Current AATS guidelines on surgical treatment of infective endocarditis

© Annals of Cardiothoracic Surgery. The 2016 American Association for Thoracic Surgery (AATS) guidelines for surgical treatment of infective endocarditis (IE) are question based and address questions of specific relevance to cardiac surgeons. Clinical scenarios in IE are often complex, requiring prompt diagnosis, early institution of antibiotics, and decision-making related to complications, including risk of embolism and timing of surgery when indicated. The importance of an early, multispecialty team approach to patients with IE is emphasized. Management issues are divided into groups of questions related to indications for and timing of surgery, pre-surgical work-up, preoperative antibiotic treatment, surgical risk assessment, intraoperative management, surgical management, surveillance, and follow up. Standard indications for surgery are severe heart failure, severe valve dysfunction, prosthetic valve infection, invasion beyond the valve leaflets, recurrent systemic embolization, large mobile vegetations, or persistent sepsis despite adequate antibiotic therapy for more than 5-7 days. The guidelines emphasize that once an indication for surgery is established, the operation should be performed as soon as possible. Timing of surgery in patients with strokes and neurologic deficits require close collaboration with neurological services. In surgery infected and necrotic tissue and foreign material is radically debrided and removed. Valve repair is performed whenever possible, particularly for the mitral and tricuspid valves. When simple valve replacement is required, choice of valve-mechanical or tissue prosthesis-should be based on normal criteria for valve replacement. For patients with invasive disease and destruction, reconstruction should depend on the involved valve, severity of destruction, and available options for cardiac reconstruction. For the aortic valve, use of allograft is still favored

Early introduction of fish decreases the risk of eczema in infants

BACKGROUND: Atopic eczema in infants has increased in western societies. Environmental factors and the introduction of food may affect the risk of eczema. AIMS: To investigate the prevalence of eczema among infants in western Sweden, describe patterns of food introduction and assess risk factors for eczema at 1 year of age. METHODS: Data were obtained from a prospective, longitudinal cohort study of infants born in western Sweden in 2003; 8176 families were randomly selected and, 6 months after the infant\u27s birth, were invited to participate and received questionnaires. A second questionnaire was sent out when the infants were 12 months old. Both questionnaires were completed and medical birth register data were obtained for 4921 infants (60.2% of the selected population). RESULTS: At 1 year of age, 20.9% of the infants had previous or current eczema. Median age at onset was 4 months. In multivariable analysis, familial occurrence of eczema, especially in siblings (OR 1.87; 95% confidence interval (CI) 1.50 to 2.33) or the mother (OR 1.54; 95% CI 1.30 to 1.84), remained an independent risk factor. Introducing fish before 9 months of age (OR 0.76; 95% CI 0.62 to 0.94) and having a bird in the home (OR 0.35; 95% CI 0.17 to 0.75) were beneficial. CONCLUSIONS: One in five infants suffer from eczema during the first year of life. Familial eczema increased the risk, while early fish introduction and bird keeping decreased it. Breast feeding and time of milk and egg introduction did not affect the risk

Clostridium difficile infection after cardiac surgery: Prevalence, morbidity, mortality, and resource utilization

ObjectiveDespite increasing efforts to prevent infection, the prevalence of hospital-associated Clostridium difficile infections (CDI) is increasing. Heightened awareness prompted this study of the prevalence and morbidity associated with CDI after cardiac surgery.MethodsA total of 22,952 patients underwent cardiac surgery at Cleveland Clinic from January 2005 to January 2011. CDI was diagnosed by enzyme immunoassay for toxins and, more recently, polymerase chain reaction (PCR) testing. Hospital outcomes and long-term survival were compared with those of the remaining population in propensity-matched groups.ResultsOne hundred forty-five patients (0.63%) tested positive for CDI at a median of 9 days postoperatively, 135 by enzyme immunoassay and 11 by PCR. Its prevalence more than doubled over the study period. Seventy-seven patients (48%) were transfers from outside hospitals. Seventy-three patients (50%) were exposed preoperatively to antibiotics and 79 (56%) to proton-pump inhibitors. Patients with CDI had more baseline comorbidities, more reoperations, and received more blood products than patients who did not have CDI. Presenting symptoms included diarrhea (107; 75%), distended abdomen (48; 34%), and abdominal pain (27; 19%). All were treated with metronidazole or vancomycin. Sixteen patients (11%) died in hospital, including 5 of 10 who developed toxic colitis; 3 of 4 undergoing total colectomy survived. Among matched patients, those with CDI had more septicemia (P < .0001), renal failure (P = .0002), reoperations (P < .0001), prolonged postoperative ventilation (P < .0001), longer hospital stay (P < .0001), and lower 3-year survival, 52% versus 64% (P = .03), than patients who did not have CDI.ConclusionsAlthough rare, the prevalence of CDI is increasing, contributing importantly to morbidity and mortality after cardiac surgery. If toxic colitis develops, mortality is high, but colectomy may be lifesaving

Deltagardriven forskning – Växtodlingsgruppen, resultat och utvärdering av arbetet under 1998 till 2001

Då arbetet i växtodlingsgruppen påbörjades var förväntningarna på deltagardriven forskning att den sammanlagda erfarenheten hos lantbrukare, forskare och rådgivare skulle bidra till utförandet av relevanta gårdsförsök. Lantbrukarna önskade dessutom sträva efter att öka och vidarebefordra den kunskap som fanns i gruppen, samt att få etablerade forskare att undersöka områden som praktikerna upplever som viktiga och svåra. Redan i initialskedet slog växtodlingsgruppen fast att arbeta för att gemensamt identifiera problem och använda relevanta forskningsmetoder på gårdsnivå. Syftet var att genom olika odlingsåtgärder kunna förbättra förutsättningarna för ekologisk växtodling. Ett mål var att finna effektiva metoder för optimal växtnäringstillförsel i ekologisk produktion på lerjordar i Mälardalen. För närvarande saknas bra underlag för hur kväveleveransen varierar under säsongen framförallt till stråsäd. Detta påverkar i sin tur både skördeutfall, proteinhalt, miljöbelastning och ekonomi. Ett annat mål var att kunna reglera ogräsförekomsten, främst kvickrot och tistel, på ett effektivt sätt i växtföljden. Motivationen för lantbrukarna har under projektets gång varit att främja det ekologiska lantbruket som helhet. Detta har möjliggjorts genom erfarenhetsutbyte på gruppträffar kombinerat med gårdsbesök där lantbrukarnas intressen och frågeställningar har varit drivande. Växtodlingsgruppen har på så vis initialt bidragit till ett lokalt utvecklingsarbete och en uppbyggnad av ökat kunnande inom ekologiskt växtodling

Model-Checking Real-Time Control Programs. Verifying LEGO Mindstorms Systems Using UPPAAL

In this paper, we present a method for automatic verificationof real-time control programs running on LEGO RCX bricks using the verification tool UPPAAL. The controlprograms, consisting of a number of tasks running concurrently,are automatically translated into the timed automatamodel of UPPAAL. The fixed scheduling algorithmused by the LEGO RCX processor is modeled in UPPAAL,and supply of similar (sufficient) timed automatamodels for the environment allows analysis of the overallreal-time system using the tools of UPPAAL. To illustrateour techniques we have constructed, modeled and verifieda machine for sorting LEGO bricks by color

Uncertainty quantification for kinetic models in socio-economic and life sciences

Kinetic equations play a major rule in modeling large systems of interacting particles. Recently the legacy of classical kinetic theory found novel applications in socio-economic and life sciences, where processes characterized by large groups of agents exhibit spontaneous emergence of social structures. Well-known examples are the formation of clusters in opinion dynamics, the appearance of inequalities in wealth distributions, flocking and milling behaviors in swarming models, synchronization phenomena in biological systems and lane formation in pedestrian traffic. The construction of kinetic models describing the above processes, however, has to face the difficulty of the lack of fundamental principles since physical forces are replaced by empirical social forces. These empirical forces are typically constructed with the aim to reproduce qualitatively the observed system behaviors, like the emergence of social structures, and are at best known in terms of statistical information of the modeling parameters. For this reason the presence of random inputs characterizing the parameters uncertainty should be considered as an essential feature in the modeling process. In this survey we introduce several examples of such kinetic models, that are mathematically described by nonlinear Vlasov and Fokker--Planck equations, and present different numerical approaches for uncertainty quantification which preserve the main features of the kinetic solution.Comment: To appear in "Uncertainty Quantification for Hyperbolic and Kinetic Equations

The event generator DECAY4 for simulation of double beta processes and decay of radioactive nuclei

The computer code DECAY4 is developed to generate initial energy, time and angular distributions of particles emitted in radioactive decays of nuclides and nuclear (atomic) deexcitations. Data for description of nuclear and atomic decay schemes are taken from the ENSDF and EADL database libraries. The examples of use of the DECAY4 code in several underground experiments are described.Comment: 8 pages, 1 fi

Integral representation of the linear Boltzmann operator for granular gas dynamics with applications

We investigate the properties of the collision operator associated to the linear Boltzmann equation for dissipative hard-spheres arising in granular gas dynamics. We establish that, as in the case of non-dissipative interactions, the gain collision operator is an integral operator whose kernel is made explicit. One deduces from this result a complete picture of the spectrum of the collision operator in an Hilbert space setting, generalizing results from T. Carleman to granular gases. In the same way, we obtain from this integral representation of the gain operator that the semigroup in L^1(\R \times \R,\d \x \otimes \d\v) associated to the linear Boltzmann equation for dissipative hard spheres is honest generalizing known results from the first author.Comment: 19 pages, to appear in Journal of Statistical Physic

High resolution spectroscopy of Ne II emission from young stellar objects

Constraining the spatial and thermal structure of the gaseous component of circumstellar disks is crucial to understand star and planet formation. Models predict that the [Ne II] line at 12.81 {\mu}m detected in young stellar objects with Spitzer traces disk gas and its response to high energy radiation, but such [Ne II] emission may also originate in shocks within powerful outflows. To distinguish between these potential origins for mid-infrared [Ne II] emission and to constrain disk models, we observed 32 young stellar objects using the high resolution (R~30000) mid-infrared spectrograph VISIR at the VLT. We detected the 12.81 {\mu}m [Ne II] line in 12 objects, tripling the number of detections of this line in young stellar objects with high spatial and spectral resolution spectrographs. We obtain the following main results: a) In Class I objects the [Ne II] emission observed from Spitzer is mainly due to gas at a distance of more than 20-40 AU from the star, where neon is, most likely, ionized by shocks due to protostellar outflows. b) In transition and pre-transition disks, most of the emission is confined to the inner disk, within 20-40 AU from the central star. c) Detailed analysis of line profiles indicates that, in transition and pre-transition disks, the line is slightly blue-shifted (2-12 km s{^-1}) with respect to the stellar velocity, and the line width is directly correlated with the disk inclination, as expected if the emission is due to a disk wind. d) Models of EUV/X-ray irradiated disks reproduce well the observed relation between the line width and the disk inclination, but underestimate the blue-shift of the line.Comment: 35 pages, 7 figures, accepted for publication on Ap