Streptococcus pneumoniae infections in the neonate (SPIN) are relatively unusual events (1%-11% of neonatal sepsis) but are associated with substantial morbidity and mortality. Previous reports ...suggest that invasive SPIN is associated with prolonged rupture of membranes, maternal colonization/illness, prematurity, early-onset pneumonia presentation (<72 hours), and high mortality (50%). The aim of this study was to review the current epidemiology and clinical course of SPIN.
The US Pediatric Multicenter Pneumococcal Surveillance Group has been prospectively monitoring S pneumoniae infections since 1993 in 8 children's hospitals. For this report, data were gathered retrospectively from the charts of neonates who were 30 days of age and younger and had SPIN from September 1993 to February 2001. All pneumococcal isolates were sent to a central laboratory for serogrouping/typing and susceptibility testing.
Twenty-nine cases of SPIN were identified from a total of 4428 episodes of S pneumoniae infection in children. Sixty-six percent were male, and 55% were white; the mean age was 18.1 day (+/-8.2). Ninety percent of infants were >or=38 weeks' gestation. Two mothers had bacterial infections at delivery; 1 had S pneumoniae isolated from both blood and cervix, and 1 had clinical amnionitis. The primary diagnoses in the neonates were bacteremia (8), meningitis (8), bacteremic pneumonia (4), septic arthritis/osteomyelitis (1), and otitis media (8). Thirty percent of infants with invasive SPIN presented with leukopenia/neutropenia, but this did not predict poor outcome. The infecting pneumococcal serogroups were 19 (32%); 9 (18%); 3 and 18 (11% each); 1, 6, and 14 (7% each); and 5 and 12 (3.5% each). Twenty-six percent of invasive neonatal infections were caused by serogroups 1, 3, 5, and 12, which are not contained in the heptavalent pneumococcal vaccine. In contrast, 6% of invasive nonneonatal disease was caused by these same nonvaccine serogroups. Susceptibility testing demonstrated that 21.4% of isolates were penicillin nonsusceptible and 3.6% were ceftriaxone nonsusceptible. Three (14.3%) neonates with invasive SPIN died; all deaths occurred within 36 hours of presentation. Deaths did not appear to be related to pneumococcal serogroup or susceptibilities.
Compared with previous studies of neonates with pneumococcal infection, this series showed that infants with SPIN were usually 2 to 3 weeks of age at presentation; likely to be full term; and ill with pneumonia, meningitis, and otitis media. This late-onset presentation was associated with an overall mortality rate of 10.3% (14.3% for invasive disease).
Genetic heterozygosity in wild, unmanaged animal populations is often associated with protection against infectious disease. However, little is known about the relationship between heterozygosity and ...disease susceptibility in domesticated livestock, where disease resistance has the potential to improve animal welfare and productivity. We have investigated whether susceptibility to footrot, an important cause of poor welfare and reduced productivity in sheep, is associated with heterozygosity at 14 candidate microsatellite loci. Heterozygosity at locus BMC5221 was associated with resistance to footrot (P=0.0034). This locus was selected based on a gene ontology classification of ‘response to Gram-negative bacteria’. Sheep homozygous at BMC5221 were at increased risk of virulent footrot (OR=4.8, 95% CI=1.5–15.3), with a dose response relationship between homozygosity and disease severity. A highly significant homozygote deficit was observed in sheep without virulent footrot (observed=4, expected=21, χ2=13.76, P=0.0002) but not in sheep that had clinical disease, suggesting homozygotes were disproportionately likely to contract virulent footrot. Our results indicate that genetic heterozygosity might be important for healthy immune function in domesticated livestock. The use of gene ontology codes might prove a useful strategy to target selection of candidate markers in future studies.
In recent years, Type-II InAs/GaSb superlattice photodetectors have experienced significant improvements in material quality, structural designs, and imaging applications. They now appear to be a ...possible alternative to the state-of-the-art HgCdTe (MCT) technology in the long (LWIR) and very long wavelength infrared regimes. At the Center for Quantum Devices, we have successfully realized very high quantum efficiency, very high dynamic differential resistance R 0 A-product LWIR Type-II InAs/GaSb superlattice photodiodes with efficient surface passivation techniques. The demonstration of high-quality LWIR focal plane arrays that were 100% fabricated in-house reaffirms the pioneer position of this university-based laboratory.
To identify the optimal timing of perioperative chemical thromboprophylaxis (CTP) and incidence of occult preoperative deep vein thrombosis (OP-DVT) in patients undergoing major colorectal surgery.
...There is limited Level 1 data regarding the optimal timing of CTP in major colorectal surgery and the incidence of OP-DVT remains unclear. Both issues influence the occurrence of venous thromboembolism (VTE) and may impact Medicare reimbursement because of penalties for hospital-acquired conditions.
Patients undergoing major colorectal surgery underwent preoperative lower extremity venous duplex (LEVD) immediately before surgery. Those without OP-DVT were randomized to preoperative or postoperative CTP with 5000 units of subcutaneous heparin. Patients underwent repeat LEVD in the recovery room and on postoperative day 2. Outcome measures included early (48-hrs) and overall (30-days) postoperative VTE, bleeding complications, and OP-DVT.
Eighteen patients (4.2%) had OP-DVT and were excluded. The randomized group included 376 patients (51.6% female) with mean age of 52.7 ± 17.6 years. No pulmonary embolism occurred. There was no significant difference in preoperative versus postoperative CTP with respect to early postoperative DVT 3/184 (1.6%) vs 5/192 (2.6%); P = 0.72, DVT at 30 days (1.6% vs 3.6%; P = 0.34) or bleeding complications requiring reoperation (0.5% vs 1.6%; P = 0.62).
The risk of OP-DVT is higher than that of perioperative DVT after colorectal surgery and preoperative screening LEVD should be considered to identify and treat patients at risk for pulmonary embolism. Preoperative and postoperative CTP are equally safe in protecting against VTE. CMS should account for these factors when assigning financial disincentives for perioperative VTE.
Clinicaltrials.gov #NCT01976988.
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•Ten laboratories participate in three inter-laboratory exercises in glass analysis.•Three databases of LA-ICP-MS data were used to evaluate LR calculations.•The ten laboratories all ...perform well in correctly reporting associations and non-associations.•The LR provides an objective and quantitative assessment attached to a “source association”.
Ten laboratories conducting forensic glass analysis participated in three inter-laboratory exercises to evaluate the use of a standard method (ASTM 2927-16e1) for the analysis and comparison of glass evidence using LA-ICP-MS. This study was designed to evaluate the rate of misleading evidence (ROME) when blind glass samples were distributed to the participants and asked to compare the glass samples (K vs. Q) and report their findings as they would in a case. Three different databases were used as background populations to calculate likelihood ratios (LRs) and frequency of elemental profile. The first database was composed of 420 vehicle windshield samples and the analytical data and application of this database is reported here, for the first time. The second database was provided by the BKA laboratory in Germany representing 385 casework samples including an assortment of float glass, container glass, and specialty glasses. The third background database was a combination of both databases. In the first inter-laboratory exercise, the likelihood ratio (LR) calculations result in 34/36 (94.4%) correct associations and no false inclusions for all labs. LRs in the second and third inter-laboratory exercises result in all participating laboratories correctly associating glass samples originating from the same source (57 comparisons) and all laboratories correctly discriminating glass samples from different sources (167 comparisons). The random match probability of glass samples known to originate from different glass sources was found to be ∼0.1% and in agreement with previously reported values by other researchers.
Six hospitals from the San Francisco Bay Area participated in a 12-month quality improvement project conducted by the Integrated Nurse Leadership Program (INLP). A quality improvement intervention ...that focused on improving medication administration accuracy was spread from two pilot units to all inpatient units in the hospitals.
INLP developed a 12-month curriculum, presented in a combination of off-site training sessions and hospital-based training and consultant-led meetings, to teach clinicians the key skills needed to drive organizationwide change. Each hospital established a nurse-led project team, as well as unit teams to address six safety processes designed to improve medication administration accuracy: compare medication to the medication administration record; keep medication labeled throughout; check two patient identifications; explain drug to patient (if applicable); chart immediately after administration; and protect process from distractions and interruptions.
From baseline until one year after project completion, the six hospitals improved their medication accuracy rates, on average, from 83.4% to 98.0% in the spread units. The spread units also improved safety processes overall from 83.1% to 97.2%. During the same time, the initial pilot units also continued to improve accuracy from 94.0% to 96.8% and safety processes overall from 95.3% to 97.2%.
With thoughtful planning, engaging those doing the work early and focusing on the "human side of change" along with technical knowledge of improvement methodologies, organizations can spread initiatives enterprisewide. This program required significant training of frontline workers in problem-solving skills, leading change, team management, data tracking, and communication.
Abstract
COVID-19 resulted in societal disruptions across the lifespan. School (K-12) closures were among the most challenging impacts of the virus, leaving many parents with the burden of schooling ...their children at home. Another major impact of the virus was the social isolation and loneliness felt by many retired, older adults, who were sheltering at home. The disruptions of COVID-19 led our inter-professional team to develop the Intergenerational Tutoring program. Intergenerational Tutoring addresses a service delivery gap in schools because tutors expand schools' capacity to implement evidence-based instruction with students in need of individual support. At the same time, research shows that meaningful volunteering supports the well-being of older adults across physical, psychosocial and cognitive dimensions of health. The aim of the Intergenerational Tutoring program is to pair older adults with kindergarten children in high needs schools to implement early literacy interventions remotely via Zoom. Our poster will describe the Intergenerational Tutoring program including tutor training and tutoring implementation. We will summarize the initial findings from our pilot study conducted in spring and summer 2021 with tutors and children. Data will include (1) themes from tutor interviews regarding the personal meaningfulness of the program and the program’s associated benefits and challenges; (2) implementation fidelity data; (3) impact of tutoring on children’s early literacy skills; and (4) parent feedback. We will summarize lessons learned and next steps for the program.
Amphotericin B (AMB) arabinogalactan (AG) conjugate was synthesized by the conjugation of AMB to oxidized AG by reductive amination. The conjugate was evaluated for in vitro antifungal activity and ...in vivo toxicity. Optimization of the conjugation process was investigated using large batches of 100 g, which are 20 times larger than previously reported for AMB-AG conjugation. The efficacy of AMB-AG conjugates was studied as a function of reaction conditions and time, aldehyde/reducing agent mole ratio, and purification procedure. The most potent AMB-AG conjugate having low minimal inhibitory concentration (MIC) and high maximal tolerated dose (MTD) was obtained following reduction with NaBH4 at 1:2 mol ratio (AG units/NaBH4) at 25 °C for 24 h. AMB-AG conjugate prepared under these conditions demonstrated MIC of 0.5 mg/L (equiv of AMB) in Candida albicans, and an MTD of 60 mg/kg (equiv of AMB) in mice, while AMB clinical formulation (Fungizone) demonstrated high toxicity (MTD = 3 mg/kg). These findings confirm the simplicity and reproducibility of the conjugation allowing this method to be applied on larger scale production.
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