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In contrast to other qnr families, qnrVC has been reported mainly in Vibrio spp. and inserted in class 1 integrons. This study aimed to identify the variants of qnrVC genes detected in Klebsiella pneumoniae carbapenemase-2-producing Enterobacter and Klebsiella strains isolated from Brazilian coastal waters and the genetic contexts associated with their occurrence.qnrVC variants were identified by Sanger sequencing. Stains were typified by pulsed-field gel electrophoresis. Antimicrobial susceptibility testing, conjugation assays, and whole genome sequencing (WGS) were applied to identify the strains' antimicrobial resistance profile, qnrVC and blaqnrVC1 was identified in 15 Enterobacter and 3 Klebsiella, and qnrVC4 in 2 Enterobacter strains. Pulsed-field gel electrophoresis revealed 12 clonal profiles of Enterobacter and one of Klebsiella. Strains were resistant to aminoglycosides, beta-lactams, fosfomycin, quinolones, and sulfamethoxazole-trimethoprim. Co-transference of qnrVC and blaOur results suggest that the dissemination of qnrVC among Enterobacterales in Brazilian coastal waters is associated with several genetic recombination events.

The dissemination of carbapenem-resistant and third generation cephalosporin-resistant pathogens is a critical issue that is no longer restricted to hospital settings. The rapid spread of critical priority pathogens in Brazil is notably worrying, considering its continental dimension, the diversity of international trade, livestock production, and human travel. We conducted a nationwide genomic investigation under a One Health perspective that included Escherichia coli strains isolated from humans and nonhuman sources, over 45 years (1974-2019). One hundred sixty-seven genomes were analyzed extracting clinically relevant information (i.e., resistome, virulome, mobilome, sequence types [STs], and phylogenomic). The endemic status of extended-spectrum β-lactamase (ESBL)-positive strains carrying a wide diversity of variants, and the growing number of colistin-resistant isolates carrying -type genes was associated with the successful expansion of international ST10, ST38, ST115, ST131, ST354, ST410, ST648, ST517, and ST711 clones; phylogenetically related and shared between human and nonhuman hosts, and polluted aquatic environments. Otherwise, carbapenem-resistant ST48, ST90, ST155, ST167, ST224, ST349, ST457, ST648, ST707, ST744, ST774, and ST2509 clones from human host harbored and genes. A broad resistome to other clinically relevant antibiotics, hazardous heavy metals, disinfectants, and pesticides was further predicted. Wide virulome associated with invasion/adherence, exotoxin and siderophore production was related to phylogroup B2. The convergence of wide resistome and virulome has contributed to the persistence and rapid spread of international high-risk clones of critical priority E. coli at the human-animal-environmental interface, which must be considered a One Health challenge for a post-pandemic scenario. A One Health approach for antimicrobial resistance must integrate whole-genome sequencing surveillance data of critical priority pathogens from human, animal and environmental sources to track hot spots and routes of transmission and developing effective prevention and control strategies. As part of the Grand Challenges Explorations: New Approaches to Characterize the Global Burden of Antimicrobial Resistance Program, we present genomic data of WHO critical priority carbapenemase-resistant, ESBL-producing, and/or colistin-resistant Escherichia coli strains isolated from humans and nonhuman sources in Brazil, a country with continental proportions and high levels of antimicrobial resistance. The present study provided evidence of epidemiological and clinical interest, highlighting that the convergence of wide virulome and resistome has contributed to the persistence and rapid spread of international high-risk clones of E. coli at the human-animal-environmental interface, which must be considered a One Health threat that requires coordinated actions to reduce its incidence in humans and nonhuman hosts.

The late Paleozoic ice age (LPIA) began in the Mississippian period (Visean-Serpukhovian) and is associated with a global mass extinction. This study examines how the development of high-amplitude glacioeustasy at the start of the LPIA affected the taxonomic richness and ecologic diversity of tropical marine macro-invertebrate assemblages from the Illinois Basin (United States). Rarefaction and faunal turnover analyses reveal that regional taxonomic and guild richness persist nearly unchanged across the inferred onset of the LPIA and through multiple glacioeustatic cycles spanning a total duration of ∼3 to 5 myr. In addition, low levels of taxonomic turnover characterize the LPIA transition and subsequent glacioeustatic cycles; 76% to 92% of pre-LPIA taxa persist into the ice age where they account for 63% to 75% of LPIA taxa. Thus, the onset of high-amplitude glacioeustasy was not a main driver of regional biotic change or extinction in the Illinois Basin at the start of the LPIA. Potential mechanisms for the regional persistence of taxonomic diversity and faunal composition despite major glacioeustasy include habitat tracking and an immigration rescue effect, where localized extinction is balanced by immigration of taxa from nearby areas. Finally, evidence from this and other studies of late Paleozoic faunal turnover suggest that persistence, not change, is the normal biotic response to high-amplitude glacioeustasy during the LPIA.

Standardization of care can reduce the risk of errors, increase efficiency, and provide a framework for best practice. In 2008, the American Society of Clinical Oncology (ASCO) and the Oncology Nursing Society (ONS) invited a broad range of stakeholders to create a set of standards for the administration of chemotherapy to adult patients in the outpatient setting. At the close of a full-day structured workshop, 64 draft standards were proposed. After a formal process of electronic voting and conference calls, 29 draft standards were eliminated, resulting in a final list of 35 draft measures. The proposed set of standards was posted for 6 weeks of open public comment. Three hundred twenty-two comments were reviewed by the Steering Group and used as the basis for final editing to a final set of standards. The final list includes 31 standards encompassing seven domains, which include the following: review of clinical information and selection of a treatment regimen; treatment planning and informed consent; ordering of treatment; drug preparation; assessment of treatment compliance; administration and monitoring; and assessment of response and toxicity monitoring. Adherence to ASCO and ONS standards for safe chemotherapy administration should be a goal of all providers of adult cancer care. J Clin Oncol 27:5469-5475. © 2009 by American Society of Clinical Oncology

More than a decade ago, the Institute of Medicine created the National Cancer Policy Board and identified a need to assess national quality of cancer care, generating a cascade of projects, including ASCO's QOPI.

Linking biotic patterns across spatiotemporal scales provides a greater understanding of the processes that drive ecological and evolutionary change. Here, we examine how global patterns of biotic turnover are expressed in the structure of regional biotic gradients from the Illinois Basin (USA) during the late Paleozoic ice age (LPIA)— an interval noted for low global rates of taxonomic turnover. Results indicate that the pre-LPIA interval is characterized by well-defined biotic gradients; depositional environments are dominated by distinct sets of taxa, arrayed along a gradient of substrate composition, and are clearly differentiated by ordination and ANOSIM analyses. There is a marked shift in gradient structure across the onset of the LPIA; environments become weakly distinguished, are dominated by similar sets of taxa that are widespread across the ramp, and are arrayed along a nearshore-offshore gradient. Our results are consistent with findings from global-level studies, which indicate that broadly adapted taxa (eurytopes) increased in importance following the start of the LPIA. Unlike the global level, however, the regional increase in eurytopy is not linked to the extinction of narrowly adapted taxa in response to climate change. Instead, eurytopy increased as the geometry of the Illinois Basin shifted from a flat carbonate ramp, composed of shallower-water and higher-stress environments in the pre-LPIA interval, to a steeper ramp comprising deeper-water and more stable habitats in the LPIA interval. We suggest that increased eurytopy drove (1) a previously documented decrease in regional-level turnover during the late Paleozoic and (2) a perceived pattern of greater persistence in late versus early Paleozoic biotic gradients.

Associations of fossil genera and species commonly display repeated and predictable patterns of change in stratigraphic sections. These changes exhibit some analogies with the phenomenon of ecological succession but are longer-term allogenic temporal changes, occurring over time scales of tens to hundreds of thousands of years, that should be referred to as biotic (faunal-floral) replacement. Habitat tracking is one of a suite of possible mechanisms of biotic replacement, but one that may be important in certain marine settings. Evidence of tracking includes (1) recurrence of similar replacement series of differing age; (2) mirroring of vertical replacement of faunas by lateral gradients of species associations along single time planes; (3) the occurrence of similar gradient transects at different time planes; (4) the correlatability of highs and lows of quantitative faunal curves (e.g., variations of detrended correspondence analysis scores) at different localities despite offsets of absolute scores; and (5) the high fidelity recurrence of stenotopic species in particular associations representing narrowly defined environments. The degree of ecological fidelity (e.g., similarity of species richness, guild structure) that is maintained during tracking is variable. Recurrent assemblages in different cycles, separated by as much as several million years, can be very similar in terms of species composition and trophic structure. Common species, however, may show significant differences in rank and relative abundances. This evidence indicates individualistic tracking of preferred habitat by various species. In shallow-shelf and ramp settings, sea-level fluctuations may produce approximately symmetrical patterns of biotic replacement where biofacies are arrayed typically in elongate belts parallel to depositional strike. Asymmetries, however, are common and may result from variations in sediment supply during sea-level fluctuation. Hence, the low siliciclastic input typical of transgressions predictably favors those organisms that require lower sedimentation or turbidity and perhaps firmgrounds to hardgrounds, whereas the regressive half cycle at analogous depths favors more eurytopic organisms that tolerate or prefer higher sedimentation or turbidity. The phenomenon of tracking may be of considerable importance in evolutionary paleoecology. Tracking implies that species commonly respond to long-term physical changes, not by adaptation, but primarily by migration of species to preferred habitats, if the rate or magnitude of environmental change is not too great. Provided that the same basic environment existed through time, despite lateral shifting by up to hundreds of kilometers, most species of benthic invertebrates were capable of surviving with little or no evolutionary change. Tracking may be the primary basis of patterns of morphological stasis, as well as relative stability in biofacies richness, composition, and trophic structure.

Physicochemical properties of the charcoal arising from pyrolysis of sugarcane bagasse at 600°C and 800°C were determined to evaluate potentialities for specific end uses. The charcoals were found fairly adequate as solid bio-fuels. Their quality was comparable to charcoals obtained from some other agro-industrial by-products, reportedly proposed as substitutes of wood-based ones. Surface properties of the charcoal generated at the higher temperature indicated that it is reasonably suited for potential use as low-cost rough adsorbent, soil amender, and/or for further upgrading to activated carbon. Moreover, kinetic measurements for pyrolysis of the sugarcane bagasse individually and mixed with an Argentinean subbituminous coal in equal proportions were conducted by thermogravimetry for the range 25°C–900°C. Data modeling accounting for variations in the activation energy with process evolution provided a proper description of pyrolysis and co-pyrolysis over the entire temperature range.

The adsorption characteristics of self-oriented multi-walled carbon nanotube (MWCNT) arrays are examined from N2 (−196 °C) adsorption measurements. The arrays were synthesized in a laboratory by in situ chemical vapour deposition of iron or cobalt phthalocyanines at 880 and 950 °C, under otherwise constant conditions, in an attempt to obtain different morphological structures. For both precursors, increasing the temperature leads to MWCNT arrays with lower Brunauer–Emmett–Teller (BET) surface area and total pore volume, though the effect is more pronounced for those arising from the iron-based compound. Despite this, precursor yields of individual nanotubes of larger diameter, higher BET area and total pore volume characterize the resulting arrays compared to those arising from cobalt phthalocyanine for the same temperatures. As evidenced by SEM and TEM images, the arrays synthesized from iron phthalocyanine at 880 °C show better vertical alignment and denser structures than those obtained from this compound at 950 °C, and also from cobalt phthalocyanine at both temperatures. Further ultrasonication of the arrays produced from the iron compound brings about a significant reduction in their adsorption capacity, attributable to the pronounced disarrangement of the resulting structures. The present results demonstrate that the alignment of MWCNT arrays plays a crucial role in their N2 adsorption characteristics.

A series of Au/FeOx/SBA-15 type materials were prepared by two methods: one conventional and one non-conventional: gold deposition-precipitation on FeOx/SBA-15 and bimetallic carbonyl cluster deposition on SBA-15, respectively. Both chemical physical characterization and catalytic activity tests in the complete combustion of methanol show that the new preparation method of Au/FeOx-supported catalysts leads to the anchoring of the Au by modifying the surface of SBA-15 with FeOx species. This effect results in a considerable improvement in catalyst performance as compared to the classic preparation by deposition-precipitation of Au on SBA-15 and FeOx/SBA-15.

The total oxidation of methanol and toluene, chosen as representative VOCs, was investigated over CeO2-supported Au/FeOx catalysts prepared utilizing the bimetallic carbonyl cluster salt [NEt4][AuFe4(CO)16]. Characterization data showed that the catalysts prepared by the reported method exhibit highly and homogeneously dispersed iron oxide species on the ceria support together with small gold nanoparticles, whose size increases on increasing the amount of gold/iron. Addition of iron oxide species did not substantially increase the methanol combustion activity of ceria, whereas the presence of the mixed gold and FeOx species has been found to strongly enhance the activity towards the total oxidation of methanol. In the case of the toluene combustion the addition of FeOx or FeOx/Au species caused a significant decrease in the activity of the bare CeO2. The above catalytic behavior was rationalized on the basis of different interactions occurring among gold, iron oxide and cerium oxide, which synergically affects both the reactivity of the surface oxygen and the capacity of the support to adsorb the organic reactant.

The assessment of health-related quality of life (hrQoL) is an important tool in therapy studies and in the treatment of patients with Huntington's disease (HD). In the absence of causal interventions, HD therapy targets the alleviation of symptoms aiming to improve impaired hrQoL. The aim of this study was to determine the impact of disease characteristics on hrQoL in HD.A total of 80 genetically confirmed HD patients underwent an assessment using the Unified Huntington's Disease Rating Scale, the Beck Depression Inventory, the Hamilton Rating Scale and the SF-36, a scale for the assessment of physical and mental QoL.Multiple regression analysis revealed that health-related physical and mental QoL was considerably influenced by the functional capacity. The mental QoL also correlated with the degree of depressive symptoms, age and the number of CAG repeats. However, there was no statistical relation between QoL and motor and cognitive abilities.This study underlines the relationship between function capacity and depressive symptoms with mental and physical QoL. This is the first time that hrQoL has been investigated in a German speaking cohort. The results are in accordance with previous studies of hrQoL in HD.

Final report including an evaluation of the cost-effectiveness of the newly developed components

Publishable Report

Shale plays have been considered statistical plays by many people in our industry. During the early years of the shale boom and even today, technical teams have looked to find correlations between variables to help explain well performance. Simple one-to-one correlations between individual variables and production performance in the Haynesville Shale appear to be weak because complex relationships may exist. Regression analysis techniques have assumptions and limitations, moreover, such techniques encounter difficulties when analyzing complex relationships. In this study, ordination, a multivariate analysis technique, was applied to subsurface and completion data to identify the variables that seem to influence well performance. The debate of nature versus nurture has often been applied to shale gas developments where some believe an effective well completion can make up for a poor shale reservoir rock quality while others believe a high quality shale reservoir rock is essential to obtain better producers despite an average well completion. The ordination technique successfully separated better performing wells from the less prolific wells and identified the variables that characterize the better producers. The same technique provided various optimum ranges for the different variables that could be used to identify core and non-core areas within the play. Our results suggest that (1) ordination is a viable method for multivariate statistical analysis in the Haynesville Shale; (2) subsurface variables are critical in obtaining better performing wells; and (3) completions variables are secondary but also very important.

In order to investigate to what extent various determinants in the decision-making process for the treatment of severely ill incompetent patients are influenced by cultural and sociopolitical factors, 540 physicians in Austria, Germany (East and West), and Sweden, countries representing different healthcare systems, were surveyed using a self-administered questionnaire. It provided three case vignettes with different levels of information about the patient's treatment wishes in case of incompetence in a life-threatening situation. We found a general trend to a lower level of treatment in line with the patient's wishes when the information provided was more detailed. Remarkably, a substantial number of doctors did not comply with the patient's wishes. Ethical concerns and patient's wishes appeared as the most important factors whereas religious beliefs of the physician and hospital costs scored lowest. Because of the variability of treatment decisions and the importance of various factors determining the decision-making, an advance directive may be a feasible way of reducing the number of conflicts in critical situations. We recommend that ethical issues of clinical practice should be emphasized in the medical curriculum and in the training of physicians.

Since intensive care medicine enables us to maintain blood circulation and respiration artificially for some time, the usual criteria for death, such as cardiac arrest and cessation of respiration, are not applicable in all cases. Thus, the irreversible breakdown of the brain functions have come to be accepted as the most prominent factor for the occurence of death. This criterion is linked primarily to the disintegration of the organism as a whole. Yet the controversy surrounding the moment when a man can be declared dead or alive has not yet been resolved. The decisive weak point in this controversial discussion seems to be that the notion of the “organism as a whole” is inadequately defined. The aim of this study is to fill this void. Thus, at a first approximation, a rough definition of the “organism as a whole” is given. In a second step we turn to examine the empirical evidence related to the question of whether this attribute is possessed or not by a human body with an irreparably damaged brain. For the characterization of life and death, as related to our question, it is important to distingnish between derivated biological life (isolatedly living cells or organs, cell cultures, heart-lung-compound) and a living being. For this distinction the criteria of completion, indivisibility, auto-finality and identity have been considered. If these are missing a living being does not exist. Then a man is no longer a living man, he is dead. In brain-dead body one finds a number of signs of life such as heartbeat, metabolism, growth of cells, regeneration an so forth. These signs of life, however, are not signs of an organsim as a whole but signs of a physiological combination of organs whose parts - directed from the outside - are dependent on each other. The brain-dead body lacks, however, the four criteria of a living being. Thus it is no longer a living man. It is a purely derivated biological life. If we regard the brain-dead body indirectly by considering the status of the brain itself and its functions we can say that the brain is the constitutive foundation (the guarantor) for the identity and completion of an individual as a whole. With the loss of the brain this wholeness is lost. The man is dead.

PEM water electrolyser

The aim of this study was to evaluate the incidence of cognitive and affective problems in the treatment of children suffering from myodystrophy. It was hypothesised that psychomotory assessment taking appropriate account of data regarding the evaluation of cognitive and affective development might allow an adequate and realistic therapeutic protocol to be defined. For this purpose the authors examined 55 myodystrophic patients aged between 6 and 10 years old during the period January 1980 and June 1993 using traditional psychomotory tests (Stanford-Binet and/or WISC in relation to the various age groups), projective tests (CAT, TAT) and graphic tests. The latter were also evaluated according to Koppitz's criterion which enabled emotional indicators (EI) to be assessed. All 55 cases were evaluated in collaboration with the 1st Pediatric Clinic of the Neuro-Psychomotory Unit of "G. Gaslini" Institute. Psychomotory treatment, which by definition is addressed to the entire person, specifically took cognitive and affective data into consideration. In fact, as observed by Johnson and Alexander, in myodystrophy functional skills are more often limited by cognitive and motivational factors than by actual menomation. The results showed that the concentration on psychological aspects in the rehabilitation of myodystrophic children allows the neuropsychological component of movement (practognosia) to be preserved for as long as possible despite the progress of instrumental deficit (anatomic degeneration). In the authors' experience and in comparison to that of other Authors, it was possible to state that a "personalized" approach allows the subjects to improve their own "presence in the world".

We studied central and peripheral hemodynamics and exercise tolerance in 24 patients with left ventricular dysfunction. All were in NYHA class II or III, and echocardiographic left ventricular ejection fraction was35% without pharmacologic influences. Patients underwent to treadmill test (Naughton protocol), cardiopulmonary upright bicycle test, and supine bicycle test with haemodynamic measurements. All tests were exhaustive. Average exercise time was 9 +/- 3.4 min, (range 3-20). Average ejection fraction (.28 +/- 0.65) dis not correlate with working capacity (r = .32), nor did left ventricular filling pressure (pulmonary capillary wedge pressure) at rest and at peak exercise (r = .29 and r = .02). Stroke volume and stroke volume index were on average depressed, with no variations during work; cardiac output and cardiac index were also depressed, with a significant increase at peak exercise (both p.001). Systemic and pulmonary resistances were increased, but systemic resistances tended to decrease during effort (p.001), while pulmonary resistances did not (p = NS). We subdivided patients according to systemic vascular resistances lower or higher than 1500 dynes.cm.sec-5 at rest; this identifies two different working capacities (low systemic vascular resistances 11.7 +/- 4.4 min, high systemic vascular resistances 6.9 +/- 3.2 min, p.05). Patients were then divided in two groups: group I (rest stroke volume60 ml) and group II (rest stroke volume60 ml). Group I worked 11 +/- 5 min, group II 8.5 +/- 3 min (p.05). We performed a linear regression analysis between cardiac output and systemic vascular resistances at rest and during exercise in the two groups.(ABSTRACT TRUNCATED AT 250 WORDS)

In the present study we evaluated the influence of intravenous thrombolysis and patency of the infarct-related coronary artery on both markers of ventricular electrical instability and incidence of late arrhythmic events after acute myocardial infarction (AMI). Ninety one patients surviving a first AMI who consecutively performed coronary angiography were enrolled in the present study; 44 patients (48%) received thrombolysis, 47 patients (52%) were treated conventionally. Of 91 patients, 90 (99%) had signal-averaged electrocardiogram (SAECG), and 40 (44%) programmed ventricular stimulation. No significant difference was observed between thrombolytic-treated and control group in late potential rate, SAECG determinants and ventricular arrhythmia inducibility. Of 91 patients, 40 (44%) had occlusion of the infarct-related artery: of these, 15 (37%) had late potentials compared with 5 of 51 patients (9%) with a patent artery (p0.01). Mean left ventricular ejection fraction was not significantly different between the two groups (0.50 +/- 0.15 vs 0.55 +/- 0.12; p = NS). No significant difference was present between the two groups of patients with regard to inducibility of sustained ventricular tachyarrhythmias, however an odds ratio of 3.5 was observed in the group with a closed vessel.(ABSTRACT TRUNCATED AT 250 WORDS)

The appearance or the increase of repolarization abnormalities in the EKG during post exercise (ET) recovery phase (R) is considered a marker of ischemia.In order to evaluate the real meaning of these changes we compared the EKG data with eventual modifications of left ventricular kinesis analyzed by 2D-ECHO. 10 male patients with previous myocardial infarction, mean age 50 +/- 4.8 y, underwent exercise testing on a treadmill (Bruce's protocol) and continuous 2D-ECHO observation from the end of exercise along the whole R. Patients were divided in two groups: Group A (6 patients) and Group B (4 patients), all free of symptoms.Group A showed ischemic EKG markers during exercise which increased during R; Group B showed ischemic EKG markers only during R. The 2D-ECHO showed in Group A an impairment of left ventricular kinesis at peak exercise without increase or extension during R (WMSI at rest 1.32; peak ET 1.60; R 1.60); in Group B the kinetic alterations appeared only in R (WMSI at rest 1.33, peak ET 1.42; R 1.80), strictly related to EKG markers.The data suggest : 1) that the increase of EKG abnormalities already present during exercise do not seem to imply more severe ischemia; 2) that EKG changes appearing during R are markers of ischemia which occur in the R.

Early functional evaluation after non-complicated acute myocardial infarction (AMI) is widely recommended because of its prognostic value in the short term. In fact it seems to have a prognostic value within 15–20 days of the AMI, but in this period the patient is particularly controlled and is often still hospitalized. To evaluate the real significance of an early functional evaluation within 10 days of the AMI (mean 8.6 days±1.2) as compared to an identical functional evaluation performed at 3 weeks after AMI (mean 20.16 days ± 5.38) 25 patients with uncomplicated myocardial infarction were studied. Significant statistical differences were found between the first (ET1) and second (ET2) functional evaluations: they concern the maximal heart rate reached (P

Treatment of childhood enuresis requires a careful anamnesis, physical examination, urinalysis, and urine culture to determine if a subject is affected with functional or organic enuresis. Functional enuresis (FE) was present in the majority of our patients (168/204). These 168 subjects, aged from 6 to 11 years, were randomly divided into three therapy groups (pharmacological therapy, behavioral therapy, and behavioral therapy with the aid of a personal computer). Our study shows that behavioral therapy gave better results in FE than did pharmacological therapy. We point out the usefulness of combining bladder retention training and behavioral therapy to improve the general maturity and autonomous behavior of the child, and the resultant positive effects on his personality.

Il piu basso livello energetico dell'Ortoelio e stato calcolato applicando il metodo variazionale alla funzione 1sZ′(1)2sZ″(2)−2sZ″(1)1sZ′(2). E stato ottenuto il valoreE=−4,3322RHehc, conZ′=1,991,Z″=1,497.