Prior criteria for organ dysfunction in critically ill children were based mainly on expert opinion. We convened the Pediatric Organ Dysfunction Information Update Mandate (PODIUM) expert panel to ...summarize data characterizing single and multiple organ dysfunction and to derive contemporary criteria for pediatric organ dysfunction. The panel was composed of 88 members representing 47 institutions and 7 countries. We conducted systematic reviews of the literature to derive evidence-based criteria for single organ dysfunction for neurologic, cardiovascular, respiratory, gastrointestinal, acute liver, renal, hematologic, coagulation, endocrine, endothelial, and immune system dysfunction. We searched PubMed and Embase from January 1992 to January 2020. Study identification was accomplished using a combination of medical subject headings terms and keywords related to concepts of pediatric organ dysfunction. Electronic searches were performed by medical librarians. Studies were eligible for inclusion if the authors reported original data collected in critically ill children; evaluated performance characteristics of scoring tools or clinical assessments for organ dysfunction; and assessed a patient-centered, clinically meaningful outcome. Data were abstracted from each included study into an electronic data extraction form. Risk of bias was assessed using the Quality in Prognosis Studies tool. Consensus was achieved for a final set of 43 criteria for pediatric organ dysfunction through iterative voting and discussion. Although the PODIUM criteria for organ dysfunction were limited by available evidence and will require validation, they provide a contemporary foundation for researchers to identify and study single and multiple organ dysfunction in critically ill children.
One of the challenges in antibiotic lead discovery is the difficulty and time-consuming task of determining the mechanism of action (MOA) of antibacterial compounds. In this report, we describe the ...development and validation of a facile and inexpensive assay system utilizing disk diffusion of inhibitors on solid agar medium embedded with mixed pools of a comprehensive collection of Escherichia coli clones each containing a plasmid-borne inducible essential gene from E. coli. From individual clones, pilot small-scale (48 or 50 clones) assays, to full-scale target identification platform for antibacterials (TIPA) system, involving a variety of assay formats (liquid vs solid media, individual vs mix clones), we demonstrate that elevated resistance phenotypes of relevant cell clones were highly specific. In particular, the TIPA system was able to reveal cellular targets of several known antibacterial inhibitors: cerulenin, diazaborine, indolmycin, phosphomycin, and triclosan. Complementary to several existing MOA profiling schemes, the TIPA system offers a simple and low-cost method for elucidating the target proteins of antibacterial inhibitors, thus will facilitate discovery and development of novel antibacterial compounds to combat multidrug-resistant bacterial pathogens.
Studies have demonstrated strong associations between the prone sleep position (on the stomach) and sudden infant death syndrome (SIDS). In 1992, the American Academy of Pediatrics recommended that ...infants be placed to sleep laterally (on their side) or supine (on their back) to reduce SIDS risk, and in 1994, the national public education campaign "Back to Sleep" was launched.
To determine the typical sleep position of infants younger than 8 months in the United States, the changes that occurred after these recommendations, and the factors associated with the placement of infants prone or supine.
Annual nationally representative telephone surveys.
The 48 contiguous states of the United States.
Nighttime caregivers of infants born within the last 7 months between 1992 and 1996. Approximately 1000 interviews were conducted per year.
The position the infant was usually placed in for sleep, and the position the infant was most commonly found in when checked during the night's sleep.
Ninety-seven percent of respondents in each wave of the survey usually placed their infant to sleep in a specific position. Infants were placed in the prone position by 70% of caregivers in 1992, prior to the campaign, but only 24% in 1996. Supine and lateral placements increased during this time period, from 13% in 1992 to 35% in 1996 and from 15% in 1992 to 39% in 1996, respectively. Significant predictors of prone placement included maternal race reported as black (odds ratio OR, 2.34; 95% confidence interval CI, 1.68-3.26), mother's age 20 to 29 years (OR, 1.28; 95% CI, 1.09-1.50), region reported as the mid-Atlantic (OR, 1.41; 95% CI, 1.12-1.78) or southern states (OR, 1.47; 95% CI, 1.22-1.70), mothers with a previous child (OR, 1.68; 95% CI, 1.43-1.97), and infants younger than 8 weeks (OR, 0.63; 95% CI, 0.46-0.85). Infants aged 8 to 15 weeks were significantly more likely to be placed nonprone over time compared with the other age groups. Most of the risk factors for prone were significantly related in the opposite direction to supine placement.
The prevalence of infants placed in the prone sleep position declined by 66% between 1992 and 1996. Although causality cannot be proved, SIDS rates declined approximately 38% during this period. To achieve further reduction in prone sleeping, efforts to promote the supine sleep position should be aimed at groups at high risk for prone placement.
As a result of the recent Bovine Spongiform Encephalopathy crisis in the European beef industry, safe animal by-product disposal is currently being addressed. One such disposal option is the ...combustion of by-product material such as meat and bone meal (MBM) in a fluidised bed combustor (FBC) for the purpose of energy recovery. Two short series of combustion tests were conducted on a FBC (10 cm diameter) at the University of Twente, the Netherlands. In the first series, pellets (10 mm in diameter and approximately 10 mm in length) were made from a mixture of MBM and milled peat, at MBM inclusion rates of 0%, 30%, 50%, 70% and 100%. In the second series of tests, the pellets were commercially made and were 4.8 mm in diameter and between 12 and 15 mm long. These pellets had a weight of about 0.3 g and contained 0%, 25%, 35%, 50% and 100% MBM inclusion with the peat. Both sets of pellets were combusted at 880°C. The residence times in the FBC varied from 300 s (25% MBM inclusion) to 120 s (100% MBM inclusion) for the first series of pellets. Increasing compaction pressure increased the residence time. For the second series of pellets, the residence time varied from about 300 s (25% MBM inclusion) to 100 s (100% MBM inclusion). MBM was found to be a volatile product (about 65%) and co-firing it with milled peat in a pelleted feed format reduces its volatile intensity. Pellets made from 100% bone based meal remained intact within the bed and are thought to have undergone a process of calcination during combustion. A maximum MBM inclusion rate of 35% with milled peat in a pellet is recommended from this work.
Building the Evryscope Ratzloff, Jeffrey K.; Law, Nicholas M.; Fors, Octavi ...
Publications of the Astronomical Society of the Pacific,
07/2019, Volume:
131, Issue:
1001
Journal Article
Peer reviewed
The Evryscope is a telescope array designed to open a new parameter space in optical astronomy, detecting short-timescale events across extremely large sky areas simultaneously. The system consists ...of a 780 MPix 22-camera array with an 8150 sq. deg. field of view, 13″ per pixel sampling, and the ability to detect objects down to
m
g
′
≃
16
in each 2-minute dark-sky exposure. The Evryscope, covering 18,400 sq. deg. with hours of high-cadence exposure time each night, is designed to find the rare events that require all-sky monitoring, including transiting exoplanets around exotic stars like white dwarfs and hot subdwarfs, stellar activity of all types within our galaxy, nearby supernovae, and other transient events such as gamma-ray bursts and gravitational-wave electromagnetic counterparts. The system averages 5000 images per night with ∼300,000 sources per image, and to date has taken over 3.0M images, totaling 250 TB of raw data. The resulting light curve database has light curves for 9.3M targets, averaging 32,600 epochs per target through 2018. This paper summarizes the hardware and performance of the Evryscope, including the lessons learned during telescope design, electronics design, a procedure for the precision polar alignment of mounts for Evryscope-like systems, robotic control and operations, and safety and performance-optimization systems. We measure the on-sky performance of the Evryscope, discuss its data analysis pipelines, and present some example variable star and eclipsing binary discoveries from the telescope. We also discuss new discoveries of very rare objects including two hot subdwarf eclipsing binaries with late M-dwarf secondaries (HWVir systems), two white dwarf/hot subdwarf short-period binaries, and four hot subdwarf reflection binaries. We conclude with the status of our transit surveys, M-dwarf flare survey, and transient detection.
The regions around the celestial poles offer the ability to find and characterize long-term variables from ground-based observatories. We used multi-year Evryscope data to search for high-amplitude ...(≈5% or greater) variable objects among 160,000 bright stars (mv < 14.5) near the South Celestial Pole. We developed a machine-learning-based spectral classifier to identify eclipse and transit candidates with M-dwarf or K-dwarf host stars, and potential low-mass secondary stars or gas-giant planets. The large amplitude transit signals from low-mass companions of smaller dwarf host stars lessens the photometric precision and systematics removal requirements necessary for detection, and increases the discoveries from long-term observations with modest light-curve precision among the faintest stars in the survey. The Evryscope is a robotic telescope array that observes the Southern sky continuously at 2-minute cadence, searching for stellar variability, transients, transits around exotic stars and other observationally challenging astrophysical variables. The multi-year photometric stability is better than 1% for bright stars in uncrowded regions, with a 3σ limiting magnitude of g = 16 in dark time. In this study, covering all stars 9 < mv < 14.5, in declinations −75° to −90°, and searching for high-amplitude variability, we recover 346 known variables and discover 303 new variables, including 168 eclipsing binaries. We characterize the discoveries and provide the amplitudes, periods, and variability type. A 1.7 RJ planet candidate with a late K-dwarf primary was found and the transit signal was verified with the PROMPT telescope network. Further follow-up revealed this object to be a likely grazing eclipsing binary system with nearly identical primary and secondary K5 stars. Radial-velocity measurements from the Goodman Spectrograph on the 4.1 meter SOAR telescope of the likely lowest-mass targets reveal that six of the eclipsing binary discoveries are low-mass (.06–.37 M
⊙) secondaries with K-dwarf primaries, strong candidates for precision mass–radius measurements.
Stellar flares are stochastic events that occur when a star's magnetic field re-connects, releasing intense radiation across the electromagnetic spectrum. Rocky planets in the habitable zones of ...M-dwarfs are often subjected to superflares, events of at least 1033 erg and 10-1000X the energy of the largest solar flares. Frequent superflares can erode the ozone layer of an Earth-like atmosphere and allow lethal amounts of UV flux to reach the surface. Conversely, too few flares may result in insufficient UV radiation to power pre-biotic chemistry due to the inherent faintness of M-dwarfs in the UV. Cool stars are often found to exhibit superflares. Cool stars are the most common type of star, and are known to frequently host rocky planets. As a result, they may host most of the universe’s Earth-size planets orbiting in the habitable zones of main sequence stars. My EvryFlare Survey uses observations from the Evryscope array of small telescopes and the Transiting Exoplanet Survey Satellite (TESS) to answer two questions about superflares and their impacts on the habitability of terrestrial planets orbiting cool stars: (1) How frequently are superflares emitted from the nearby cool stars, both in the present and in the first 200 Myr after formation? (2) What impact does superflare UV emission have on planetary atmospheres and surface habitability of planets orbiting cool stars? The EvryFlare Survey has resulted in the detection of 575 superflares from 284 stars. Results include a superflare from Proxima Cen, the nearest host star to a rocky planet in the habitable zone. I used these events to measure a decrease in superflare rates with increasing age, rotation, and starspot coverage. I will discuss the effects of superflares on ozone loss to planetary atmospheres, including one superflare with sufficient energy to photo-dissociate all ozone in an Earth-like atmosphere in a single event. I present the largest-ever survey of simultaneous observations of dozens of M-dwarf superflares with Evryscope and TESS to measure the flare blackbody and estimate UV-C continuum emission. I find superflare temperatures increase with flare energy. The largest and hottest flare briefly reached an estimated 42,000 K. During superflares, I estimate rocky HZ planets orbiting <200 Myr stars typically receive a top-of-atmosphere UV-C flux of ~120 W m-2 and up to 103 W m-2, 100-1000X the time-averaged XUV flux from Proxima Cen. Finally, I will describe a data analysis project with Robo-AO, exploring the performance of laser guide star adaptive optics systems in the absence of tip-tilt correction.
To develop evidence-based clinical practice guidelines for interventional techniques in the diagnosis and treatment of chronic spinal pain.
Systematic assessment of the literature.
I. Lumbar Spine • ...The evidence for accuracy of diagnostic selective nerve root blocks is limited; whereas for lumbar provocation discography, it is fair. • The evidence for diagnostic lumbar facet joint nerve blocks and diagnostic sacroiliac intraarticular injections is good with 75% to 100% pain relief as criterion standard with controlled local anesthetic or placebo blocks. • The evidence is good in managing disc herniation or radiculitis for caudal, interlaminar, and transforaminal epidural injections; fair for axial or discogenic pain without disc herniation, radiculitis or facet joint pain with caudal, and interlaminar epidural injections, and limited for transforaminal epidural injections; fair for spinal stenosis with caudal, interlaminar, and transforaminal epidural injections; and fair for post surgery syndrome with caudal epidural injections and limited with transforaminal epidural injections. • The evidence for therapeutic facet joint interventions is good for conventional radiofrequency, limited for pulsed radiofrequency, fair to good for lumbar facet joint nerve blocks, and limited for intraarticular injections. • For sacroiliac joint interventions, the evidence for cooled radiofrequency neurotomy is fair; limited for intraarticular injections and periarticular injections; and limited for both pulsed radiofrequency and conventional radiofrequency neurotomy. • For lumbar percutaneous adhesiolysis, the evidence is fair in managing chronic low back and lower extremity pain secondary to post surgery syndrome and spinal stenosis. • For intradiscal procedures, the evidence for intradiscal electrothermal therapy (IDET) and biaculoplasty is limited to fair and is limited for discTRODE. • For percutaneous disc decompression, the evidence is limited for automated percutaneous lumbar discectomy (APLD), percutaneous lumbar laser disc decompression, and Dekompressor; and limited to fair for nucleoplasty for which the Centers for Medicare and Medicaid Services (CMS) has issued a noncoverage decision. II. Cervical Spine • The evidence for cervical provocation discography is limited; whereas the evidence for diagnostic cervical facet joint nerve blocks is good with a criterion standard of 75% or greater relief with controlled diagnostic blocks. • The evidence is good for cervical interlaminar epidural injections for cervical disc herniation or radiculitis; fair for axial or discogenic pain, spinal stenosis, and post cervical surgery syndrome. • The evidence for therapeutic cervical facet joint interventions is fair for conventional cervical radiofrequency neurotomy and cervical medial branch blocks, and limited for cervical intraarticular injections. III. Thoracic Spine • The evidence is limited for thoracic provocation discography and is good for diagnostic accuracy of thoracic facet joint nerve blocks with a criterion standard of at least 75% pain relief with controlled diagnostic blocks. • The evidence is fair for thoracic epidural injections in managing thoracic pain. • The evidence for therapeutic thoracic facet joint nerve blocks is fair, limited for radiofrequency neurotomy, and not available for thoracic intraarticular injections. IV. Implantables • The evidence is fair for spinal cord stimulation (SCS) in managing patients with failed back surgery syndrome (FBSS) and limited for implantable intrathecal drug administration systems. V. ANTICOAGULATION • There is good evidence for risk of thromboembolic phenomenon in patients with antithrombotic therapy if discontinued, spontaneous epidural hematomas with or without traumatic injury in patients with or without anticoagulant therapy to discontinue or normalize INR with warfarin therapy, and the lack of necessity of discontinuation of nonsteroidal anti-inflammatory drugs (NSAIDs), including low dose aspirin prior to performing interventional techniques. • There is fair evidence with excessive bleeding, including epidural hematoma formation with interventional techniques when antithrombotic therapy is continued, the risk of higher thromboembolic phenomenon than epidural hematomas with discontinuation of antiplatelet therapy prior to interventional techniques and to continue phosphodiesterase inhibitors (dipyridamole, cilostazol, and Aggrenox). • There is limited evidence to discontinue antiplatelet therapy with platelet aggregation inhibitors to avoid bleeding and epidural hematomas and/or to continue antiplatelet therapy (clopidogrel, ticlopidine, prasugrel) during interventional techniques to avoid cerebrovascular and cardiovascular thromboembolic fatalities. • There is limited evidence in reference to newer antithrombotic agents dabigatran (Pradaxa) and rivaroxan (Xarelto) to discontinue to avoid bleeding and epidural hematomas and are continued during interventional techniques to avoid cerebrovascular and cardiovascular thromboembolic events.
Evidence is fair to good for 62% of diagnostic and 52% of therapeutic interventions assessed.
The authors are solely responsible for the content of this article. No statement on this article should be construed as an official position of ASIPP. The guidelines do not represent "standard of care."
A write-once programmable memory element is based on a spin-coated sol-gel silica antifuse layer cured at 100/spl deg/C. This antifuse is integrated with a thin-film silicon diode deposited at ...160/spl deg/C by hot-wire chemical vapor deposition. When a 3 to 5 V electrical pulse is applied across a diode/antifuse element, the silica breaks down suddenly and the current passing through the element increases irreversibly by more than about 10/sup 4/. The on-state exhibits a diode-like current-voltage characteristic with a forward-reverse asymmetry of nearly 100 at 1 V and is stable if there was hexamethyldisilazane treatment of the wet-gel film before curing.
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