We have made time-of-flight mass-spectroscopic observations of 85/15 wt % water/glycine solutions and of crystalline α-glycine subjected to strong shock loading. The shockwaves were produced by ...placing the materials in contact with detonating solid explosives. In the solution observations, we have done experiments with glycine molecules composed of ordinary isotopes and with molecules labeled with 13C, 15N, and D atoms. The primary reason for conducting this research was to examine whether glycine molecules can survive exposure to strong shock loading, e.g., as might occur in the entry of a meteor into the earth’s atmosphere. Our results show that glycine molecules can withstand the rigors of shock environments that generate pressure and temperature up to 180 kbar and 3200 K. Glycine in a 85 H2O/15 glycine wt % solution (i.e., one molecule of glycine to ca. 24 H2O molecules) exists primarily in its zwitterionic form. In both the solution and crystal experiments, we observed zwitterionic dimers, trimers, and, possibly, tetramers, after the materials were shocked. This implies that the solvating water molecules in the solution experiments must reside on the exterior of groups of solvated glycine molecules. We report quantum-chemical calculations, using density functional theory, that predict that two glycine zwitterions are bound together by ca. 15.72 kcal when immersed in an Onsager model of water. Our observations allow us to place lower-bound estimates on the lifetime of glycine zwitterions under our conditions. We have examined our data to determine whether dipeptide formation has occurred and found no evidence that it has. Compressible fluid-mechanical calculations were performed to estimate the pressures, temperatures, and the time scales present in the experiments.
Abstract Objective The aims of this study were to determine whether the application of vibration on a postural lower limb muscle altered the sensorimotor control of its joint as measured by isometric ...force production parameters and to compare present findings with previous work conducted on trunk muscle. Methods Twenty healthy adults were asked to reproduce submaximal isometric plantar flexion under 3 different conditions: no vibration and vibration frequencies of 30 and 80 Hz on the soleus muscle. Time to peak torque, variable error, as well as constant error and absolute error in peak torque were calculated and compared across conditions. Results Under vibration, participants were significantly less accurate in the force reproduction task, as they mainly undershot the target torque. Applying an 80-Hz vibration resulted in a significantly higher negative constant error than lower-frequency vibration (30 Hz) or no-vibration condition. Decreases in isometric force production accuracy under vibration influence were also observed in a previous study conducted on trunk muscle. However, no difference in constant error was found between 30- and 80-Hz vibration conditions. Conclusion The results suggest that acute soleus muscle vibration interferes with plantar flexion torque generation by distorting proprioceptive information, leading to decreases in accuracy of a force reproduction task. Similar results in an isometric trunk extension force reproduction task were found with vibration applied on erector spinae muscle. However, high-frequency vibration applied on soleus muscle elicited higher force reproduction errors than low-frequency stimulation.
Conventional dermatophyte identification is based on morphological features. However, recent studies have proposed to use the nucleotide sequences of the rRNA internal transcribed spacer (ITS) region ...as an identification barcode of all fungi, including dermatophytes. Several nucleotide databases are available to compare sequences and thus identify isolates; however, these databases often contain mislabeled sequences that impair sequence-based identification. We evaluated five of these databases on a clinical isolate panel. We selected 292 clinical dermatophyte strains that were prospectively subjected to an ITS2 nucleotide sequence analysis. Sequences were analyzed against the databases, and the results were compared to clusters obtained via DNA alignment of sequence segments. The DNA tree served as the identification standard throughout the study. According to the ITS2 sequence identification, the majority of strains (255/292) belonged to the genus
, mainly
complex (
= 184),
(
= 40),
(
= 26), and
(
= 5). Other genera included
(e.g.,
= 21,
= 10,
= 3, and
= 3). Species-level identification of
complex isolates was an issue. Overall, ITS DNA sequencing is a reliable tool to identify dermatophyte species given that a comprehensive and correctly labeled database is consulted. Since many inaccurate identification results exist in the DNA databases used for this study, reference databases must be verified frequently and amended in line with the current revisions of fungal taxonomy. Before describing a new species or adding a new DNA reference to the available databases, its position in the phylogenetic tree must be verified.
The clinical involvement and antifungal susceptibility of Aspergillus section
are poorly known. We analyzed 52 isolates, including 48 clinical isolates, belonging to 9 species inside the section
. ...The whole section exhibited, by the EUCAST reference method, a poor susceptibility to amphotericin B, but species/series-specific patterns were observed for azole drugs. This underlines the interest in getting an accurate identification inside the section
to guide the choice of antifungal treatment in clinical practice.
Although inhaled nitric oxide (iNO) may be a promising treatment for newborn infants with severe respiratory failure, the results from 3 previous small trials were inconclusive.
Infants of <34 weeks' ...gestation, <28 days old, and with severe respiratory failure requiring ventilatory support were randomized to receive or not receive iNO. The study was not blinded.
Recruited were 108 infants (55 allocated to receive iNO and 53 not allocated to receive iNO) from 15 neonatal units in the United Kingdom and Republic of Ireland. Fifty-nine percent (64 of 108) died, and 84% of the survivors (37 of 44) had signs of some impairment or disability, 9 (20%) of them classified as severely disabled. There was no evidence of an effect of iNO on the primary outcomes: death or severe disability at 1 year corrected age (relative risk RR: 0.99; 95% confidence interval CI: 0.76 to 1.29); death or supplemental oxygen on expected date of delivery (RR: 0.84; 95% CI: 0.68 to 1.02); or death or supplemental oxygen at 36 weeks' postmenstrual age (RR: 0.98; 95% CI: 0.87 to 1.12). There was a trend for infants allocated to the iNO group to spend more time on the ventilator (log rank: 3.6), on supplemental oxygen (log rank: 1.4), and in hospital (log rank: 3.5) than those allocated to receive no iNO. This pattern predominantly reflected the infants who died. Mean total costs at 1 year corrected age were significantly higher in the iNO group, partly because of the costs of the gas but mainly because of the difference in initial hospitalization costs.
Evidence of prolongation of intensive care and increased costs of such care, without clear beneficial effects, implies that iNO cannot be recommended for preterm infants with severe hypoxic respiratory failure.
Abstract
New mold species are increasingly reported in invasive fungal infections. However, these fungi are often misdiagnosed or undiagnosed due to the use of inappropriate laboratory diagnostic ...tools. Tropical countries, such as French Guiana, harbor a vast diversity of environmental fungi representing a potential source of emerging pathogens. To assess the impact of this diversity on the accuracy of mold-infection diagnoses, we identified mold clinical isolates in French Guiana during a five-month follow-up using both microscopy and matrix-assisted laser desorption ionization time-of-flight mass spectrometry. In total, 38.8% of the 98 obtained molds isolates could not be identified and required a DNA-based identification. Fungal diversity was high, including 46 species, 26 genera, and 13 orders. Fungal ecology was unusual, as Aspergillus species accounted for only 27% of all isolates, and the Nigri section was the most abundant out of the six detected Aspergillus sections. Macromycetes (orders Agaricales, Polyporales, and Russulales) and endophytic fungi accounted for respectively 11% and 14% of all isolates. Thus, in tropical areas with high fungal diversity, such as French Guiana, routine mold identification tools are inadequate. Molecular identifications, as well as morphological descriptions, are necessary for the construction of region-specific mass spectrum databases. These advances will improve the diagnosis and clinical management of new fungal infections.
Lay Summary
In French Guiana, environmental fungal diversity may be a source of emerging pathogens. We evaluated microscopy and mass spectrometry to identify mold clinical isolates. With 39% of unidentified isolates, a region-specific mass spectrum database would improve the diagnosis of new fungal infections.
Liquid crystal lasers have advantageous features, including continuous wavelength tuning at low cost. Although many potential applications have been highlighted, use of these lasers is not ...widespread, partially due to performance limitations. This paper presents a method of overcoming repetition rate limitations. A rapidly spinning stage is used to allow operation of a LC laser at 10 kHz: two orders of magnitude greater than possible with a static cell. Average power outputs of up to 3.5 mW are achieved along with an improvement in emission stability. Lastly, a mechanical wavelength-switching method is demonstrated. The spinning cell approach will enable research into the use of liquid crystal lasers in fluorescence imaging and display applications.
Economics of care for adults with serious illness is a policy priority worldwide. Palliative care may lower costs for hospitalized adults, but the evidence has important limitations.
To estimate the ...association of palliative care consultation (PCC) with direct hospital costs for adults with serious illness.
Systematic searches of the Embase, PsycINFO, CENTRAL, PubMed, CINAHL, and EconLit databases were performed for English-language journal articles using keywords in the domains of palliative care (eg, palliative, terminal) and economics (eg, cost, utilization), with limiters for hospital and consultation. For Embase, PsycINFO, and CENTRAL, we searched without a time limitation. For PubMed, CINAHL, and EconLit, we searched for articles published after August 1, 2013. Data analysis was performed from April 8, 2017, to September 16, 2017.
Economic evaluations of interdisciplinary PCC for hospitalized adults with at least 1 of 7 illnesses (cancer; heart, liver, or kidney failure; chronic obstructive pulmonary disease; AIDS/HIV; or selected neurodegenerative conditions) in the hospital inpatient setting vs usual care only, controlling for a minimum list of confounders.
Eight eligible studies were identified, all cohort studies, of which 6 provided sufficient information for inclusion. The study estimated the association of PCC within 3 days of admission with direct hospital costs for each sample and for subsamples defined by primary diagnoses and number of comorbidities at admission, controlling for confounding with an instrumental variable when available and otherwise propensity score weighting. Treatment effect estimates were pooled in the meta-analysis.
Total direct hospital costs.
This study included 6 samples with a total 133 118 patients (range, 1020-82 273), of whom 93.2% were discharged alive (range, 89.0%-98.4%), 40.8% had a primary diagnosis of cancer (range, 15.7%-100.0%), and 3.6% received a PCC (range, 2.2%-22.3%). Mean Elixhauser index scores ranged from 2.2 to 3.5 among the studies. When patients were pooled irrespective of diagnosis, there was a statistically significant reduction in costs (-$3237; 95% CI, -$3581 to -$2893; P < .001). In the stratified analyses, there was a reduction in costs for the cancer (-$4251; 95% CI, -$4664 to -$3837; P < .001) and noncancer (-$2105; 95% CI, -$2698 to -$1511; P < .001) subsamples. The reduction in cost was greater in those with 4 or more comorbidities than for those with 2 or fewer.
The estimated association of early hospital PCC with hospital costs may vary according to baseline clinical factors. Estimates may be larger for primary diagnosis of cancer and more comorbidities compared with primary diagnosis of noncancer and fewer comorbidities. Increasing palliative care capacity to meet national guidelines may reduce costs for hospitalized adults with serious and complex illnesses.
This study compares and contrasts the recommended indications for cardiac resynchronization therapy (CRT) according to the most recent guidelines from international cardiology societies.
CRT has been ...shown to reduce morbidity and mortality in selected patients with systolic heart failure. Cardiology societies provide guidelines regarding the indications for CRT. As evidence evolves, it is challenging for the guideline committees to review the impact of newer evidence in a timely fashion.
Six of the most recent international guidelines providing recommendation concerning CRT implantation ranging from 2011 to 2017 were reviewed. These included guidelines from 2 European, 1 North American, 1 Canadian, and 1 Australian/New Zealand societies and the National Institute for Health and Care Excellence guidelines, specific to the United Kingdom.
Although international societies provide consistent recommendations for most CRT indications, differences are found in recommendations for several important patient populations. Specifically, divergent recommendations exist regarding QRS duration, bundle branch morphology, patients in atrial fibrillation, choice of device type (CRT pacemakers vs. CRT defibrillators), and selected patients who are likely to be dependent on right ventricular pacing. The timing of publication of specific guidelines appears to play an essential role in explaining these disparities.
Despite general consistency in international guideline recommendations, there remain certain patient populations for whom there are variations in recommendations concerning eligibility for CRT and selection of the most appropriate device in the individual patient.
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