Search

Objective Group B Streptococcus (GBS) colonization of the lower urinary tract in pregnancy is associated with severe infections such as chorioamnionitis, endometritis, and pyelonephritis. The objective of this study was to compare rates of progression to pyelonephritis between GBS and Escherichia coli lower urinary tract infections (LUTIs), as well as compare infectious and obstetric morbidity secondary to these pathogens.

Abstract Background Treatment of opiate addiction with opiate substitution treatment (e.g. methadone) is beneficial. However, some individuals desire or would benefit from abstinence but there are limited options to attenuate problems with opiate withdrawal. Preclinical and preliminary clinical evidence suggests that the GABA-B agonist, baclofen, has the desired properties to facilitate opiate detoxification and prevent relapse. This study aims to understand whether there are any safety issues in administering baclofen to opioid-dependent individuals receiving methadone. Methods Opiate-dependent individuals (DSM-5 severe opioid use disorder) maintained on methadone will be recruited from addiction services in northwest London (NHS and third sector providers). Participants will be medically healthy with no severe chronic obstructive pulmonary disease or type 2 respiratory failure, no current dependence on other substances (excluding nicotine), no current severe DSM-5 psychiatric disorders, and no contraindications for baclofen or 4800 IU vitamin D (placebo). Eligible participants will be randomised in a 3:1 ratio to receive baclofen or placebo in an adaptive, single-blind, ascending dose design. A Bayesian dose-escalation model will inform the baclofen dose (10, 30, 60, or 90 mg) based on the incidence of ‘dose-limiting toxicity’ (DLT) events and participant-specific methadone dose. A range of respiratory, cardiovascular, and sedative measures including the National Early Warning Score (NEWS2) and Glasgow Coma Scale will determine DLT. On the experimental day, participants will consume their usual daily dose of methadone followed by an acute dose of baclofen or placebo (vitamin D3) ~ 1 h later. Measures including oxygen saturation, transcutaneous CO2, respiratory rate, QTc interval, subjective effects (sedation, drug liking, craving), plasma levels (baclofen, methadone), and adverse events will be obtained using validated questionnaires and examinations periodically for 5 h after dosing. Discussion Study outcomes will determine what dose of baclofen is safe to prescribe to those receiving methadone, to inform a subsequent proof-of-concept trial of the efficacy baclofen to facilitate opiate detoxification. To proceed, the minimum acceptable dose is 30 mg of baclofen in patients receiving ≤ 60 mg/day methadone based on the clinical experience of baclofen’s use in alcoholism and guidelines for the management of opiate dependence. Trial registration Clinicaltrials.gov NCT05161351. Registered on 16 December 2021.

Aims: People with type 2 diabetes mellitus are more susceptible to infections. This study aimed to compare the microbiology, incidence and clinical outcome of bloodstream infections (BSIs) in people with type 2 diabetes and matched controls amongst a cohort of hospital inpatients in the United Kingdom. Methods: A retrospective analysis was conducted on all positive blood cultures obtained over a one-year period, identifying inpatients with type 2 diabetes and BSIs (n = 151). Matched controls were collated from the same cohort. Admission data were obtained from clinical coding. Patient outcomes were analysed in terms of 90-day mortality, length of stay (LOS) and admission rate to high or intensive dependency units (HDU/ICU). Microbial culture and clinical source of infection were compared between groups. Results: Patients with type 2 diabetes comprised 10.6% of admissions but 21.1% (n = 151) of analysed BSIs (OR: 2.27, p

Appendicitis is the most common surgical disease in the pediatric population, yet most patients are preschool age or older at the time of diagnosis. Rarely, appendicitis does occur in infants. The diagnosis of acute appendicitis in an infant is less commonly considered, given its rarity and often vague presenting symptoms. When the diagnosis is missed in this age group, greater morbidity and mortality may occur. Typically, appendicitis is not associated with gastroenteritis, however, we present a 3-month-old with acute appendicitis with concurrent rotavirus infection.

Background. Maternal GBS colonization is associated with early-onset neonatal sepsis and extensive efforts are directed to preventing this complication. Less is known about maternal risks of GBS colonization. We seek to provide a modern estimate of the incidence and impact of maternal GBS colonization and invasive GBS disease. Methods. A single center historical cohort study of all births between 2003 and 2015 was performed. Data was collected via electronic health record abstraction using an institutional specific tool. Descriptive statistics were performed regarding GBS status. Inferential statistics were performed comparing risk of adverse pregnancy outcomes in cohorts with and without GBS colonization as well as cohorts with GBS colonization and invasive GBS disease. Results. A total of 60,029 deliveries were included for analysis. Overall, 21.6% of the population was GBS colonized and 0.1% had invasive GBS disease. GBS colonization was associated with younger maternal age, Black race, non-Hispanic ethnicity, chronic hypertension, preexisting diabetes, and tobacco use (p

Abstract Introduction Early detection and treatment of HIV and sexually transmitted infections (STIs) are crucial for effective control. We previously developed MySTIRisk, an artificial intelligence-based risk tool that predicts the risk of HIV and STIs. We examined the attributes that encourage potential users to use it. Methods Between January and March 2024, we sent text message invitations to the Melbourne Sexual Health Centre (MSHC) attendees to participate in an online survey. We also advertised the survey on social media, the clinic's website, and posters in affiliated general practice clinics. This anonymous survey used a discrete choice experiment (DCE) to examine which MySTIRisk attributes would encourage potential users. We analysed the data using random parameters logit (RPL) and latent class analysis (LCA) models. Results The median age of 415 participants was 31 years (interquartile range, 26–38 years), with a minority of participants identifying as straight or heterosexual (31.8%, n = 132). The choice to use MySTIRisk was most influenced by two attributes: cost and accuracy, followed by the availability of a pathology request form, level of anonymity, speed of receiving results, and whether the tool was a web or mobile application. LCA revealed two classes: "The Precisionists" (66.0% of respondents), who demanded high accuracy and "The Economists" (34.0% of respondents), who prioritised low cost. Simulations predicted a high uptake (97.7%) for a tool designed with the most preferred attribute levels, contrasting with lower uptake (22.3%) for the least preferred design. Conclusions Participants were more likely to use MySTIRisk if it was free, highly accurate, and could send pathology request forms. Tailoring the tool to distinct user segments could enhance its uptake and effectiveness in promoting early detection and prevention of HIV and STIs.

To assess patterns of Chagas disease, we reviewed results of screening umbilical cord blood from a US public cord blood bank during 2007–2014. Nineteen maternal donors tested positive for Trypanosoma cruzi parasites (0.04%). Because perinatal transmission of Chagas disease is associated with substantial illness, targeted prenatal programs should screen for this disease.

Carbon dioxide (CO2), methane (CH4), and nitrous oxide (N2O) are the most important anthropogenic greenhouse gases (GHGs). Variation in soil moisture can be very dynamic, and it is one of the dominant factors controlling the net exchange of these three GHGs. Although technologies for high-frequency, precise measurements of CO2 have been available for years, methods for measuring soil fluxes of CH4 and N2O at high temporal frequency have been hampered by lack of appropriate technology for in situ real-time measurements. A previously developed automated chamber system for measuring CO2 flux from soils was configured to run in line with a new quantum cascade laser (QCLAS) instrument that measures N2O and CH4. Here we present data from a forested wetland in Maine and an agricultural field in North Dakota, which provided examples of both net uptake and production for N2O and CH4. The objective was to provide a range of conditions in which to run the new system and to compare results to a traditional manual static-chamber method. The high-precision and more-than-10-times-lower minimum detectable flux of the QCLAS system, compared to the manual system, provided confidence in measurements of small N2O uptake in the forested wetland. At the agricultural field, the greatest difference between the automated and manual sampling systems came from the effect of the relatively infrequent manual sampling of the high spatial variation, or "hot spots", in GHG fluxes. Hot spots greatly influenced the seasonal estimates, particularly for N2O, over one 74-day alfalfa crop cycle. The high temporal frequency of the automated system clearly characterized the transient response of all three GHGs to precipitation and demonstrated a clear diel pattern related to temperature for GHGs. A combination of high-frequency automated and spatially distributed chambers would be ideal for characterizing hot spots and "hot moments" of GHG fluxes.

No abstract available.

Abstract Premise There is a general lack of consensus on the best practices for filtering of single‐nucleotide polymorphisms (SNPs) and whether it is better to use SNPs or include flanking regions (full “locus”) in phylogenomic analyses and subsequent comparative methods. Methods Using genotyping‐by‐sequencing data from 22 Glycine species, we assessed the effects of SNP vs. locus usage and SNP retention stringency. We compared branch length, node support, and divergence time estimation across 16 datasets with varying amounts of missing data and total size. Results Our results revealed five aspects of phylogenomic data usage that may be generally applicable: (1) tree topology is largely congruent across analyses; (2) filtering strictly for SNP retention (e.g., 90–100%) reduces support and can alter some inferred relationships; (3) absolute branch lengths vary by two orders of magnitude between SNP and locus datasets; (4) data type and branch length variation have little effect on divergence time estimation; and (5) phylograms alter the estimation of ancestral states and rates of morphological evolution. Discussion Using SNP or locus datasets does not alter phylogenetic inference significantly, unless researchers want or need to use absolute branch lengths. We recommend against using excessive filtering thresholds for SNP retention to reduce the risk of producing inconsistent topologies and generating low support.

We present some preliminary results on the mapping of coseismically-induced ground ruptures following the Aug. 24, 2016, Central Italy earthquake (Mw 6.0). The seismogenic source, as highlighted by InSAR and seismological data, ruptured across two adjacent structures: the Vettore and Laga faults. We collected field data on ground breaks along the whole deformed area and two different scenarios of on-fault coseismic displacement arise from these observations. To the north, along the Vettore fault, surface faulting can be mapped quite continuously along a well-defined fault strand while such features are almost absent to the south, along the Laga fault, where flysch-like marly units are present. A major lithological control, affects the surface expression of faulting, resulting in a complex deformation pattern.

Advanced extrauterine pregnancy is an extremely rare, life-threatening pregnancy complication. Management of these pregnancies presents significant challenges, especially when they have progressed to an advanced stage of fetal viability. With high rates of maternal and fetal mortality associated with this complication, delivery or pregnancy interruption should be expedited following diagnosis. Localization of the placenta and its blood supply is critical to preoperative planning. Hybrid operating suites that can accommodate a multidisciplinary team of subspecialists may improve the chance of a successful outcome with this rare complication.

Objectives. Physiologic and immunologic changes in pregnancy result in increased susceptibility to infection. These shifts are more pronounced in pregnancies complicated by multiple gestation. The objective of this study was to determine the association between multiple gestation and risk of infectious morbidity. Study Design. The Nationwide Inpatient Sample for the years 2008–2010 was used to identify pregnant women during admission for delivery with International Classification of Diseases codes. Logistic regression was used to compute odds ratios and 95% confidence intervals for demographic data, preexisting medical conditions, and acute medical and infectious complications for women with multiple versus singleton gestations. Results. Among women with multiple gestation, 38.4 per 1,000 women had an infectious complication compared to 12.8 per 1,000 women with singletons. The most significant infectious morbidity associated with multiple gestation was intestinal infections, pyelonephritis, influenza, and pneumonia. After controlling for confounding variables, infectious complications at delivery persisted for women with multiples, though the association was dependent on mode of delivery. Conclusions. Women with multiple gestations are at increased risk for infectious morbidity identified at the time of delivery. This association was diminished among women who had a cesarean suggesting that operative delivery is not responsible for this association.

Objective. Pyelonephritis is a common infectious morbidity of pregnancy. Though anemia is commonly associated with pyelonephritis, there are little data describing the effect of pyelonephritis with anemia on pregnancy outcomes. The purpose of this study was to further assess the association of anemia with infectious morbidity and pregnancy complications among women with pyelonephritis. Study Design. We conducted a retrospective cohort study of pregnant women admitted to Duke University Hospital between July 2006 and May 2012 with pyelonephritis. Demographic, laboratory, and clinical data from the subject’s pregnancy and hospitalizations were analyzed. Patients with pyelonephritis and anemia (a hematocrit < 32) were compared to those without anemia. Descriptive statistics were used to compare the two groups. Results. 114 pregnant women were admitted with pyelonephritis and 45 (39.5%) had anemia on admission. There was no significant difference in age, race, preexisting medical conditions, or urine bacterial species between patients with anemia and those without. Women with anemia were more likely to deliver preterm (OR 3.3 (95% CI 1.07, 11.4), ). When controlling for race and history of preterm delivery, women with anemia continued to have increased odds of preterm birth (OR 6.0, CI 1.4, 35, ). Conclusion. Women with pyelonephritis and anemia are at increased risk for preterm delivery.

Objective. Pyelonephritis is a common cause of antepartum admission and maternal morbidity. Medical complications associated with pyelonephritis during delivery are not well described; thus the objective of this study was to estimate medical, infectious, and obstetric complications associated with pyelonephritis during the delivery admission. Study Design. We conducted a retrospective cohort study using the Nationwide Inpatient Sample (NIS) for the years 2008–2010. The NIS was queried for all delivery-related discharges. During the delivery admission, the ICD-9-CM codes for pyelonephritis were used to identify cases and were compared to women without pyelonephritis. A multivariable logistic regression model was constructed for various medical, infectious, and obstetric complications among women with pyelonephritis compared to women without, while controlling for preexisting medical conditions and demographics. Results. During the years 2008–2010, there were 26,397 records with a diagnosis of pyelonephritis during the delivery admission, for a rate of 2.1 per 1000 deliveries. Women with pyelonephritis had increased associated risks for transfusion, need for mechanical ventilation, acute heart failure, pneumonia, pulmonary edema, acute respiratory distress syndrome, sepsis, acute renal failure, preterm labor, and chorioamnionitis, while controlling for preexisting medical conditions. Conclusions. Pyelonephritis at delivery admissions is associated with significant medical and infectious morbidity.

Objective. To determine if gestational age of prior preterm delivery influences a woman's receipt of 17-hydroxyprogesterone caproate (17-OHP-C). Methods. Retrospective cohort of women eligible for 17-OHP-C at Duke Obstetrics Clinic were identified by medical record review. Sociodemographic and clinical characteristics were abstracted. Results. Of 104 eligible subjects, 82 (78.8%) were offered 17-OHP-C. Of these, thirty-four (41.5%) declined. The median gestational age of the most recent preterm delivery was significantly lower among subjects who accepted 17-OHP-C as compared to those who declined (28.7 vs. 34.0 weeks, 𝑃=.02) and in subjects offered 17-OHP-C compared to those not offered 17-OHP-C (30.2 vs. 36.0 weeks, 𝑃=.03). Subjects not offered 17-OHP-C were more likely to have had an interval term delivery (31.8% vs. 9.7%, 𝑃=.009) Conclusion. Women with earlier preterm deliveries were more likely to be offered and accept 17-OHP-C. Prior obstetric history may influence both providers' and patients' willingness to discuss and/or accept 17-OHP-C.

The uptake of web-based lecture technologies for recording and delivering live lectures has increased markedly in recent years. Students have responded positively, and for many their use has transformed learning – freeing them up from rigid timetables by providing choice in lecture attendance and supporting learning by extending the lecture experience and enabling them to revisit key concepts and ideas in their own time. Less transformational has been the impact on teaching. Although changing attendance patterns and disquiet about the quality of learning are of concern to many, lecturers have largely responded by simply modifying lectures. For most, the challenges of catering for the learning needs of a cohort with variable lecture attendance have not been addressed at a whole of the curriculum level. The technologies have been added on, rather than integrated into the curriculum. This paper will review the changes taking place in learning and teaching, explore the reluctance to embrace more wholesale change to the curriculum, and discuss the implications for institutions in the face of ongoing change.

Phoenix sylvestris, commonly known as the wild date palm, holds immense potential in traditional medicine due to its diverse phytochemical composition. Leaf identification plays a crucial role in botanical research, ecological studies, and biodiversity conservation. Phoenix sylvestris, commonly known as the wild date palm or silver date palm, is an economically and ecologically significant palm species. Traditional methods of identifying plant species based on morphological characteristics can be challenging, especially when dealing with closely related species or in cases of morphological variation. In this study, we present a DNAbased approach for the identification of Phoenix sylvestris leaves through DNA extraction, amplification of specific genetic markers, and sequencing. Leaf samples were collected from various geographical locations to encompass genetic diversity. DNA was extracted using a modified CTAB method, and the internal transcribed spacer (ITS) region of the nuclear ribosomal DNA was amplified using polymerase chain reaction (PCR). Sanger sequencing was performed to obtain DNA sequences, which were then compared to reference sequences in public databases for species identification. The results demonstrate the efficacy of this approach in accurately identifying Phoenix sylvestris leaves, even in cases where morphological characteristics may be ambiguous or variable. This DNA-based method provides a reliable tool for rapid and accurate identification of Phoenix sylvestris, contributing to its conservation and management efforts, as well as facilitating research on its ecology, distribution, and evolutionary history. This study presents a multifaceted analysis of P. sylvestris extract, encompassing phytochemical characterization, antioxidant, antimicrobial, and anticancer evaluations, along with molecular docking simulations. The phytochemical analysis revealed the presence of various bioactive compounds such as phenolics and flavonoids contributing to its medicinal properties. Assessment of antioxidant activity through DPPH assay demonstrated significant radical scavenging potential, indicating its potential therapeutic application in oxidative stress-related disorders. Moreover, the antimicrobial evaluation against a panel of pathogenic microorganisms highlighted the extract's efficacy in inhibiting microbial growth, suggesting its utility as a natural antimicrobial agent. Furthermore, the anticancer potential was evaluated against various cancer cell lines, revealing promising cytotoxic effects, particularly against specific cancer types. Molecular docking studies provided insights into the interaction between bioactive compounds of P. sylvestris extract and key molecular targets implicated in cancer progression, validating its potential as a source of novel anticancer agents. Overall, this comprehensive investigation underscores the pharmacological significance of P. sylvestris extract, emphasizing its therapeutic versatility and potential for drug discovery and development. [ABSTRACT FROM AUTHOR]

Students select, research, organize, and effectively present information (oral and written) using appropriate language, voice, articulation, and nonverbal communication in a mock interview setting. Keywords: interviewing, public speaking, first-generation college students, career preparation, oral communication, Rationale First-generation college students (FGCS) tend to come from families with relatively few professional individuals and career networks (Engle & Tinto, 2008; Tate et al., 2015). FGCS often cannot benefit [...]

Lesotho is an independent enclave within the Republic of South Africa. It is roughly the size of Belgium and has a population of approximately one million. Prior to independence (4 October 1966) no official action had been taken toward nature conservation. Priority had been given to rural development schemes, improvement of agricultural practices, and to urban and industrial development.

Clinical pharmacology studies that describe the pharmacokinetics and pharmacodynamics of drugs in pregnant women are critical for informing on the safe and effective use of drugs during pregnancy. That being said, multiple factors have hindered the ability to study drugs in pregnant patients. These include concerns for maternal and fetal safety, ethical considerations, the difficulty in designing appropriate trials to assess the study objectives, and funding limitations. This document summarizes the recommendations of a panel of experts convened by the Division of Microbiology and Infectious Diseases at the National Institute of Allergy and Infectious Diseases, National Institutes of Health. These experts were charged with reviewing the issues related to the development of preclinical and clinical drug studies in pregnant women and to develop strategies for addressing these issues. These findings may also be utilized in the development of future drug studies involving pregnant women and their fetus/neonate.