Effect of Contrast-Enhanced Echocardiograms on the Prognosis of Infective Endocarditis

Objective - Infective endocarditis (IE) is an infectious disease of the cardiac valves where bacteria colonize the valves; typically, via the formation of vegetations. Recent research has shown that the microbubbles in a contrast-enhanced ultrasound (CEUS) examination can move and dislodge bacterial vegetations in vitro. This study investigated whether CEUS resulted in faster resolution of IE in vivo by dislodging the vegetations. Methods - This IRB approved retrospective study reviewed 36 patients who were diagnosed with IE via echocardiography. Data was sourced from patients within the Jefferson University Hospital’s Cardiology EMR system by searching for contrast and vegetation from January 1st, 2013 – January 1st, 2018. Fifteen patients were not given contrast, whereas 21 patients were given contrast via agitated saline (n=16) or an ultrasound contrast agent (n=5). All patients received an echocardiogram after blood cultures confirmed an infection, but before resolution of infection (defined by negative blood cultures). A student’s t-test was used for analyses. Results - The study population was heterogeneous in terms of sex (67.5% male) and race (70% Caucasian, 25% African American, and 5% Asian), with an average age of 51±20 years, and an average BMI of 29.65±7.43 in the contrast group and 27.67±3.16 in the non-contrast group (p=0.37). Following ultrasound, no patients had documented stroke, pulmonary embolism, or systemic blood clot, which physicians could have attributed to a thrombus resulting from dislodging of bacterial vegetation. Overall, blood cultures did not clear faster in patients receiving CEUS compared to those undergoing standard echocardiography, (2.63±2.69 days vs. 1.34 ±1.11 days, p=0.09). CEUS also did not shorten the admission length in patients with IE, (16.9±7.7 days vs. 19.9±12.1 days; p=0.36). Conclusion - Based on this limited sample size, patients who underwent CEUS did not have a different prognosis when compared to patients who received a non-contrast echocardiogram

Elastic effects of vacancies in strontium titanate: Short- and long-range strain fields, elastic dipole tensors, and chemical strain

We present a study of the local strain effects associated with vacancy defects in strontium titanate and report the first calculations of elastic dipole tensors and chemical strains for point defects in perovskites. The combination of local and long-range results will enable determination of x-ray scattering signatures that can be compared with experiments. We find that the oxygen vacancy possesses a special property -- a highly anisotropic elastic dipole tensor which almost vanishes upon averaging over all possible defect orientations. Moreover, through direct comparison with experimental measurements of chemical strain, we place constraints on the possible defects present in oxygen-poor strontium titanate and introduce a conjecture regarding the nature of the predominant defect in strontium-poor stoichiometries in samples grown via pulsed laser deposition. Finally, during the review process, we learned of recent experimental data, from strontium titanate films deposited via molecular-beam epitaxy, that show good agreement with our calculated value of the chemical strain associated with strontium vacancies.Comment: 14 pages, 11 figures, 4 table

Analisis Kinerja Guru yang Merangkap sebagai Pengelola Perpustakaan ( Studi Kasus di SMA Negeri 1, 5, 7, dan 8 di Lingkungan Surakarta )

Pengelola Perpustakaan di SMA Negeri 1, 5, 7, dan 8 Surakarta yang mendapat tugas tambahan untuk mengelola perpustakaan sekolah masing-masing. Penelitian dilakukan di Perpustakaan Sekolah SMA Negeri 1, 5, 7, dan 8 di lingkungan Surakarta dengan menggunakan metode kualitatif. Pengumpulan data dilakukan dengan wawancara. Jumlah informannya sebanyak 5 orang, yang terpilih dengan menggunakan teknik pengambilan sampel Purposive Sampling. Hasil yang diperoleh dari penelitian ini bahwa para guru pustakawan di SMA Negeri 1, 5, 7, dan 8 Surakarta merasa terganggu ketika menjalani profesinya sebagai guru dan pengelola perpustakaan. Namun begitu pelaksanaan tugas sebagai guru yang merangkap sebagai pengelola perpustakaan perlu adanya manajemen sumber daya manusia, sehingga dalam menjalankan tugas tidak saling mengganggu satu sama lain, antara lain: pembagian jadwal mengajar dan mengelola perpustakaan

Engineering geology and tunnelling in the Limmo Peninsula, East London

The Limmo Peninsula site has some of the most complex geology of London's Crossrail project and was the launching point for four tunnel boring machines (TBMs) to allow construction of Crossrail's eastern running tunnels. It is located in East London, c. 2 km east of the Canary Wharf business district, adjacent to the River Lea. It consists of a ventilation shaft, an auxiliary shaft, two sprayed concrete lining (SCL) tunnels interconnecting the shafts and four SCL adits for assisting in the launching of the TBMs. As part of the design requirements, some geological formations had to be depressurized from surface wells. The site is geologically complex: it is in the vicinity of a drift-filled hollow and it is located within the area of influence of several tectonic features. A geological ground model developed from important new information obtained during the design stage ground investigations and from direct observations conducted during construction stages reveals an inverted transtensional flower structure (i.e. it is now a transpressional restraining bend). Of special interest are the unusually low values of undrained shear strength of the London Clay associated with the tectonic setting