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A diagnosis of I Ureaplasma i spp. meningitis was considered most likely because of the combination of intraventricular haemorrhage, hydrocephalus, seizures and persistent detection of I Ureaplasma i spp. on CSF culture.5 Even in confirmed cases of I Ureaplasma i spp. meningitis, optimal treatment is not well defined. We present the case of a preterm neonate with intraventricular haemorrhage and hydrocephalus associated with I Ureaplasma i spp. meningitis, successfully treated with macrolide and quinolone therapy. I Ureaplasma i spp. meningitis is rare but has been described in preterm neonates and, less frequently, term neonates. First, I Ureaplasma i spp. will not be detected using conventional culture media or standard CSF NAAT panels and targeted testing is required.4 In this case, I Ureaplasma i spp. was unexpectedly detected on 16S rRNA gene sequencing. [Extracted from the article]

Global warming and climate change have been major problems in the present world. Greenhouse gas emissions contribute to global warming in which carbon dioxide being the best known. The aviation sector (excluding aerospace) has contributed to a total of 49.4 billion tons of carbon dioxide emission in 2016 alone. A solution to curb the increase of greenhouse gases has been proposed to temporarily solve this problem while future technological advancements occur. Having a heat recovery system by using heat exchangers in the engine helps to not only improves the performance of the engine but to also reduce temperature of the exhaust gases that will be eliminated as waste heat into the atmosphere. The main objective of the introduction of intercoolers and recuperators is to reduce the thrust specific fuel consumption whilst increasing the thrust and reducing emissions. This research thesis focuses on the analysis of intercooling and recuperation within the aspects of thermodynamics to be integrated into a typical turbofan engine. The analysis will be conducted via process simulation software – Aspen Plus V11 and the data from the software will be exported to Microsoft Excel for post-processing and graph visualization. Three main objectives of the study are to determine whether compression work will be reduced, studying the increase of thrust and performance of the engine with the positioning of heat exchangers and the improvement of TSFC with the integration of heat exchangers. For the first objective, it has been proven that there is a reduction in compression work for the recuperated engine of 7.64% but there is a 13.17% increase in compression work for the intercooled engine. For the second objective, thrust increased in both recuperated and intercooled cycles with 1.14% and 1.31% for the recuperated and intercooled cycles, respectively. Finally for the third objective, a decrease in TSFC for both recuperated and intercooled cycles show that both the heat recovery systems have an improvement of TSFC.

Objectives: Screening of men who have sex with men (MSM) for Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) requires sampling from anorectal and pharyngeal sites in addition to urogenital sampling. Due to the cost of testing multiple anatomical sites individually testing of pooled specimens has potential merit. The Cepheid GeneXpert CT/NG assay (GeneXpert), which also has potential for point-of-care nucleic acid testing in the sexual health clinic, has not been assessed for pooled specimen testing.Methods: We prospectively compared GeneXpert testing of pooled pharyngeal and rectal swabs with urine samples to standard of care testing of individual specimens from 107 participants using the Roche cobas 4800 CT/NG assay (cobas) for CT and NG in high-risk MSM attending an inner city sexual health clinic.Results: We found testing of pooled pharyngeal, rectal and urine samples by the GeneXpert to have 100% agreement for NG and 94% overall agreement for CT when compared with individual specimen testing by cobas. For CT testing, 14 cases were detected for both tests, 4for cobas only, 2 for GeneXpert only and 89 participants were negative for both tests.Conclusions: Pooled specimen CT and NG testing by the GeneXpert was accurate when compared with single specimen testing and has potential for screening MSM for CT and NG. The role of pooled specimen testing with the GeneXpert as a point-of-care nucleic acid test in MSM requires further investigation. [ABSTRACT FROM AUTHOR]

Most patients with atherosclerosis exhibit isolated stenoses of one or more epicardial coronary arteries. The wall shear stresses produced in high-grade stenosis are important in the understanding of atheromatous plaque rupture and thrombosis. This study is designed to establish a method which can be used to scale the different wall shear stresses obtained under different flow conditions to be normalized and subsequently collapsed on to a single general curve. The simulations include both steady and pulsatile flow. The reduced area percentages of the stenoses studied are 50, 75 and 90 per cent. Scaling laws for steady and pulsatile flow conditions are proposed and presented. It can be found from the results that the scaling analysis for pulsatile flow conditions is more complicated than for steady flow conditions and is restricted to, and only valid at, certain time intervals. [ABSTRACT FROM AUTHOR]

Using a thermal-crosslinkable siloxane bisbenzocyclobutene, high quality spin-on (solutionprocessable) gate dielectric layers as thin as 50 nm have been fabricated over the semiconductor layer for polymer field-effect transistors. This was demonstrated on a poly(9,9-dialkylfluorene-alt-triarylamine) as p-channel semiconductor, with a surfactantion-exchanged poly(3,4-ethylenedioxythiophene)-polystyrenesulfonate complex as top-gate electrode. The devices operate at a low voltage with a field-effect mobility of few 10-4 cm2/Vs, and can be continuously operated at 120 °C. © 2004 American Institute of Physics. [ABSTRACT FROM AUTHOR]

Importance: Numerous studies show that early palliative care improves quality of life and other key outcomes in patients with advanced cancer and their caregivers, although most lack access to this evidence-based model of care., Objective: To evaluate whether delivering early palliative care via secure video vs in-person visits has an equivalent effect on quality of life in patients with advanced non-small cell lung cancer (NSCLC)., Design, Setting, and Participants: Randomized, multisite, comparative effectiveness trial from June 14, 2018, to May 4, 2023, at 22 US cancer centers among 1250 patients within 12 weeks of diagnosis of advanced NSCLC and 548 caregivers., Intervention: Participants were randomized to meet with a specialty-trained palliative care clinician every 4 weeks either via video visit or in person in the outpatient clinic from the time of enrollment and throughout the course of disease. The video visit group had an initial in-person visit to establish rapport, followed by subsequent virtual visits., Main Outcomes and Measures: Equivalence of the effect of video visit vs in-person early palliative care on quality of life at week 24 per the Functional Assessment of Cancer Therapy-Lung questionnaire (equivalence margin of ±4 points; score range: 0-136, with higher scores indicating better quality of life). Participants completed study questionnaires at enrollment and at weeks 12, 24, 36, and 48., Results: By 24 weeks, participants (mean age, 65.5 years; 54.0% women; 82.7% White) had a mean of 4.7 (video) and 4.9 (in-person) early palliative care encounters. Patient-reported quality-of-life scores were equivalent between groups (video mean, 99.7 vs in-person mean, 97.7; difference, 2.0 [90% CI, 0.1-3.9]; P = .04 for equivalence). Rate of caregiver participation in visits was lower for video vs in-person early palliative care (36.6% vs 49.7%; P < .001). Study groups did not differ in caregiver quality of life, patient coping, or patient and caregiver satisfaction with care, mood symptoms, or prognostic perceptions., Conclusions and Relevance: The delivery of early palliative care virtually vs in person demonstrated equivalent effects on quality of life in patients with advanced NSCLC, underscoring the considerable potential for improving access to this evidence-based care model through telehealth delivery., Trial Registration: ClinicalTrials.gov Identifier: NCT03375489.

Introduction: Treatment of proximal humerus fractures remains controversial. Understanding the factors that can affect the long-term functional outcomes can aid with management choices. This primary aim of this paper is to evaluate the association of radiographic parameters with functional outcomes., Methods: Radiographic parameters [Caput-collum-diaphyseal (CCD) angles, Y-scapular angles, and humeral head height (HHH)] were studied. The patients were split into varus and valgus groups based on the CCD angles and retroverted and anteverted groups based on Y-scapular angles. Functional outcome was measured by Oxford Shoulder Score (OSS), Constant Shoulder Score (CSS), and quick Disabilities of Arm, Shoulder and Hand score at 1 year follow-up. Intra- and interrater reliability were measured with the intraclass correlation coefficients (ICCs). Receiver operator curve (ROC) analysis and logistic regression analysis defined the optimal value for abnormalities on radiographic evaluation as an outcome predictor., Results: 111 patients were recruited (mean age 69, 78% female). Median final radiographic assessment was at 7 months. Mean initial/final CCD was 119 o /111 o (varus, n = 36) and 153 o /140 o (valgus, n = 75). Mean initial/final Y-scapula angle was 27 o /27 o (retroversion, n = 101) and 70 o /40 o (anteversion, n = 9). There was a significant relationship between OSS and final Y-scapular angle in the retroverted group (adj coeff 0.034, p = 0.009) with optimum predictive retroversion angulation of 25 o predicting poor functional outcome (OSS < 40), area under the ROC curve of 0.614. Higher initial valgus and retroversion significantly predicted more change in the final angle (adj coeff - 0.349, p = 0.002, adj coeff - 0.527, p < 0.001 respectively). Both intra-rater and inter-rater reliability for the radiographic parameters were excellent (ICC > 0.9)., Conclusion: Radiographic parameters whilst having excellent reliability, have a limited ability to predict short-term functional recovery. The extent of retroversion is the most important predictor for functional recovery with 25 o a cut-off guide. Fractures with a higher initial valgus and retroversion tend to displace more., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Small animal models play an important role in investigating and revealing the molecular determinants and mechanisms underlying neuro-virulence of enterovirus A71 (EV-A71). In our previous study, we successfully developed two mouse cell-line replication competent EV-A71 strains (EV71:TLLm and EV71:TLLmv) which were capable of inducing neuro-invasion in BALB/c mice. The more virulent EV71:TLLmv exhibited ability to induce acute encephalomyelitis accompanied by neurogenic pulmonary oedema. EV71:TLLcho virus strain was generated from EV71:TLLm by a series of passages in CHO-K1 cells. EV71:TLLcho demonstrated a broader range of infectivity across various mammalian cell lines and exhibited complete cytopathic effects (CPE) within 48 hours post-inoculation in comparison to EV71:TLLm or EV71:TLLmv. EV71:TLLcho consistently yielded higher levels of viral replication at all time points examined. In comparison to EV71:TLLm, EV71:TLLcho consistently induced more severe disease and increased mortality in one-week old BALB/c mice. However, unlike mice challenged with EV71:TLLmv, none of the mice challenged with EV71:TLLcho progressed to severe acute encephalomyelitis and developed neurogenic pulmonary oedema.

Background: In global health, international nongovernmental organizations (NGOs) frequently hire, train, and partner with host-country clinicians who manage public outreach and patient care. Purpose and Research Design: We conducted a general interpretivist study of Basotho clinicians hired by NGOs and academic affiliates in Lesotho to identify cultural barriers and facilitators to community and patient education. Data Collection and Analysis: We conducted 13 interviews involving 16 participants (one physician, one nutritionist, 14 nurses). Using an inductive and iterative approach, we analyzed interview transcripts through the lens of social cognitive theory and identified 15 themes. Results: Major findings highlighted: 1) patient and community learners may view Basotho clinicians as authority figures; 2) family and community power dynamics affect healthcare access for vulnerable patient groups; and 3) village leaders may refuse community education when excluded from problem-solving and early planning. Conclusions: Although local clinicians and community members may identify with the same cultural group, clinicians can encounter cultural barriers to patient and community education.

Background: Increased access to interprofessional palliative care is needed in ambulatory oncology settings. To achieve this, Dana-Farber Cancer Institute launched a collaborative drug therapy management clinic, PharmPAL, where credentialed advanced practice pharmacists lead independent patient visits., Methods: As part of a pilot project focused on clinical innovation, we analyzed PharmPAL referrals and pharmacist interventions between July 2020 and June 2021. We extracted referral patterns, patient hospitalizations, and deaths from the electronic medical record. Outpatient palliative care clinicians completed a survey to determine pharmacist needs and overall satisfaction with PharmPAL., Results: From July 2020 to June 2021, PharmPAL constituted 4.7% (299/6305) of all outpatient palliative care encounters. Most palliative care clinicians (86% [6/7]) reported a desire to increase PharmPAL availability. No patient hospitalizations or deaths were attributed to PharmPAL visits., Conclusion: PharmPAL increased access to palliative care services. All clinicians reported satisfaction with PharmPAL. We continue to assess the impact PharmPAL has on clinic operations and provider satisfaction.

Objective: US-based academic institutions involved in global health (GH) partnerships can have a positive impact on health care systems in low/middle-income countries but lack a consistent approach. Existing priority setting and resource allocation (PSRA) frameworks do not adequately capture the interpersonal and sociopolitical complexity of decision-making in GH work. The authors explored how US-based GH practitioners prioritize and allocate resources for different types of support in academic GH partnerships., Method: In 2020 to 2021, the authors invited 36 US-based GH practitioners from the 2015 Pediatric GH Leadership Conference to participate in individual 1-hour semi-structured interviews. Using an iterative and inductive grounded theory approach, the study team analyzed interview transcripts through the lens of Heyse's framework on decision-making in humanitarian aid., Results: The authors interviewed 20 GH practitioners and reached thematic sufficiency. A descriptive conceptual framework, capturing 18 distinct themes in 4 major categories, emerged from the data. In this framework, categories included: 1) stakeholders: those who influence and are influenced by the partnership; 2) goals: vision, mission, aims, and scope of the partnership; 3) implementation strategy: approach to accomplishing goals, categorized as relationship-oriented, task-oriented, context-oriented, or nonprescriptive; and 4) approach to conflict: response when goals and strategies do not align among stakeholders., Conclusion: Themes revealed a dynamic process for PSRA. Using our study findings, and building on existing literature, our framework highlights the complex interpersonal relationships, resource limitations, and sociopolitical and economic constraints that affect PSRA in GH partnerships. Finally, themes point to the field's evolution toward a more decolonized approach to GH., (Copyright © 2022 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.)