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Background Despite high vaccination rates, the United States has experienced a resurgence in reported cases of pertussis after switching to the acellular pertussis vaccine, indicating a need for improved vaccines that enhance infection control. Methods Bordetella pertussis antigens recognized by convalescent-baboon serum and nasopharyngeal wash were identified by immunoproteomics and their subcellular localization predicted. Genes essential or important for persistence in the baboon airway were identified by transposon-directed insertion-site sequencing (TraDIS) analysis. Results In total, 314 B. pertussis antigens were identified by convalescent baboon serum and 748 by nasopharyngeal wash. Thirteen antigens were identified as immunogenic in baboons, essential for persistence in the airway by TraDIS, and membrane-localized: BP0840 (OmpP), Pal, OmpA2, BP1485, BamA, Pcp, MlaA, YfgL, BP2197, BP1569, MlaD, ComL, and BP0183. Conclusions The B. pertussis antigens identified as immunogenic, essential for persistence in the airway, and membrane-localized warrant further investigation for inclusion in vaccines designed to reduce or prevent carriage of bacteria in the airway of vaccinated individuals.

ZusammenfassungDie perioperative Medizin ist ein Hochrisikobereich, der besonders anfällig für Kommunikationsdefizite und -fehler ist. Das Schema „situation, background, assessment, recommendation“ (SBAR) bietet einen einfach anzuwendenden Kommunikationsleitfaden, der mit einer verbesserten Qualität der Übergabe assoziiert ist. Im März 2022 ist die Verwendung des SBAR-Schemas in der Perioperativmedizin durch die DGAI schon in zweiter Auflage empfohlen worden. Darüber hinaus hat die moderne Kommunikationsforschung ein ganzes Bündel von Maßnahmen identifiziert, die essenzielle Voraussetzungen für eine effektive Teamarbeit und die Gewährleistung der Patientensicherheit schaffen. Das SBAR-Schema ist eine Möglichkeit, strukturierte Kommunikation im klinischen Alltag umzusetzen. Entscheidend sind die konsequente Nutzung und eine klare Definition der Handlungsabläufe. Nur so können Kommunikationsdefizite in Hochrisikobereichen schneller identifiziert und durch Einführung eines strukturierten Übergabekonzeptes reduziert werden. Unabdingbar bleibt das gemeinsame Verständnis für die Notwendigkeit, diese Konzepte zu erlernen, umzusetzen und als Team zu trainieren. Das übergeordnete Ziel einer Kultur der Patientensicherheit ist nur durch die konsequente Zusammenarbeit des interprofessionellen Teams und durch das Vorleben der Führungskräfte erreichbar.

Purpose A study was conducted using high-fidelity electronic health record (EHR)–based simulations with incorporated eye tracking to understand the workflow of critical care pharmacists within the EHR, with specific attention to the data elements most frequently viewed. Methods Eight critical care pharmacists were given 25 minutes to review 3 simulated intensive care unit (ICU) charts deployed in the simulation instance of the EHR. Using monitor-based eye trackers, time spent reviewing screens, clinical information accessed, and screens used to access specific information were reviewed and quantified to look for trends. Results Overall, pharmacists viewed 25.5 total and 15.1 unique EHR screens per case. The majority of time was spent looking at screens focused on medications, followed by screens displaying notes, laboratory values, and vital signs. With regard to medication data, the vast majority of screen visitations were to view information on opioids/sedatives and antibiotics. With regard to laboratory values, the majority of views were focused on basic chemistry and hematology data. While there was significant variance between pharmacists, individual navigation patterns remained constant across cases. Conclusion The study results suggest that in addition to medication information, laboratory data and clinical notes are key focuses of ICU pharmacist review of patient records and that navigation to multiple screens is required in order to view these data with the EHR. New pharmacy-specific EHR interfaces should consolidate these elements within a primary interface.

Water quality data parameters consist of a large data set. Such a large amount of data incurs great effort in processing and conducting visualization techniques to facilitate the analysis and building of the necessary views for decision makers. The current study included a set of steps to data reduction for 34 parameters during two seasons, at different sites and depths for Mosul Dam Lake, Northern Iraq by using VARCLUS technique. VARCLUS showed that there were seven main clusters during winter with 77% of the total variation in the dataset. Depending on Rratio results indicating that there are 12 parameters could be used to monitoring the water quality and F, SO4 and Li are appears to be more important parameters than among them to predict overall the water quality of the lake for this season. During summer eight main clusters with 79% of the total variation displayed result of summer season. B, Na and S were more significant parameters depending on Rratio among 11 parameters for this season. Each of Li, Ni, S, and total inorganic carbon are dominate parameters during measurement periods. This technique for water quality assessment could be using to reduce by about 64% of water quality data and can support decision-makers by providing an effective and secure tool for managing and monitoring the reservoir.

In 2015 and 2016, groundwater samples were collected in Hanoi to analyse the isotopic composition (δ2H, δ18O and 3H) and elucidate the relationship between groundwater and surface water, as well as the origin of the groundwater. The values for δ18O and δ2H indicate that the groundwater originated from evaporated meteoric water and the isotope enrichment is due to the evaporation of shallow groundwater. Evaporation is the primary process affecting stable isotope signatures. Water samples collected from both Holocene and Pleistocene aquifers are more depleted in the heavy isotopes 18O and 2H than the rainfall in the area. This indicates that part of the groundwater is paleo-groundwater or may be caused by the altitude effect due to recharge at a higher elevation. The results also show the close interaction between two granular aquifers and the Red River. Furthermore, the contribution of modern groundwater could be observed by the appearance of tritium in both aquifers. The presence of tritium indicates that originally tritium-free groundwater from the margins of the basin has been diluted by young water. The results of this study might help managers to evaluate the origin and reserves of groundwater more accurately.

Despite high vaccine coverage, reported cases of pertussis have increased steadily over the last twenty years. This resurgence has stimulated interest in host responses to pertussis infection and vaccination with the goal of developing more effective next-generation vaccines and vaccination strategies. Optimal protection against Bordetella pertussis appears to be multifactorial requiring both humoral and cellular responses. Natural infection and whole-cell pertussis vaccination induce Th1 and Th17-dominated responses. In contrast, acellular vaccines induce Th2-dominated responses. Available immunological data indicate that while antibodies provide protection against disease, Th1 and Th17-mediated immune responses are required for bacterial clearance and long-lasting protection. The nature of the priming in children appears to be important in modulating bias and durability of immune responses required to provide protection against B. pertussis. This review summarizes the current understanding of differences in immune responses and their role in protection against B. pertussis following infection or vaccination.

We conducted a systematic review to describe the frequency of mild, atypical, and asymptomatic infection among household contacts of pertussis cases and to explore the published literature for evidence of asymptomatic transmission. We included studies that obtained and tested laboratory specimens from household contacts regardless of symptom presentation and reported the proportion of cases with typical, mild/atypical, or asymptomatic infection. After screening 6789 articles, we included 26 studies. Fourteen studies reported household contacts with mild/atypical pertussis. These comprised up to 46.2% of all contacts tested. Twenty-four studies reported asymptomatic contacts with laboratory-confirmed pertussis, comprising up to 55.6% of those tested. Seven studies presented evidence consistent with asymptomatic pertussis transmission between household contacts. Our results demonstrate a high prevalence of subclinical infection in household contacts of pertussis cases, which may play a substantial role in the ongoing transmission of disease. Our review reveals a gap in our understanding of pertussis transmission.

Electromagnetic interference from monopolar electrosurgery may disrupt implantable cardioverter defibrillators.Current management recommendations by the American Society of Anesthesiologists and Heart Rhythm Society are based on expert clinical opinion since there is a paucity of data regarding the risk of electromagnetic interference to implantable cardioverter defibrillators during surgery.With protocolized electrosurgery dispersive electrode positioning in patients with implantable cardioverter defibrillators, the risk of clinically meaningful electromagnetic interference was 7% in above-the-umbilicus noncardiac surgery and 0% in below-the-umbilicus surgery. In cardiac surgery, clinically meaningful electromagnetic interference with use of an underbody dispersive electrode was 29%.Despite protocolized dispersive electrode positioning, the risk of electromagnetic interference in above-the-umbilicus surgery is high, supporting recommendations to suspend antitachycardia therapy when monopolar electrosurgery is used above the umbilicus.With protocolized dispersive electrode positioning, the risk of electromagnetic interference in below-the-umbilicus surgery is negligible, implying that suspending antitachycardia therapy might be unnecessary in these cases.With an underbody dispersive electrode, the risk of electromagnetic interference in cardiac surgery is high.The goal of this study was to determine the occurrence of intraoperative electromagnetic interference from monopolar electrosurgery in patients with an implantable cardioverter defibrillator undergoing surgery. A protocolized approach was used to position the dispersive electrode.This was a prospective cohort study including 144 patients with implantable cardioverter defibrillators undergoing surgery between May 2012 and September 2016 at an academic medical center. The primary objectives were to determine the occurrences of electromagnetic interference and clinically meaningful electromagnetic interference (interference that would have resulted in delivery of inappropriate antitachycardia therapy had the antitachycardia therapy not been programmed off) in noncardiac surgeries above the umbilicus, noncardiac surgeries at or below the umbilicus, and cardiac surgeries with the use of an underbody dispersive electrode.The risks of electromagnetic interference and clinically meaningful electromagnetic interference were 14 of 70 (20%) and 5 of 70 (7%) in above-the-umbilicus surgery, 1 of 40 (2.5%) and 0 of 40 (0%) in below-the-umbilicus surgery, and 23 of 34 (68%) and 10 of 34 (29%) in cardiac surgery. Had conservative programming strategies intended to reduce the risk of inappropriate antitachycardia therapy been employed, the occurrence of clinically meaningful electromagnetic interference would have been 2 of 70 (2.9%) in above-the-umbilicus surgery and 3 of 34 (8.8%) in cardiac surgery.Despite protocolized dispersive electrode positioning, the risks of electromagnetic interference and clinically meaningful electromagnetic interference with surgery above the umbilicus were high, supporting published recommendations to suspend antitachycardia therapy whenever monopolar electrosurgery is used above the umbilicus. For surgery below the umbilicus, these risks were negligible, implying that suspending antitachycardia therapy is likely unnecessary in these patients. For cardiac surgery, the risks of electromagnetic interference and clinically meaningful electromagnetic interference with an underbody dispersive electrode were high. Conservative programming strategies would not have eliminated the risk of clinically meaningful electromagnetic interference in either noncardiac surgery above the umbilicus or cardiac surgery.

Determining groundwater recharge is in particular in areas with Monsoon rainfall a challenge. Several methods were used to estimate groundwater recharge for the first time ever for the urban area of Hanoi city, Vietnam. Water table fluctuation method (WTF), hydrograph analyses including recession curve displacement, graphical separation, the Automated Web GIS-Base Hydrology Analysis Tool (WHAT), and empirical formulas were utilized. The mean recharge is approximately 340 mm/year accounting for 20% of precipitation in the period 1996 to 2009 with a certain decrease during this period. Baseflow separation methods show the highest values, whereas the displacement recession curve obtains the lowest recharge. The WTF methods approximate values are close to the mean value of all other proxies. The differences between all proxies are around 10%, and Spearman correlation is statistically significant. This indicates that these methods can be used to estimate recharge for this area. With long-term data, however, the results of WTF appear more consistent and more reasonable than the other approaches.

PURPOSE A new postcardiac surgery fluid resuscitation strategy was implemented in our cardiovascular intensive care unit (CVICU) to implement evidence-based practice. We transitioned from a primarily albumin fluid-based strategy to a lactated Ringer's fluid-based strategy. We sought to determine whether a new postoperative fluid resuscitation strategy significantly altered the fluid composition for postcardiac surgery patients and what effect that would have on fluid resuscitation costs. Secondary outcomes included various clinical parameters. METHODS This was a retrospective, before-and-after cohort study of postcardiac surgery patients in an academic quaternary care intensive care unit (ICU) during two different 3-month time intervals. A total of 192 patients were studied: 108 pre-intervention and 84 post intervention. The intervention consisted of surveying stakeholders regarding potential concerns of reducing albumin use, an educational intervention addressing those concerns, and removing albumin from the routine postcardiac surgery ICU admission order set. RESULTS In the post intervention time period, albumin use decreased significantly compared to pre-invention (p

Environmental earth sciences 80(8), 314 (2021). doi:10.1007/s12665-021-09531-8, Published by Springer, Berlin ; Heidelberg

Pertussis is a highly contagious disease for which prompt, point-of-care diagnosis remains an unmet clinical need. Results from conventional test modalities (nucleic acid detection, serology, and culture) take hours to days. To overcome this challenge, we identified a new biomarker (tracheal colonization factor A, TcfA) for detection of Bordetella pertussis infection by lateral flow immunoassay (LFIA). We developed a library of 28 epitope-mapped monoclonal antibodies against TcfA and incorporated three antibodies into a LFIA. The LFIA did not cross-react with common bacterial or fungal organisms, but did react with nine distinct B. pertussis strains. The minimal linear epitope sequences targeted by the LFIA were conserved in 98% of 954 B. pertussis isolates collected across 12 countries from 1949–2017. The LFIA’s limit of detection was 3.0 × 105 CFU/mL with B. pertussis cells in buffer, 6.2 × 105 CFU/mL with nasopharyngeal washes from a non-human primate model, and 2.3 ng/mL with recombinant TcfA. The LFIA reacted with patient nasopharyngeal swab specimens containing as few as 1.8 × 106B. pertussis genomes/mL and showed no false-positives. Rapid (B. pertussis infection is feasible and may facilitate early detection of pertussis.

This brief report describes the rapid deployment of a real-time electronic tracking board for all hospitals in the state of Oregon. In preparation for the coronavirus disease 2019 surge on hospital resources, and in collaboration across health systems, with health authorities and an industry partner, we combined existing infrastructures to create the first automated tracking board for our entire state, including bed types by health system and geographic area, and with granularity to the individual unit level for each participating hospital. At the time of submission, we have a live snapshot of 87% of beds in the state, including real-time ventilator data across eight health systems. The tracking board allows for rapid assessment of available bed and ventilator resources and pulls electronic health record data that is created through normal care processes rather than relying upon manual entry. It is updated every 5 minutes and is drillable from state to unit level. Together these factors make the data actionable, which is essential in a crisis. The new tracking system integrates seamlessly with our preexisting statewide, manually updated tracking board via bidirectional data sharing to ensure existing processes across the state can continue. This new tool allows any health system in our state to visualize occupancy by type and location in real time. Amid pandemic uncertainty, having a reliable tool for tracking critical hospital resources will enhance our statewide ability to maintain healthcare functionality in a world with coronavirus disease 2019.

Additional file 2. Temporal development in AMR for apramycin (1a), cefquinome (1b), ceftiofur (1c), cephalothin (1d), colistin (1e), enrofloxacin (1f), florfenicol (1 g) and gentamicin (1 h).

The immune response elicited by the protective whole-cell pertussis (wP) versus the less-protective acellular pertussis (aP) vaccine has been well characterized; however, important clinical problems remain unsolved, as the inability of the currently administered aP vaccine is resulting in the reemergence of clinical disease (i.e., whooping cough). Strong evidence has shown that original, childhood aP and wP priming vaccines provide a long-lasting imprint on the CD4+ T cells that impacts protective immunity. However, aP vaccination might prevent disease but not infection, which might also affect the breadth of responses to Bordetella pertussis (BP) antigens. Thus, characterizing and defining novel targets associated with T cell reactivity are of considerable interest. Here, we compare the T cell reactivity of original aP and wP priming for different antigens contained or not contained in the aP vaccine and define the basis of a full-scale genomic map of memory T cell reactivity to BP antigens in humans. Our data show that the original priming after birth with aP vaccines has higher T cell reactivity than originally expected against a variety of BP antigens and that the genome-wide mapping of BP using an ex vivo screening methodology is feasible, unbiased, and reproducible. This could provide invaluable knowledge towards the direction of a new and improved pertussis vaccine design.

Additional file 1. Multifactorial logistic regression analysis with fixed effect time period and factors “age-group” and “sampling site” with respect to apramycin resistance (1a), cefquinome resistance (1b), ceftiofur resistance (1c), cephalothin resistance (1d), colistin resistance (1e), enrofloxacin resistance (1f), florfenicol resistance (1 g) and gentamicin resistance (1 h).

Despite being the main drinking water resource for over 5 million people, the water balance of the Eastern Mountain Aquifer system on the western side of the Dead Sea is poorly understood. The regional aquifer consists of fractured and karstified limestone – aquifers of Cretaceous age, and it can be separated into a Cenomanian aquifer (upper aquifer) and Albian aquifer (lower aquifer). Both aquifers are exposed along the mountain ridge around Jerusalem, which is the main recharge area. From here, the recharged groundwater flows in a highly karstified aquifer system towards the east and discharges in springs in the lower Jordan Valley and Dead Sea region. We investigated the Eastern Mountain Aquifer system for groundwater flow, groundwater age and potential mixtures, and groundwater recharge. We combined 36Cl ∕ Cl, tritium, and the anthropogenic gases SF6, CFC-12 (chlorofluorocarbon) and CFC-11, while using CFC-113 as “dating” tracers to estimate the young water components inside the Eastern Mountain Aquifer system. By application of lumped parameter models, we verified young groundwater components from the last 10 to 30 years and an admixture of a groundwater component older than about 70 years. Concentrations of nitrate, simazine (pesticide), acesulfame K (ACE-K; artificial sweetener) and naproxen (NAP; drug) in the groundwater were further indications of infiltration during the last 30 years. The combination of multiple environmental tracers and lumped parameter modelling helped to understand the groundwater age distribution and to estimate recharge despite scarce data in this very complex hydrogeological setting. Our groundwater recharge rates support groundwater management of this politically difficult area and can be used to inform and calibrate ongoing groundwater flow models.

When it comes to the discovery and analysis of yet uncharted bacterial traits, pure cultures are essential as only these allow detailed morphological and physiological characterization as well as genetic manipulation. However, microbiologists are struggling to isolate and maintain the majority of bacterial strains, as mimicking their native environmental niches adequately can be a challenging task. Here, we report the diversity-driven cultivation, characterization and genome sequencing of 79 bacterial strains from all major taxonomic clades of the conspicuous bacterial phylum Planctomycetes. The samples were derived from different aquatic environments but close relatives could be isolated from geographically distinct regions and structurally diverse habitats, implying that ‘everything is everywhere’. With the discovery of lateral budding in ‘Kolteria novifilia’ and the capability of the members of the Saltatorellus clade to divide by binary fission as well as budding, we identified previously unknown modes of bacterial cell division. Alongside unobserved aspects of cell signalling and small-molecule production, our findings demonstrate that exploration beyond the well-established model organisms has the potential to increase our knowledge of bacterial diversity. We illustrate how ‘microbial dark matter’ can be accessed by cultivation techniques, expanding the organismic background for small-molecule research and drug-target detection., This work was funded by the Deutsche Forschungsgemeinschaft (grant no. JO 893/4-1) and the Volkswagen foundation (experiment no. 89256). M.Y.G. was funded by the NIH IRP at the US National Library of Medicine. Work in the Mascher lab was supported by the Deutsche Forschungsgemeinschaft (grant no. MA2837/2-2) and the Bundeministerium für Bildung und Forschung in the framework of the ERAnet Synthetic Biology (project: ERASynBio2-ECFexpress). R.A. and A.M. were funded by the Max Planck Society.

This erratum corrects measurements of the prompt and secondary (from-b).

The distribution of U, Sr, V, Ni, Cr, B, and Mo in sediments of the Al-Batin Alluvial Fan in southern Iraq was investigated. A total of 18 sediment samples were collected in the study area and the clay and silt fraction was analyzed using a six-step sequential extraction method. Results of the sequential extraction were used to evaluate the potential origin and environmental impacts of the selected elements. Except for Sr, the highest average concentration of the investigated trace elements is mainly in the residual fraction with the following descending order: Cr > V > B > Ni > Mo > U. This suggests a geogenic origin of these trace elements. Sr occurs mainly in the acid soluble fraction due to its authigenic formation from the underlying carbonate beds. Anthropogenic pollution in the study area is restricted to agricultural activities and fertilizer application which adds B and Mo to the soil in some cases. The Sr elevation and fractionation within the sediments suggests a possibility of Sr accumulation in cultivated crops, and thus a potential risk to infants and children. High concentrations and fractionation pattern of U in three samples shows a considerable risk to the environment in certain areas.

For many years, the Dead Sea suffers from an annual inflow deficiency of about one billion cubic meters, flood and baseflow. The water level changes are related to the majority of surface water inflows diverted for irrigation purposes, in addition to intensive loss of water by the high rate of evaporation and industrial water use. This causes the Dead Sea water level to decline about 35 m within the last 50 years for a long-term average of about 0.79 m per year. The changes in the hydrochemical composition were simulated experimentally to determine the changes that take place as a function of brine water evaporation level and its density. The Total Dissolved Solids (TDS) and the density of the Dead Sea water varies as a function of its water evaporation level changes. It was found that the density variation is not following a linear function with respect to water volume changes. But it follows the total amount of precipitate that occurred at different water levels. The electrical conductivity (EC) changes with respect to time and the prevailing temperature. There was no formula to calculate the high salinity of brine water above the normal ocean water. Consequently, the EC measurements were adopted to represent the Dead Sea water salinity. But in this research a converging factor (0.80971) has been found to convert the TDS values into salinity values. On contrary, the pH values revealed an inverse relationship with respect to the evaporation levels.

A submarine hydrothermal fluid discharge structure in Akureyri Bay, Eyjafjörður region, Iceland, was investigated by means of structural, geochemical, and mineralogical methods. Thermal and chemical gradients between the hydrothermal fluid and the subarctic seawater lead to an ongoing mineral precipitation. This process builds up hydrothermal chimneys of dozens of meters in height and they are still growing. The structural analysis reveals an internal stratification of the mineral precipitates at various scales from sub-micrometers to several decimeters. This stratification indicates random changes in the depositional system during the formation of the hydrothermal cones. Some mineral layers are characterized by a dominance of Si, Mg, and O. In contrast, others are dominated by Ca and O. However, the results of XRD analysis proved that the material consists mainly of a trioctahedral phyllosilicate of the smectite group, presumably saponite or stevensite. Additionally, aragonite and hisingerite could be present. The material is built up of numerous parallel tubes, which act as conductors in the hydrothermal chimneys. Consequently, a large amount of available pore space with pore volumes of up to 6 mm3 was detected in the sample by the porosity analysis.

Patientenubergaben in allen Fachgebieten der Medizin variieren in der Art und in ihrem Ausmas. Kommunikation kann unstrukturiert verlaufen und dann erheblich zu einem erhohten Risiko fur einen Zwischenfall beitragen. Es ist somit unverzichtbar, in allen Bereichen der Medizin strukturierte Ubergabekonzepte zu etablieren. Die perioperative Medizin ist ein Hochrisikobereich, der aufgrund von organisatorischen Rahmenbedingungen und einer teilweise hohen Arbeitsbelastung besonders anfallig fur Kommunikationsdefizite und -fehler ist. Die Weltgesundheitsorganisation (WHO) fordert bereits seit 2005 ein strukturiertes Ubergabekonzept, das die Information eines Patienten in einer inhaltlich vollstandigen und konsequent eingehaltenen Reihenfolge wiedergibt. Das SBAR-Konzept („situation, background, assessment, recommendation“) ist ein einfach anzuwendendes Kommunikationskonzept, das bei konsequenter Verwendung mit einer verbesserten Qualitat der Ubergabe assoziiert ist. In diesem Ubersichtsartikel werden einfache Hilfsmittel fur eine klare und konsistente Kommunikation dargestellt. Sie sind essenziell fur eine effektive Teamarbeit und die Gewahrleistung der Patientensicherheit. Anhand des SBAR-Konzepts werden die Effektivitat einer strukturierten Patientenubergabe sowie die Moglichkeiten der Implementierung in den klinischen Alltag und potenzielle Barrieren anhand der bisher erschienenen Literatur aufgearbeitet. Kommunikationsdefizite zwischen den Berufsgruppen konnen so schneller identifiziert und durch Einfuhrung eines strukturierten Ubergabekonzepts reduziert werden.

The Golgohar mine produces iron ore from an open pit in south-central Iran that is now more than 100 m below the water table, and dewatering has not solved the mine’s water seepage problem. Previous studies had reported that Kheirabad (Sirjan) Playa, 13 km north of the mine, was the most probable groundwater source. A combination of geological, hydrogeological, hydrochemical, and isotopic techniques were used to evaluate the hydraulic connectivity between the mine and the lake, and to characterize the probable water sources. Thirty-two surface and groundwater samples were collected and analyzed for major and minor (Li, B, and Br) constituents. Ten water samples were analyzed for oxygen-18 and deuterium and three samples were analyzed for tritium. The results indicated that impermeable formations and very low-permeability alluvial deposits lie between lake and the pit. In addition, the chemical and isotopic signatures of the two water sources indicated different origins. Inverse geochemical modeling and the mine water’s isotopic signatures suggest that the water is coming from the surrounding alluvial aquifer, or is deep basin water from within the fractured bedrock, or a mixture of the two.

Not many bathymetric maps are available for many lakes and reservoirs in developing countries. Usually the bathymetric mapping requires investment in expensive equipment and fieldwork, both of which are not accessible in these countries. This work demonstrates the ability to develop bathymetric map of Mosul Lake by using a digital elevation model (DEM). The depths model of the lake was designed through the use of three main stages; a coastline extraction, dataset interpolation and a triangular irregular network model. The normalized difference water index (NDWI) was used for automatic delineation of the lake coastline from satellite images. The ordinary kriging interpolation with a stable model was used to interpolate the water depths dataset. Finally a triangulated irregular network (TIN) model was used to visualize the resulting interpolation model. Calculated values of area and volume of a TIN model during 2011 were compared with values of supposed initial operation of the reservoir. The differences of water volume storage between these stages at 321 m water level was about 0.81 × 109 m3, where the lake lost around 10% of storage value. Also the results of depths lake model show that the change in water storage between March and July 2011 was about 3.08 × 109 m3.

The purpose is to review the current application of extracorporeal life support (ECLS) in trauma patients. In addition, programmatic development is described.ECLS use is increasing among trauma patients. Several recent studies among trauma patients report survival rates of 65-79%. Despite the high bleeding risk, extracorporeal membrane oxygenation (ECMO) may be safely implemented in trauma patients based on a strict protocol-driven policy. Early implementation may improve overall outcomes. Alternative anticoagulants and heparin free periods may be well tolerated in trauma patients at high risk of hemorrhage.ECMO is becoming a more routine option in severely injured trauma patients that develop severe respiratory failure. Well tolerated implementation and program development is possible among regional trauma centers. Although clinical knowledge gaps exist, ECMO is a promising treatment in this high-risk population.

B. pertussis is a human-specific pathogen and the causative agent of whooping cough. The ongoing resurgence in pertussis incidence in high income countries is likely due to faster waning of immunity and increased asymptomatic colonization in individuals vaccinated with acellular pertussis (aP) vaccine relative whole-cell pertussis (wP)-vaccinated individuals. This has renewed interest in developing more effective vaccines and treatments and, in support of these efforts, defining pertussis vaccine correlates of protection and the role of vaccine antigens and toxins in disease. Pertussis and its toxins have been investigated by scientists for over a century, yet we still do not have a clear understanding of how pertussis toxin (PT) contributes to disease symptomology or how anti-PT immune responses confer protection. This review covers PT’s role in disease and evidence for its protective role in vaccines. Clinical data suggest that PT is a defining and essential toxin for B. pertussis pathogenesis and, when formulated into a vaccine, can prevent disease. Additional studies are required to further elucidate the role of PT in disease and vaccine-mediated protection, to inform the development of more effective treatments and vaccines.

Background Bordetella pertussis is among the leading causes of vaccine-preventable deaths and morbidity globally. Human asymptomatic carriage as a reservoir for community transmission of infections might be a target of future vaccine strategies, but has not been demonstrated. Our objective was to demonstrate that asymptomatic nasopharyngeal carriage of Bordetella pertussis is inducible in humans and to define the microbiological and immunological features of presymptomatic infection. Methods Healthy subjects aged 18–45 years with an antipertussis toxin immunoglobin G (IgG) concentration of, Asymptomatic Bordetella pertussis nasopharyngeal colonization can be induced in adults, resulting in seroconversion in most colonized volunteers, but not in those noncolonized. Nasal wash sampling is more sensitive than pernasal swabbing. Azithromycin clears carriage in most people within 48 hours.

Oil shales are sedimentary rocks that contain organic material in its inorganic matrix. The oil shale deposits of Jordan have been investigated since the 1960s. An extensive investigation studies have been commenced to evaluate the quality and quantity of these resources. In 2006, the government of Jordan invited pioneer companies in oil shale field to submit their proposal to utilize and develop the oil shale of Jordan using different extraction technologies. Jordan is considered one of the driest countries in the world, which poses an additional challenge for oil shale development, because a vast quantity of water is needed for this process. El-Lajjun study area is located in central Jordan; the oil shale in the study area was deposited in marine environment; it comprises massive beds of brown-black, kerogen-rich, bituminous chalky marl. Ten representative oil shale rock samples were collected for risk assessment investigations from different localities of oil shale exposures. A standardized laboratory Fischer assay test delivered oil shale characteristics. Sequential extraction was used to evaluate mobility and distribution of the trace elements Ti, V, Cr, Co, Zn, As, Zr, Cd, Pb, and U. Column leaching experiments were performed to simulate the leaching behavior of the above elements from oil shale and spent shale to evaluate the possible negative impact on groundwater in the study area. Results of sequential extraction indicate that concentration of trace elements and trace elements are richer in oil shale and in the spent shale compared to most rocks and soils. The concentrations in the leachate were below the maximum contaminant levels of the Environmental Protection Agency (EPA) and the Jordanian standards for drinking water. The significance of this study lies in that its utilizes for the first time the sequential extraction and column leaching techniques to investigate the Jordanian oil shale rocks.

MALIGNANT HYPERTHERMIA (MH) is a well-described and known complication of modern anesthesia, with volatile anesthestics and succinylcholine recognized as triggering agents. Incidence rates vary, but it is estimated to occur in 1:50,000-100,000 individuals undergoing general anesthesia 1. The authors present a case of a patient undergoing a surgical mitral valve replacement who develops Malignant Hyperthermia during separation from cardiopulmonary bypass (CPB}, with urgent return to CPB as a method for the successful treatment of hyperkalemia, hyperthermia, acidemia and hypercarbia. This suggests the potential for CPB or Extracorporeal Membrane Oxygenation (ECMO) as a possible treatment for the symptoms of MH. Consent was obtained from the patient prior to submission of this case report.

BACKGROUND: Acute right ventricular dysfunction is a challenging problem in the immediate postoperative period following orthotopic heart transplantation. There are no prior reports of the use of inhaled iloprost in the setting of acute right ventricular dysfunction and acute pulmonary hypertension. Our hypothesis was that the use of inhaled iloprost in heart transplant recipients would be associated with a reduction in the duration of mechanical ventilation compared to patients being treated with continuous inhaled epoprostenol. Additionally, we hypothesized that the change in inhaled vasodilatory therapy would not be associated with a significant change in postoperative bleeding or use of vasoactive medications. METHODS: We reviewed charts of 80 consecutive patients undergoing heart transplantation at our institution between July 1, 2003, and August 8, 2008. From July 1, 2003 to March 13, 2006, epoprostenol was our primary vasodilator; subsequently epoprostenol was replaced with iloprost. We included 39 subjects who received epoprostenol and 40 subjects who received iloprost. Data were collected on the use of inhaled vasodilators, comparing periods before and after our institutional protocol change. Demographic data, hemodynamic values, drain output, and any requirement for vasoactive medication infusions were collected. Our primary end point was the natural logarithm of duration of mechanical ventilation. Secondary end points were hemodynamic values and length of ICU and hospital stay. RESULTS: Subjects treated with iloprost were mechanically ventilated for 0.36 ± 0.20 (adjusted mean ± SE) log days, which was shorter (P = .033) than the 1.00 ± 0.22 logdays for subjects treated with epoprostenol. This resulted in an estimated median number of mechanically ventilated days for subjects treated with epoprostenol that was approximately 1.9 times longer than the estimated median number of ventilated days for subjects treated with iloprost (95% CI 1.05–3.4, P = .033). There were no differences in safety end points or length of hospital stay. CONCLUSIONS: Use of inhaled iloprost was associated with shorter duration of mechanical ventilation compared to inhaled epoprostenol, without safety concerns.

Background Since 2011, antibiotic usage has decreased continuously in livestock in Germany. Whether this is accompanied by a reduction in bacterial antimicrobial resistance has not been proven so far. In this study 3054 Escherichia coli (E. coli) isolates from pigs which had suffered from disease on 2161 farms in North Western Germany were evaluated retrospectively from 2006 to 2017 for trends in their antimicrobial resistance pattern. Data were substantially related to the “pre-reduction period” and were therefore suggested as a basis for this task. Minimal inhibitory concentrations for selected antimicrobial substances were evaluated for E. coli strains isolated from different organs of diseased swine sampled for routine diagnostic. In total, 81% of E. coli were isolated from faeces or the gastrointestinal tract, 11% from the genito-urinary tract and 8% from other organs. Susceptibility testing and classification of isolates in accordance with clinical cut-offs followed the Clinical and Laboratory Standards Institute (CLSI). If no clinical cut-offs were available for the respective combination of species, substance and organ, other published clinical cut-offs were used. Results Differences in susceptibility patterns between isolates from the gastrointestinal and genito-urinary tract were found for most substances. Isolates from the genito-urinary tract were less frequently resistant to ampicillin, apramycin, colistin, neomycin, spectinomycin and tetracycline and more frequently resistant to enrofloxacin and florfenicol. A multifactorial logistic regression model revealed time-dependent decreases in frequency of resistant isolates for neomycin, spectinomycin and tetracycline. For colistin, the highest percentage of resistant isolates with 16.0% was found in 2015 followed by a decrease to the level of 2009–2010 in 2017. A decrease in frequencies of ampicillin-resistant isolates was dependent on the age-group and time period. Irrespective of the year, less than 15% E. coli isolates were resistant to apramycin, cephalosporins, colistin, enrofloxacin, florfenicol, gentamicin and neomycin. Conclusion An overall time-dependent decrease in the percentage of resistant E. coli isolates was found for some substances. These data from diseased animals indicate an impact of a general reduction in antibiotic usage on development of bacterial antimicrobial resistance in the field and can support the decision-making of swine practitioners for treatment options in swine.

Salinity increase in groundwater was investigated in the area between Al-Zubair and Safwan, and close to the Khor Al-Zubair Channel of southern Iraq. Thirty-nine groundwater samples from the shallow aquifer and one sample from the Khor Al-Zubair Channel were analyzed. The mean total dissolved solids are 7556 mg/L. The δ2H and δ18O plot in two groups are below the global meteoric water line. Group A indicates the evaporation effect of irrigation return-flow, while group B is characterized by depleted δ18O values due to recharge under colder climate. Deuterium excess values plot within the region of modern precipitation and dilution of groundwater by precipitating water. The groundwater residence time is between 1000 and 2000 years and combining 14C -age with SO42− shows a contrasting effect on groundwater on both sides of Khedr Almai Fault and the Zubair anticline, which indicates the role of these geological structures on the hydrochemical evolution in the western part. Jabal Sanam shows no clear effect in this regard. The ratio Cl−/Br− and sulfate in groundwater showed that the measured salinity in groundwater is the result of a mixing process between groundwater, seawater intruding from Khor Al-Zubair Channel, and water from septic tanks in addition to dry and wet sea spray, and irrigation return-flow.

Two synthetic approaches that allow one to control PEG content within spherical nucleic acids (SNAs) have been developed. One approach begins with RNA-modified gold nanoparticles followed by a backfill of PEG 2K alkanethiols, and the other involves co-adsorption of the two entities on a gold nanoparticle template. These two methods have been used to explore the role of PEG density on the chemical and biological properties of RNA-SNAs. Such studies show that while increasing the extent of PEGylation within RNA-SNAs extends their blood circulation half-life in mice, it also results in decreased cellular uptake. Modified ELISA assays show that constructs, depending upon RNA and PEG content, have markedly different affinities for class A scavenger receptors, the entities responsible, in part, for cellular internalization of SNAs. In designing SNAs for therapeutic purposes, these competing factors must be considered and appropriately adjusted depending upon the desired use.

The management of natural resources has to follow the principles of sustainable development. Therefore, before starting new mining activities, it should be checked, whether existing deposits have been completely exploited. In this study, a three-dimensional (3D) cross-border geologic model was created to generalize the existing data of the Neogene Berzdorf–Radomierzyce basin, located in Upper Lusatia on the Polish–German border south of the city of Gorlitz–Zgorzelec. The model based on boreholes and cross sections of abandoned and planned lignite fields was extended to the Bernstadt and Neisse-Reczyn Graben, an important tectonic structure at the southern rim of the basin. The partly detailed stratigraphy of Neogene sequences was combined to five stratigraphic units, considering the lithological variations and the main tectonic structures. The model was used to check the ability of a further utilization of the Bernstadt and Neisse-Reczyn Graben, containing lignite deposits. Moreover, it will serve as a basis for the construction of a 3D cross-border groundwater model, to investigate the groundwater flow and transport in the Miocene and Quaternary aquifer systems. The large amount of data and compatibility with other software favored the application of the 3D geo-modeling software Paradigm GOCAD. The results demonstrate a very good fit between model and real geological boundaries. This is particularly evident by matching the modeled surfaces to the implemented geological cross sections. The created model can be used for planning of full-scale mining operations in the eastern part of the basin (Radomierzyce).