Clinical features and predictors of mortality in admitted patients with community- and hospital-acquired legionellosis: A Danish historical cohort study

<p>Abstract</p> <p>Background</p> <p>Legionella is a common cause of bacterial pneumonia. Community-acquired [CAL] and hospital-acquired legionellosis [HAL] may have different presentations and outcome. We aimed to compare clinical characteristics and examine predictors of mortality for CAL and HAL.</p> <p>Methods</p> <p>We identified hospitalized cases of legionellosis in 4 Danish counties from January 1995 to December 2005 using the Danish national surveillance system and databases at departments of clinical microbiology. Clinical and laboratory data were retrieved from medical records; vital status was obtained from the Danish Civil Registration System. We calculated 30- and 90-day case fatality rates and identified independent predictors of mortality using logistic regression analyses.</p> <p>Results</p> <p>We included 272 cases of CAL and 60 cases of HAL. Signs and symptoms of HAL were less pronounced than for CAL and time from in-hospital symptoms to legionellosis diagnosis was shorter for CAL than for HAL (5.5 days vs. 12 days p < 0.001). Thirty-day case fatality was 12.9% for CAL and 33.3% for HAL; similarly 90-day case fatalities in the two groups were 15.8% and 55.0%, respectively. In a logistic regression analysis (excluding symptoms and laboratory tests) age >65 years (OR = 2.6, 95% CI: 1.1-5.9) and Charlson comorbidty index ≥2 (OR = 2.7, 95% CI: 1.1-6.5) were associated with an increased risk of death in CAL. We identified no statistically significant predictors of 30-day mortality in HAL.</p> <p>Conclusions</p> <p>Signs and symptoms were less pronounced in HAL compared to CAL. Conversely, 30-day case fatality was almost 3 times higher. Clinical awareness is important for the timely diagnosis and treatment especially of HAL. There is a need for further studies of prognostic factors in order to improve the therapeutic approach to legionellosis and potentially reduce mortality.</p

A Qualified Kolmogorovian Account of Probabilistic Contextuality

We describe a mathematical language for determining all possible patterns of contextuality in the dependence of stochastic outputs of a system on its deterministic inputs. The central notion is that of all possible couplings for stochastically unrelated outputs indexed by mutually incompatible values of inputs. A system is characterized by a pattern of which outputs can be "directly influenced" by which inputs (a primitive relation, hypothetical or normative), and by certain constraints imposed on the outputs (such as Bell-type inequalities or their quantum analogues). The set of couplings compatible with these constraints represents a form of contextuality in the dependence of outputs on inputs with respect to the declared pattern of direct influences.Comment: Lecture Notes in Computer Science 8369, 201-212 (2014

Re-presenting the Paralympics: (contested) philosophies, production practices and the hypervisibility of disability

Studies that have engaged para-sport broadcasting, particularly through a narrative lens, have almost exclusively relied on textual and/or content analysis of the Paralympic Games as the source of cultural critique. We know far less about the decisions taken inside Paralympic broadcasters that have led to such representations. In this study – based on interviews with senior production and promotion staff at the UK’s Paralympic broadcaster, Channel 4 – we provide the first detailed examination of mediated para-sport from this vantage point. We explore the use of promotional devices such as athletes’ backstories – the “Hollywood treatment” – to both hook audiences and serve as a vehicle for achieving its social enterprise mandate to change public attitudes toward disability. In so doing, we reveal myriad tensions that coalesce around representing the Paralympics; with respect to the efforts made to balance the competing goals of key stakeholders and a stated desire to make the Paralympics both a commercial and socially progressive success

Adipocyte-specific protein tyrosine phosphatase 1B deletion increases lipogenesis, adipocyte cell size and is a minor regulator of glucose homeostasis

Peer reviewedPublisher PD

Towards an empirical test of realism in cognition

We review recent progress in designing an empirical test of (temporal) realism in cognition. Realism in this context is the property that cognitive variables always have well defined (if possibly unknown) values at all times. We focus most of our attention in this contribution on discussing the exact notion of realism that is to be tested, as we feel this issue has not received enough attention to date. We also give a brief outline of the empirical test, including some comments on an experimental realisation, and we discuss what we should conclude from any purported experimental ‘disproof’ of realism. This contribution is based on Yearsley and Pothos (2014)

Pharmacokinetic targeting of intravenous busulfan reduces conditioning regimen related toxicity following allogeneic hematopoietic cell transplantation for acute myelogenous leukemia

Optimal conditioning therapy for hematopoietic cell transplantation (HCT) in acute myelogenous leukemia (AML) remains undefined. We retrospectively compared outcomes of a consecutive series of 51 AML patients treated with oral busulfan (1 mg/kg every 6 hours for 4 days) and cyclophosphamide (60 mg/kg IV × 2 days) - (Bu/Cy) with 100 consecutive AML patients treated with pharmacokinetic targeted IV busulfan (AUC < 6000 μM/L*min per day × 4 days) and fludarabine (40 mg/m2 × 4 days) - (t-IV Bu/Flu). The Bu/Cy and t-IV Bu/Flu groups significantly differed according to donor relation, stem cell source, aGVHD prophylaxis, remission status, primary vs. secondary disease, median age, and % blasts prior to HCT (p < 0.01 for each). Conditioning with t-IV Bu/Flu reduced early toxicity including idiopathic pneumonia syndrome (IPS) and hepatic veno-occlusive disease (VOD). Additionally, the trajectory of early NRM (100 day: 16% vs. 3%, and1 year: 25% vs. 15% for Bu/Cy and t-IV Bu/Flu, respectively) favored t-IV Bu/Flu. Grade II-IV aGVHD (48% vs. 82%, p < 0.0001), as well as moderate/severe cGVHD (7% vs. 40%, p < 0.0001) differed between the Bu/Cy and t-IV Bu/Flu groups, due to the predominance of peripheral blood stem cells in the t-IV Bu/Flu group. Pharmacokinetic targeting of intravenous busulfan in combination with fludarabine is associated with reduced conditioning regimen related toxicity compared to oral busulfan and cyclophosphamide. However, multivariable analysis did not demonstrate significant differences in overall survival (p = 0.78) or non-relapse mortality (p = 0.6) according to conditioning regimen delivered

Leaf-cutting ant fungi produce cell wall degrading pectinase complexes reminiscent of phytopathogenic fungi

<p>Abstract</p> <p>Background</p> <p>Leaf-cutting (attine) ants use their own fecal material to manure fungus gardens, which consist of leaf material overgrown by hyphal threads of the basidiomycete fungus <it>Leucocoprinus gongylophorus </it>that lives in symbiosis with the ants. Previous studies have suggested that the fecal droplets contain proteins that are produced by the fungal symbiont to pass unharmed through the digestive system of the ants, so they can enhance new fungus garden growth.</p> <p>Results</p> <p>We tested this hypothesis by using proteomics methods to determine the gene sequences of fecal proteins in <it>Acromyrmex echinatior </it>leaf-cutting ants. Seven (21%) of the 33 identified proteins were pectinolytic enzymes that originated from the fungal symbiont and which were still active in the fecal droplets produced by the ants. We show that these enzymes are found in the fecal material only when the ants had access to fungus garden food, and we used quantitative polymerase chain reaction analysis to show that the expression of six of these enzyme genes was substantially upregulated in the fungal gongylidia. These unique structures serve as food for the ants and are produced only by the evolutionarily advanced garden symbionts of higher attine ants, but not by the fungi reared by the basal lineages of this ant clade.</p> <p>Conclusions</p> <p>Pectinolytic enzymes produced in the gongylidia of the fungal symbiont are ingested but not digested by <it>Acromyrmex </it>leaf-cutting ants so that they end up in the fecal fluid and become mixed with new garden substrate. Substantial quantities of pectinolytic enzymes are typically found in pathogenic fungi that attack live plant tissue, where they are known to breach the cell walls to allow the fungal mycelium access to the cell contents. As the leaf-cutting ant symbionts are derived from fungal clades that decompose dead plant material, our results suggest that their pectinolytic enzymes represent secondarily evolved adaptations that are convergent to those normally found in phytopathogens.</p

Visual acuity and foveal thickness after vitrectomy for macular edema associated with branch retinal vein occlusion: a case series

Abstract Background The mechanism by which vitrectomy improves macular edema in patients with branch retinal vein occlusion remains unclear, although intraocular levels of vascular endothelial growth factor have been suggested to influence the visual prognosis and macular edema. Methods A series of 54 consecutive patients (54 eyes) with branch retinal vein occlusion was studied prospectively. All patients underwent pars plana vitrectomy for treatment of macular edema. Best corrected visual acuity and retinal thickness (examined by optical coherence tomography) were assessed before and after surgery. The level of vascular endothelial growth factor in vitreous fluid harvested at operation was determined. Patients were followed for at least 6 months postoperatively. Results Both the visual acuity and the retinal thickness showed significant improvement at 6 months postoperatively (P = 0.0002 and P Conclusions These results suggest that the vitreous level of vascular endothelial growth factor might influence the visual prognosis and the response of macular edema to vitrectomy in patients with branch retinal vein occlusion.</p

Towards a realistic interpretation of quantum mechanics providing a model of the physical world

It is argued that a realistic interpretation of quantum mechanics is possible and useful. Current interpretations, from Copenhagen to many worlds are critically revisited. The difficulties for intuitive models of quantum physics are pointed out and possible solutions proposed. In particular the existence of discrete states, the quantum jumps, the alleged lack of objective properties, measurement theory, the probabilistic character of quantum physics, the wave-particle du- ality and the Bell inequalities are analyzed. The sketch of a realistic picture of the quantum world is presented. It rests upon the assump- tion that quantum mechanics is a stochastic theory whose randomness derives from the existence of vacuum fields. They correspond to the vacuum fluctuations of quantum field theory, but taken as real rather than virtual.Comment: 43 pages, paper throughout revised and somewhat enlarged, sections on the Bell inequalities and on the sketch of a picture of the quantum world rewritten, new references adde