Sensitivity of the RST test was 76.9% and specificity was 99.0% (positive predictive value, 50.0%) compared with the positive reference standard. Three discordant specimens found negative with the RST test but positive with the reference standard had an RPR titer of 1:1, compared with 10 specimens with concordant positive results that had a median RPR titer of 1:16. The RST sensitivity was 50.0% (positive predictive value, 68.4%) compared to the TP-PA test alone. Among men seeking care in an ED, the RST detected 76.9% of participants with a reactive RPR and TP-PA. CONCLUSIONS: The RST test detected all of the participants with an RPR titer ≥1:2 but less than 20% of participants with a positive TP-PA and negative RPR. The RST test was useful to detect a high proportion of participants with an active syphilis in an urban ED.

BackgroundInjection drug use-associated endocarditis (IDUaIE) incidence in Ontario has recently been associated with hydromorphone prescribing rates. Staphylococcus aureus causes the majority of cases of IDUaIE in Ontario and across North America. Hydromorphone controlled-release (Hydromorphone-CR) requires a complex technique for injection and therefore provides multiple opportunities for contamination. Hydromorphone-CR contains several excipients, which could enhance staphylococcal survival and increase risk of contaminating the injectate.MethodsUsed injection drug preparation equipment (cookers/filters) was collected from persons who inject drugs (PWID), rinsed with water, and plated on Mannitol salt agar. Bacterial isolates from bacteremic PWID were used to assess the survival of S. aureus and Streptococcus pyogenes on cookers/filters with Hydromorphone-CR, hydromorphone immediate-release (Hydromorphone-IR) or oxycodone controlled-release (Oxycodone-CR). The solutions spiked with S. aureus were heated and the remaining viable bacteria enumerated.ResultsS. aureus was detected in 12/87 (14%, 95%CI 8-23%) cookers/filters samples used for injection of Hydromorphone-CR. Hydromorphone-CR was the only opioid associated with greater survival of methicillin-sensitive S. aureus (MSSA) and methicillin-resistant S. aureus (MRSA) on cookers/filters when compared to sterile water vehicle control. There was a ~2 log reduction in the number of S. aureus that survived when cookers/filters were heated.Conclusion14% of all cookers/filters used in the preparation of Hydromorphone-CR were contaminated with S. aureus. Hydromorphone-CR prolongs the survival of MRSA and MSSA in cookers/filters. Heating cookers/filters may be a harm-reduction strategy.

Introduction Infective endocarditis is associated with high morbidity and mortality. Currently, there is concern that the incidence of infective endocarditis associated with people who inject drugs (PWID) is increasing. However, it is difficult to monitor population-wide trends in PWID-associated infective endocarditis, as there is no International Statistical Classification of Diseases, 10th Revision (ICD-10) code for injection drug use. To address this barrier, we sought to develop a validated algorithm using ICD-10 discharge diagnosis codes. Materials and methods We constructed a cohort of patients whose hospital discharge diagnosis included infective endocarditis. We reviewed 100 patients with incident infective endocarditis from 2014 to 2016 for their infective endocarditis and injection drug use status. We calculated the operating characteristics for algorithms constructed using permutations of ICD-10 codes associated with injection drug use. We repeated this analysis in a cohort of 100 patients with incident infective endocarditis from 2009 to 2011 to examine the temporal stability of the operating characteristics of each algorithm. Results We found that a combination of hepatitis C virus, drug use, and mental/behavioral disorder codes yielded the highest sensitivity (93%) and positive predictive value (83%) of the algorithms analyzed. Discussion We have described the first algorithm, validated against chart review data, for identifying PWID-associated infective endocarditis cases using ICD-10 codes. The high sensitivity and positive predictive value indicate that this algorithm can be used for surveillance and research with confidence. Conclusions This algorithm will enable researchers to examine epidemiological trends in PWID-associated infective endocarditis.

Space is a strategic sector, integral to virtually every facet of life in Europe, thus protection of this vital European space infrastructure is critical. No European organization, however, is able to provide a sufficiently independent assessment of the space environment. Efforts, therefore, are being pursued to develop an integrated Space Situational Awareness (SSA) capability in Europe. This article reviews the undertaking of SSA in Europe and the roles played by the European Union (EU) and the European Space Agency (ESA). It examines some of the obstacles ESA has faced in implementing its SSA efforts, challenges which range from budgetary limitations to the refusal of member states to share their military facilities, with the result being that ESA focuses on space weather and near-Earth objects rather than the more controversial and national security aspects of SSA, space surveillance and tracking (SST). The article also assesses the European Commission’s proposal for establishing a SST support program...

Staphylococcus aureus bacteremia is associated with significant morbidity and mortality. Given the paucity of recent Canadian data, we estimated the mortality rate associated with S. aureus bacteremia in a tertiary care hospital and identified risk factors associated with mortality.We retrospectively reviewed the records of adults with S. aureus bacteremia admitted to a tertiary care centre in southwestern Ontario between 2008 and 2012. Cox regression analysis was used to evaluate associations between predictor variables and all-cause, in-hospital, and 90-day postdischarge mortality.Of the 925 patients involved in the study, 196 (21.2%) died in hospital and 62 (6.7%) died within 90 days after discharge. Risk factors associated with in-hospital and all-cause mortality included age, sepsis (adjusted hazard ratio [adjusted HR] 1.49, 95% confidence interval [CI] 1.08-2.06, p = 0.02), admission to the intensive care unit (adjusted HR 3.78, 95% CI 2.85-5.02, p 0.0001), hepatic failure (adjusted HR 3.36, 95% CI 1.91-5.90, p 0.0001) and metastatic cancer (adjusted HR 2.58, 95% CI 1.77-3.75, p 0.0001). Methicillin resistance, hepatic failure, cerebrovascular disease, chronic obstructive pulmonary disease and metastatic cancer were associated with postdischarge mortality.The all-cause mortality rate in our cohort was 27.9%. Identification of predictors of mortality may guide empiric therapy and provide prognostic clarity for patients with S. aureus bacteremia.

Background S. aureus is the most common pathogen associated with injection drug use-associated endocarditis (IDUaIE). Our center has a high incidence of IDUaIE and the opiate of choice in our population is hydromorphone-controlled release (HCR), a prescribed oral opiate widely used in Canada and Europe. The complex technique for preparation for injection provides multiple opportunities for contamination of the solution and the controlled-release preparation contains several excipients (carbohydrates, protein, and iron), which could enhance Staphylococcal survival. A large amount of drug remains in the injection drug preparation equipment (IDPE) after each use and therefore, used IDPE is saved by people who inject drugs (PWID) for subsequent reuse by adding more water and then injecting the solution intravenously. Methods Used IDPE was collected from active PWID, rinsed with sterile water, aspirated into a syringe in a technique which mimicked reuse of equipment by PWID, and then plated on Mannitol salt agar (MSA). Bacterial isolates from local bacteremic PWID were used to test the survival of S. aureus (MRSA and MSSA) and S. pyogenes on unused IDPE with HCR or hydromorphone immediate release (HIR). The solutions were aspirated using techniques similar to that of local PWID and then plated on MSA and Blood agar. Results A total of 109 used IDPE samples were collected between March 2017 and March 2018. S. aureus was detected in 15/94 (16%) IDPE samples that had been used for injection of HMC (seven MRSA, seven MSSA, and two borderline resistant [one sample contained both MRSA and MSSA]), but 0/15 (0%) samples used for hydromorphone immediate release (HIR). HCR, but not HM, was associated with greater survival of MSSA and MRSA (but not S. pyogenes) in solutions of the drug when compared with sterile water vehicle control (Figure 1). There was a 2-log reduction in the number of viable S. aureus when IDPE containing HCR solutions spiked with MRSA or MSSA were heated with a cigarette lighter until bubbling ( Conclusion IDPE that has been used in the preparation of HCR is frequently contaminated with S. aureus; and in vitro HCR, but not HM, prolongs the survival of MRSA and MSSA. Heating IDPE may be an effective harm-reduction strategy to reduce bacterial complications of injection of HCR. Disclosures All authors: No reported disclosures.

Space debris comprises all non-functional human-made objects in Earth orbit or re-entering the atmosphere. Potentially hazardous orbital debris is proliferating. If current trends continue, orbital debris will become a significant factor in constraining space activity. Space, however, is one of the most strategically important theatres of the 21st century. It is thus imperative, given humanity's reliance on space, that the issue of space debris be addressed. This paper provides an overview of the existing space debris environment, sources of debris and international efforts to monitor it. It analyses space debris mitigation guidelines and the proposed International Code of Conduct for Outer Space Activities. It considers an international treaty to govern space debris as well as the establishment of an international review board to assist in regulating and reducing the amount of debris. It also assesses the challenges of remediation and other policy actions to increase international cooperation to preserve the space environment. Copyright The Author 2013. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com, Oxford University Press.

Meticillin-resistant Staphylococcus aureus (MRSA) bloodstream infection is responsible for significant morbidity, with mortality rates as high as 60 % if not treated appropriately. We describe a rapid method to detect MRSA in blood cultures using a combined three-hour short-incubation BRUKER matrix-assisted laser desorption/ionization time-of-flight MS BioTyper protocol and a qualitative immunochromatographic assay, the Alere Culture Colony Test PBP2a detection test. We compared this combined method with a molecular method detecting the nuc and mecA genes currently performed in our laboratory. One hundred and seventeen S. aureus blood cultures were tested of which 35 were MRSA and 82 were meticillin-sensitive S. aureus (MSSA). The rapid combined test correctly identified 100 % (82/82) of the MSSA and 85.7 % (30/35) of the MRSA after 3 h. There were five false negative results where the isolates were correctly identified as S. aureus, but PBP2a was not detected by the Culture Colony Test. The combined method has a sensitivity of 87.5 %, specificity of 100 %, a positive predictive value of 100 % and a negative predictive value of 94.3 % with the prevalence of MRSA in our S. aureus blood cultures. The combined rapid method offers a significant benefit to early detection of MRSA in positive blood cultures.

The single aperture implementation of laser radars in combination with beam scanning solutions enables low cost, compact and efficient laser systems for 3D acquisition. The design benefits include the lack of dead zones, improved stability and compact footprint for the system implementation. In our presentation we focus on the scanning solution development for 3D laser radars that is based on all solid state magneto-optic design. The novel solid-state scanner implementation results are presented. Keywords Laser radar, eye safe, 3D, range finder 1. INTRODUCTION The use of 3D capable laser radars for drone vision and driverless cars is quickly changing the ranged sensors field. The use of 2D beam scanning solutions in combination with the high repetition ranging for laser radars delivers 3D acquisition capability [1] (see Figure 1). Mechanical means of beam steering for the laser radars have a number of limitations that include slow scanning speed, mechanical inertia and limited lifetime

Over 250 species of bacteria have been detected in the vagina using genomic sequencing. Lactobacillus iners and L crispatus dominate in most women who have a clinically healthy status. Unfortunately, the abundance profiles can change dramatically with significant increases in pathogens associated with bacterial vaginosis (BV) and aerobic vaginitis (AV). The BV microbiota have at least 4 different abundance profiles, indicating this is a complex condition, yet one that is treated with essentially 2 antimicrobial agents which were never designed for eradicting these organisms in dense biofilms. Future studies will uncover which abundance profiles are particularly associated with a risk of preterm labor, and hopefully identify the mechanisms involved in the switch from healthy to a BV or AV state. The use of probiotic lactobacilli vaginally and orally has shown great promise in helping to restore and maintain a healthy vagina, and studies have shown that certain strains have the capacity to interfere with the inflammatory pathway leading to preterm delivery. There is enormous need for new diagnostic and therapeutic modalities, especially to save the lives of millions of babies in resource-disadvantaged countries.

Streptococcus pyogenes is a globally prominent human-specific pathogen that is responsible for an enormous burden of infectious disease. Despite intensive experimental efforts to understand the molecular correlates that contribute to invasive infections, there has been less focus on S. pyogenes carriage and local infection of the nasopharynx. This chapter describes an acute nasopharyngeal infection model in mice that is utilized in our laboratory to study the role of superantigen toxins in the biology of S. pyogenes. We also describe a method to detect superantigen-specific T cell activation in vivo.

Two new main-vessel bolometric cameras (KB5) with horizontal and vertical views of the plasma cross-section have been installed on JET, providing a substantial upgrade in capabilities: more viewing chords (24 chords for each camera), higher energy range (up to 8 keV), higher sensitivity (∼6.2 V/W), lower noise and therefore, lower detectable signals (∼2 μW/cm 2 at a bandwidth of 200 Hz), higher temporal resolution (∼2 ms). In addition, three new dedicated divertor bolometer cameras (KB3) with 12 lines-of-sight in total, optimised views and technical improvements have replaced the old ones. The combination of KB3 and KB5 systems provides measurements with significantly improved spatial resolution, allowing the divertor and main chamber radiation fractions to be clearly resolved. The sensitivity measured with an in situ electrical method matches very well with that obtained using a light source calibration. The deviation between the two methods is less than 7% and is in the range of the measurement accuracy. The experimentally measured geometric functions closely match those computed using the design values of geometry. Tomographic reconstructions of high density divertor plasmas with ITER-like configuration are presented which clearly demonstrate the capability of the new diagnostic.

PurposeThis paper aims to examine the influence of private corporations in the tripartite structure of the International Telecommunications Union (ITU): Telecommunications Standardization, Radiocommunication, and Telecommunications Development.Design/methodology/approachThis research employs institutional ethnography in conjunction with the case study.FindingsThe paper finds that, in the standardization sector, power has been effectively transferred from nation states to the private corporate sector since the approval process now enables standards to be approved by members of the study group that developed them, which is essentially the private sector. In the radiocommunication sector, the private sector continues to conduct much of the requisite technical work, but national governments are ultimately the decision makers and, further, it is difficult to distinguish between treaty and non‐treaty work. In the development sector, the ITU seeks to create an enabling environment for private investment in developing countries and actively seeks to build private sector partnerships. In the long run the ITU may be unable to satisfy either its narrow corporate constituency or the vast majority of its developing country members.Originality/valueAs the United Nations agency which coordinates satellite spacing and allocates access to the electromagnetic spectrum on an international basis, the ITU is the world's most prominent international telecommunications institution, so its structural modifications and membership changes are of great significance in a world increasingly dependent on a global grid of wired and wireless telecommunications networks. This paper sheds light on these.

To improve the quality of radiation measurements, two new bolometric cameras with horizontal and vertical views of the plasma cross-section have been installed on JET. These cameras provide measurements with significantly improved spatial resolution, allowing the divertor and main chamber radiation fractions to be clearly resolved. Analysis of radiation profiles under attached and detached divertor conditions as well during the formation of an X-point MARFE (XPM) close to an ohmic density limit are presented. The radiation power fraction y = P rad /P heat increases from 0.5 to 0.8 just before XPM onset. A large fraction of this radiation is located in the divertor (P div rad /P tot rad = 0.56 at low density and about 0.67 at XPM onset). In addition, spatial distributions of radiation in recent ITER-like configuration discharges are presented.

t r p f n a t c t r. Jenny McCormick: Today’s case is that of a 38ear-old woman who presented to the Emergency Deartment (ED) with complaints of bruising and transient pisodes of numbness, tingling, and speech disturbance. en days before arrival in the ED, the patient noticed arge bruises on her thighs and arms, as well as several red dots” on her lower legs. Over the next few days, she oticed new bruising after minimal trauma. Three days efore arrival, she noticed a tingling sensation in the ight 4th and 5th fingers that resolved in 10–15 min. The ollowing morning, the patient noticed a similar numb nd tingling feeling in her left arm and left leg, which esolved within half an hour. The day before presentaion, she noted trouble controlling her saliva, and then eveloped numbness in her right leg with weakness such hat the leg was dragging. This again resolved within half n hour. Later that evening, she suddenly felt that she ould not speak or communicate, and symptoms again esolved within 30 min. She decided to seek medical ttention. At the time of her presentation to the ED, the atient’s symptoms had completely resolved. Is there any urther information you would like to know about the nitial presentation? Dr. David Peak: Did the patient have any systemic omplaints to go along with the neurological symptoms, r any history of increased bleeding? Dr. McCormick: The patient denied any lighteadedness, dizziness, seizures, headaches, or visual sympoms. There was no abdominal pain, nausea, vomiting

Dysregulated immune responses to infection, such as those encountered in sepsis, can be catastrophic. Sepsis is typically triggered by an overwhelming systemic response to an infectious agent(s) and is associated with high morbidity and mortality even under optimal critical care. Recent studies have implicated unconventional, innate-like T lymphocytes, including CD1d- and MR1-restricted T cells as effectors and/or regulators of inflammatory responses during sepsis. These cell types are typified by invariant natural killer T (iNKT) cells, variant NKT (vNKT) cells, and mucosa-associated invariant T (MAIT) cells. iNKT and vNKT cells are CD1d-restricted, lipid-reactive cells with remarkable immunoregulatory properties. MAIT cells participate in antimicrobial defense, and are restricted by major histocompatibility complex-related protein 1 (MR1), which displays microbe-derived vitamin B metabolites. Importantly, NKT and MAIT cells are rapid and potent producers of immunomodulatory cytokines. Therefore, they may be considered attractive targets during the early hyperinflammatory phase of sepsis when immediate interventions are urgently needed, and also in later phases when adjuvant immunotherapies could potentially reverse the dangerous state of immunosuppression. We will highlight recent findings that point to the significance or the therapeutic potentials of NKT and MAIT cells in sepsis and will also discuss what lies ahead in research in this area.

Single aperture range finders with eye safe lasers due to their smaller size and simplified design have a strong potential for wide implementation in military and commercial systems. In this paper we present the results of experimental evaluation of a single aperture laser range finder. The new design operates at eye safe wavelength range around 1535 nm and uses passively Q switched laser for illumination. The optical circulator is used to separate the detection and illumination channels. The measurements of the power budget and ranging performance evaluation for the new design are discussed.

The design considerations for low cost, shock resistant, compact and efficient laser radars and ranging systems are discussed. The reviewed approach with single optical aperture allows reducing the size, weight and power of the system. Additional design benefits include improved stability, reliability and rigidity of the overall system. The proposed modular architecture provides simplified way of varying the performance parameters of the range finder product family by selecting the sets of specific illumination and detection modules. The performance operation challenges are presented. The implementation of non-reciprocal optical elements is considered. The cross talk between illumination and detection channels for single aperture design is reviewed. 3D imaging capability for the ranging applications is considered. The simplified assembly and testing process for single aperture range finders that allows to mass produce the design are discussed. The eye safety of the range finder operation is summarized.

Summary Sepsis is characterized by a severe systemic inflammatory response to infection that is associated with high morbidity and mortality despite optimal care. Invariant natural killer T (iNK T) cells are potent regulatory lymphocytes that can produce pro- and/or anti-inflammatory cytokines, thus shaping the course and nature of immune responses; however, little is known about their role in sepsis. We demonstrate here that patients with sepsis/severe sepsis have significantly elevated proportions of iNK T cells in their peripheral blood (as a percentage of their circulating T cells) compared to non-septic patients. We therefore investigated the role of iNK T cells in a mouse model of intra-abdominal sepsis (IAS). Our data show that iNK T cells are pathogenic in IAS, and that T helper type 2 (Th2) polarization of iNK T cells using the synthetic glycolipid OCH significantly reduces mortality from IAS. This reduction in mortality is associated with the systemic elevation of the anti-inflammatory cytokine interleukin (IL)-13 and reduction of several proinflammatory cytokines within the spleen, notably interleukin (IL)-17. Finally, we show that treatment of sepsis with OCH in mice is accompanied by significantly reduced apoptosis of splenic T and B lymphocytes and macrophages, but not natural killer cells. We propose that modulation of iNK T cell responses towards a Th2 phenotype may be an effective therapeutic strategy in early sepsis.

This article examines the organisational structure and strategic plans of the African Telecommunications Union (ATU). Although the ATU has been restructured to include private telecommunications entities as associate members, it remains essentially an inter-governmental agency. The article assesses the benefits of a regional approach to telecommunications reform and proposes that regional economic organisations replace the nation states as members of the ATU. Although the goals of the ATU, as articulated in its strategic plans are laudable, clearly defined benchmarks and specific strategies to achieve them are needed to make the organisation more effective.

Background Adherence to antiretroviral therapy is critical to treatment outcomes. Adherence studies in other therapeutic areas of medicine suggest that once-daily regimens support improved adherence when compared to twice-daily therapy. An expansion in the range of once-daily antiretrovirals is making once-daily therapy possible for persons with HIV infection. Methods A 24-week randomized open-label simplification study of twice-daily regimens based on stavudine immediate release or zidovudine to an all once-daily regimen based on the stavudine prolonged-release capsule (PRC), in persons with complete virological suppression on regimens also including efavirenz and lamivudine, was carried out. Subjects were assessed for adherence [using the Medication Event Monitoring System® (MEMS®) cap; Aardex Corporation, Union City, CA, USA], quality of life, tolerability and efficacy. Results Forty-three patients were randomly assigned: 21 remained on their original regimen and 22 switched to once-daily therapy with stavudine PRC. Although high levels of adherence and good quality of life were present at study enrolment, adherence declined to a significantly lesser extent at week 24 in the group that switched to once-daily therapy. Efficacy was maintained in both groups and there were no differences in tolerability or toxicity. Conclusions Subjects switching from twice-daily therapy to once-daily therapy demonstrate less of a decline in adherence over 24 weeks. A once-daily regimen including stavudine PRC is as effective and tolerable as a regimen containing the twice-daily formulation.

Use of the Internet to retrieve health information is increasingly common. The authors surveyed 743 undergraduate students at 2 academic institutions to examine their Internet use, health-seeking behaviors, and attitudes related to the use of the Internet to obtain health information. Fifty-three percent of the respondents indicated that they would like to get health information online, and 28% reported that they would like to attend a health program online. Overall, 74% of the students reported having ever received health information online, and more than 40% reported that they frequently searched the Internet for information. They used various search engines and multiple Web sites to find health information. Issues related to the credibility of the information on health Web sites were crucial considerations for students. The study found differences in Internet use for health information by gender and by level of Internet experience.

In the high-density H-mode of the Stellarator Wendelstein 7-AS, the plasma detaches from the island divertor targets when the line-averaged density exceeds a critical value. This quasi-stationary detachment is found to be partial and shows edge-localized, poloidally asymmetric radiation. The spectroscopic characteristics of the deeply detached plasma are reported, including evidence for volume recombination. The detached plasma radiates up to 90% of the absorbed power with larger contributions from the locations close to magnetic X-points outside the divertor region. The spectral analysis of the Balmer series indicate very high densities and low temperatures at the detached regions. The results of the spectral analysis underline the importance of three-dimensional modelling. An initial comparison is made with the latest results from EMC3-EIRENE modelling.

SUMMARY Probiotics are defined as live microorganisms that, when administered in adequate amounts, confer a health benefit on the host. There is now mounting evidence that selected probiotic strains can provide health benefits to their human hosts. Numerous clinical trials show that certain strains can improve the outcome of intestinal infections by reducing the duration of diarrhea. Further investigations have shown benefits in reducing the recurrence of urogenital infections in women, while promising studies in cancer and allergies require research into the mechanisms of activity for particular strains and better-designed trials. At present, only a small percentage of physicians either know of probiotics or understand their potential applicability to patient care. Thus, probiotics are not yet part of the clinical arsenal for prevention and treatment of disease or maintenance of health. The establishment of accepted standards and guidelines, proposed by the Food and Agriculture Organization of the United Nations and the World Health Organization, represents a key step in ensuring that reliable products with suitable, informative health claims become available. Based upon the evidence to date, future advances with single- and multiple-strain therapies are on the horizon for the management of a number of debilitating and even fatal conditions.

BACKGROUND Limitations in exercise capacity in kidney transplant recipients are thought to result in part from changes in muscle structure and function associated with immunosuppression therapy. METHODS We compared the percent distribution of skeletal muscle fiber types, cross-sectional areas, and ultrastructural morphologies in kidney transplant recipients treated with standard prednisone maintenance therapy (n=21) to those undergoing rapid withdrawal of prednisone using Simulect (interleukin 2 receptor inhibitor) (n=13). Skeletal muscle biopsy specimens from the vastus lateralis were analyzed at 3 and 12 months after transplantation and compared with sedentary controls (n=15). RESULTS Compared with the control group, the group receiving prednisone maintenance therapy had a significantly lower percentage of type I fibers and a higher percentage of type IIB/x fibers, evident at 3 and 12 months. Fiber type distribution in patients withdrawn from prednisone did not differ from controls. In patients withdrawn from prednisone, the cross-sectional areas of type I and IIA fibers were lower and the area of type IIB/x fibers was higher compared with controls. Likewise, ultrastructural studies revealed reduced volume densities of myofibrils and higher densities of interfibrillar and subsarcolemmal mitochondria. At 12 months there were no ultrastructural differences between the patients withdrawn from prednisone and controls. CONCLUSIONS We conclude that prednisone maintenance therapy contributes to the lower exercise capacity by altering the ratio of type I to type IIB/x fibers and by reducing myofilament density. The increase in mitochondria in patients receiving prednisone may reflect a switch from carbohydrate to lipid metabolism resulting from the glucocorticoid therapy.

Introduction: Cross-sectional studies have repeatedly observed that African American adolescents are less likely to smoke when compared to White and Hispanic adolescents. Although much is known among high school samples, few scientifically based studies have reported these race and ethnic differences in cigarette smoking among younger samples. Methods: This study employed a secondary analysis of data from a 3-year middle school violence prevention project. The study design was a 3-year serial cross-sectional survey, out of which a cohort of students from sixth to eighth grade was formed. Smoking measurers were taken yearly. Results: 8865 students responded in 1994, 9115 in 1995, and 9364 in 1996; 1589 students are in the 3-year cohort. Smoking prevalence rates from both measurement periods confirm the disparity between African Americans, Whites, and Hispanic youth. Although weak in sixth grade, by eighth grade, White and Hispanic students are smoking at two to four times the rate of their African American classmates. Conclusions: Clearly, more etiological research needs to be conducted to understand the social, cultural, and intrapersonal forces that operate to inhibit the onset of smoking in African American youth and promote the onset of smoking in White and Hispanic youth.

Thermography is applied on the stellarator W7-AS to monitor the thermal load of the recently installed divertor targets. A three dimensional numerical code was developed to evaluate power fluxes arriving at the targets from the measured temporal evolution of the surface temperature distribution. Values of the thermal conductivity of the used CFC-target material for all three directions are required for this evaluation and determined by observing the propagation of controlled heat pulses applied by an infrared laser. The evaluation of the thermographic measurements during plasma operation shows characteristic spatial and temporal features of the arrived heat fluxes. Significant features in high density regimes like plasma detachment from the divertor target plates or strongly enhanced localised plasma radiation (MARFE) has been observed by the installed infrared cameras. The implications of these observations for the thermographic system for W7-X are shortly addressed.

This article examines telecommunications reform and related infrastructure and service developments in Southern African states. In focusing on this region, the article analyses the role of the Southern African Development Community (SADC) and the different associations and commissions it has created to develop the telecommunications sector and facilitate reform, which is essential to promote network efficiencies and extend the infrastructure to rural areas. As a regional organisation, SADC is poised to promote restructuring of the telecommunications sector in its 14 member states, as it seeks to achieve complementary national and regional programs and promote sustainable development and economic growth through regional integration.

Introduction: Cellulosimicrobium cellulans is a rare human pathogen that is associated with chronic immunosuppression, such as human immunodeficiency virus infection, post‐transplantation or end‐stage renal disease. Case presentation: A 59‐year old man with a past medical history of significant cardiovascular, cerebrovascular and peripheral vascular disease was admitted to the intensive care unit (ICU) with intractable seizures. Physical examination, radiographic imaging and culture results suggested the patient had developed metabolic encephalopathy due to pneumonia caused by Staphylococcus aureus and Moraxella catarrhalis. The patient recovered neurologically with the use of broad‐spectrum antibiotics but developed acute renal failure during his stay. Seven days later, he relapsed into seizure activity and two separate blood cultures grew Cellulosimicrobium cellulans. Despite maximal antibiotic therapy, the patient continued to deteriorate. After 16 days, the patient’s family withdrew care and he subsequently died. Conclusion: We report the isolation of Cellulosimicrobium cellulans from a patient who developed acute renal failure following a prolonged stay in the ICU for sepsis encephalopathy.

Background The lack of a reliable scoring system that predicts the development of septic shock and death precludes comparison of disease and/or treatment outcomes in animal models of sepsis. We developed a murine sepsis score (MSS) that evaluates seven clinical variables, and sought to assess its validity and reliability in an experimental mouse model of polymicrobial sepsis. Methods Stool collected from the cecum of C57BL/6 (B6) mice was dissolved in 0.9% normal saline (NS) and filtered, resulting in a fecal solution (FS) which was injected intraperitoneally into B6 mice. Disease severity was monitored by MSS during the experimental timeline. Blood and tissue samples were harvested for the evaluation of inflammatory changes after sepsis induction. The correlation between pro-inflammatory markers and MSS was assessed by the Spearman rank correlation coefficient. Results Mice injected with FS at a concentration of 90 mg/mL developed polymicrobial sepsis with a 75% mortality rate at 24 hours. The MSS was highly predictive of sepsis progression and mortality, with excellent discriminatory power, high internal consistency (Cronbach alpha coefficient = 0.92), and excellent inter-rater reliability (intra-class coefficient = 0.96). An MSS of 3 had a specificity of 100% for predicting onset of septic shock and death within 24 hours. Hepatic dysfunction and systemic pro-inflammatory responses were confirmed by biochemical and cytokine analyses where the latter correlated well with the MSS. Significant bacterial dissemination was noted in multiple organs. Furthermore, the liver, spleen, and intestine demonstrated histopathological evidence of injury. Conclusions The MSS reliably predicts disease progression and mortality in an animal model of polymicrobial sepsis. More importantly, it may be used to assess and compare outcomes among various experimental models of sepsis, and serve as an ethically acceptable alternative to death as an endpoint.

Objective.Anticitrullinated protein/peptide antibodies (ACPA) are implicated in rheumatoid arthritis (RA) pathogenesis and linked to the shared epitope (SE). Citrulline modification is very similar to a different modified amino acid, homocitrulline. We investigated antihomocitrullinated protein/ peptide antibody (AHCPA) specificity for RA, whether ACPA were also able to bind homocitrullinated targets, and whether the SE could accommodate homocitrullinated peptide.Methods.Homocitrullinated fibrinogen was used to screen sera from patients with RA, psoriatic arthritis, and systemic lupus erythematosus, and healthy subjects for AHCPA using ELISA. Homocitrullination sites on fibrinogen were identified by mass spectrometry. ACPA were affinity-purified using a synthetic citrullinated peptide and tested for binding to homocitrullinated protein/peptide. Inhibition of antihomocitrullinated fibrinogen antibody binding was examined. Homocitrullinated peptide interaction with the SE was studied using computer modeling.Results.IgG antihomocitrullinated fibrinogen antibodies were found specifically in 49% of patients with RA. Enrichment of ACPA by affinity purification from 5 patients with RA also enriched AHCPA. Serum AHCPA was inhibited by citrullinated fibrinogen and more significantly by homocitrullinated fibrinogen. Computer modeling indicated that the SE could accommodate a homocitrullinated peptide without steric hindrance. Mass spectrometry identified that 89/103 lysines of fibrinogen could be homocitrullinated, and 5 peptides that could be both citrullinated and homocitrullinated and are predicted to bind the SE.Conclusion.Antihomocitrullinated fibrinogen antibodies are specific to RA. The presence of AHCPA coincides with ACPA, and AHCPA copurifies with ACPA in affinity purification and is inhibited by citrullinated and homocitrullinated antigens. Thus AHCPA and ACPA are frequently cross-reactive and homocitrullinated proteins/peptides may bind the SE.

Since the mid-1990s, Botswana has pursued a policy of telecommunications liberalisation. This article, based on fieldwork conducted in Botswana in the summer of 2000, analyzes several notable aspects of the process of reform and denotes those worthy of emulation by other African states. The participation and protection of domestic telecommunication users, transparency in decision-making, the creation of an independent regulatory agency, and the introduction of competition in the form of private cellular service providers are among those policy features that are recommended for replication. Various facets of the tendering process and subsequent licences granted to the mobile operators as well as recent legislation are also examined and commended.

Legal and educational interventions have not had a significant impact in reducing alcohol use among college students. The purpose of this study was to determine the frequency at which students placed themselves “at-risk” for alcohol-related traffic fatalities, either by driving while alcohol impaired or riding with an alcohol-impaired driver. On a given weekend night, 18% (n = 60) of students surveyed placed themselves at risk of being involved in an alcohol-related traffic fatality. Two-thirds of the “at-risk” subjects reported returning home with an alcohol-impaired driver. Recommendations are made for strengthening prevention efforts.

Purpose. The purpose of this study was to evaluate the effectiveness of a 1-week didactic and clinical skin cancer prevention training module. The evaluation assessed both the immediate and the 3-month effects of the module on nurse participants. In addition, this study assessed whether the module had any secondary effects on skin cancer practices, including perceived support from colleagues, resources, time, and perceived responsibility to conduct skin cancer screening activities and education. Methods. A quasi-experimental design with 32 intervention and 87 comparison subjects was employed. Instruments developed and validated specifically for this study were used to assess knowledge, self-efficacy, priority of skin cancer, and organizational level constructs. Results. The findings indicate that the module significantly increased general and prevention knowledge as well as screening ability; the increase was stable over time. The module was also found to improve self-efficacy to screen and to educate. There was no effect on the organizational-level constructs. Conclusions. Baseline knowledge assessments validated other studies indicating that nurses need more education about skin cancer. Despite promising results from program participants, system-level barriers could impose substantial barriers to implementation in health care practice. Knowledgeable nurses must educate their colleagues, their supervisors, and the public about the priority of skin cancer screening and develop strategies for creating organizational change to increase the likelihood that screening and patient education will occur for people at risk for skin cancer.

This chapter examines the ramifications of the structural alterations of International Telecommunications Satellite Organisation (INTELSAT), which especially affect developing countries, since more than 90 developing countries remain largely dependent on INTELSAT for their telecommunications needs. It begins with a review of the historical development of INTELSAT, including a critical analysis of relevant US legislation, such as the Communications Satellite Act of 1962 (Satellite Act) and the subsequently-enacted Open-market Re-organisation for the Betterment of International Telecommunications Act (ORBIT Act). The chapter assesses the effectiveness of International Telecommunications Satellite Organisation (ITSO) in addressing issues related to universal access. It considers a number of developments following INTELSAT's privatisation and their impact on the continued availability of universal access to satellite services. The chapter concludes that from the perspective of developing countries with inequitable access to communications services, INTELSAT seems unlikely to reduce disparity. Keywords: Communications Satellite Act; communications services; International Telecommunications Satellite Organisation (INTELSAT); International Telecommunications Satellite Organisation (ITSO); ORBIT Act

This chapter outlines the background and special features of International Mobile Satellite Organisation (INMARSAT), the particular forces which led inexorably to its transformation, the key elements of the new structure, the differing interests of the membership and main political, commercial and legal issues encountered. INMARSAT was created as an intergovernmental organisation, operating on a commercial basis and having public and private participation. The INMARSAT system, which comprises the space segment, earth stations on land, and mobile earth stations, has grown extensively over the years. The INMARSAT system of today offers a range of communications services comprising direct-dial telephone, telex, facsimile, electronic mail, and broadband data services for commercial use and public correspondence. The chapter concludes that the INMARSAT, and its successor, has kept pace with, and responded well to worldwide political, economic and technological evolution throughout the decades, in particular the liberalisation and privatisation of the global telecommunication industry. Keywords: communication services; International Mobile Satellite Organisation (INMARSAT); mobile satellite communications

We report the first known study of the growth of epitaxial dysprosium phosphide (DyP) grown on gallium arsenide (GaAs). DyP is lattice matched to GaAs, with the room-temperature mismatch being less than 0.01%. We have grown DyP on GaAs by gas-source and by solid-source molecular beam epitaxy using custom-designed group V thermal cracker cells and group III high temperature effusion cells. X-ray diffraction results show the DyP epilayer to be (001) single crystal on GaAs(001) substrate. Electrical and optical measurements performed to date are inconclusive as to whether DyP is a semi-metal or a semiconductor with a small band gap. The undoped films are n-type with measured electron concentrations on the order of 5 X 10 19 -6 X 10 20 cm -3 with mobilities of 1-10 cm 2 /V. s. DyP/GaAs is stable in air with no apparent oxidation taking place, even after months of exposure to ambient untreated air. Material and surface science properties measured for DyP/GaAs include Hall measurements, 2θ and double-crystal X-ray diffraction spectra and photothermal deflection spectroscopy.

The purpose of this paper is to identify, analyse and discuss the key governance challenges for the emerging Knowledge-Based Bio-Economy (KBBE) in Europe focusing on bioenergy, particularly biofuels for transport and the biorefinery concept. This paper is based on a literature review, discussions with European researchers and practitioners, and questionnaires of bioenergy industry associations. The growing bio-economy and bioenergy in Europe face a host of socio-technical issues that comprise a mix of technological, economic, social, political, environmental, regulatory and cultural aspects. More specifically, this research work highlights three key governance challenges of increasing relevance for the bio-economy, including: the important role of public-private networks; city-regions as drivers for the KBBE, especially through climate governance; and consumer-citizens and NGOs as key players in the development of the bio-economy.

This quasi-experimental study assessed impact of factors associated with classroom implementation of health curricula by North Carolina teachers. School representatives selected and implemented one of three tobacco prevention curricula — Project SMART, Growing Healthy, or the Teenage Health Teaching Modules — in either sixth or seventh grades. Prior to implementation, experimental teachers and administrators received extensive curricula training. Implementation data were collected through teacher completed checksheets and classroom observations for two time periods — initial implementation (n = 69) and maintained implementation (n = 136). While training was associated significantly with whether teachers implemented a curriculum (p < .05), other factors also were important. Variables outside of teachers' direct control, such as supportive administrators, context in which health instruction is taught, and turbulence, affected quantity and quality of curricular implementation.

Many developing countries are privatizing their telecommunication sectors, but their governments are often inexperienced in the use of regulatory power to oversee the operations of the new private company. This article reviews pertinent issues and relevant literature concerning telecommunications privatization to provide a contextual framework for discussing the privatization of Telecommunications of Jamaica. The sale of shares and public reaction to the divestiture are examined as well as Jamaica's apparently ineffectual regulatory system which seems to ensure that such goals as universal service will not be addressed.