Recommendation for the Enrollment of Hydrocephalus Patients in Children\u27s Special Health Care Services

Recommendation for the Enrollment of Hydrocephalus Patients in Children\u27s Special Health Care Services Background: Pediatric hydrocephalus is a devastating and costly disease. The mainstay of treatment is surgical shunting of cerebrospinal fluid. These shunts fail at a high rate. The relationship between clinical decision making and shunt failure is poorly understood and multifactorial. Treatment paradigms have changed little since the 1980s. In order to investigate factors that affect outcomes, we have established the Wayne State University shunt biobank. Methods: Children\u27s Hospital of Michigan is one of the participating centers in our biobank and has enrolled 73 patients from whom we have collected 115 shunt samples and 40 CSF samples. Samples were directly obtained from the OR. CSF samples were kept cold until they were spun down and put on liquid nitrogen. The shunt samples were fixed in PFA and stored in PBS+ azide. Clinical data was taken from electronic medical records and maintained in a REDCap database under coded identifiers. Regression analysis was performed to determine factors affecting number of revisions. Results: Patient age and Medicaid usage were found to be significant predictors of the number revisions; patient weight and the median income of the family\u27s zip code were not significant predictors. The number of revisions also significantly varied by type of shunt system used. Conclusion: Many studies have used median income of a patient\u27s zip code as a stand in for socioeconomic status, our study found Medicaid enrollment to be a more significant predictor than income. This variable is commonly available in patient EMRs and merits further investigation for its usage in larger cohorts. Moreover, given that the Michigan Department of Health and Human Services has a free program to provide specialist care to children with a number of congenital conditions, among which hydrocephalus is included, it is our recommendation that hospital centers make efforts to enroll their patients in this program as it was associated with better outcomes than Medicaid. Unsurprisingly age was a very significant predictor of the number of shunt failures. The relationship between number of shunt revisions and shunt system type needs further examination to yield prognostic insight, as most patients are only placed on non-standard shunt systems after experiencing multiple failures with the standard ventriculoperitoneal shunt

Characterization of a multicenter pediatric-hydrocephalus shunt biobank

BACKGROUND: Pediatric hydrocephalus is a devastating and costly disease. The mainstay of treatment is still surgical shunting of cerebrospinal fluid (CSF). These shunts fail at a high rate and impose a significant burden on patients, their families and society. The relationship between clinical decision making and shunt failure is poorly understood and multifaceted, but catheter occlusion remains the most frequent cause of shunt complications. In order to investigate factors that affect shunt failure, we have established the Wayne State University (WSU) shunt biobank. METHODS: To date, four hospital centers have contributed various components of failed shunts and CSF from patients diagnosed with hydrocephalus before adulthood. The hardware samples are transported in paraformaldehyde and transferred to phosphate-buffered saline with sodium azide upon deposit into the biobank. Once in the bank, they are then available for study. Informed consent is obtained by the local center before corresponding clinical data are entered into a REDCap database. Data such as hydrocephalus etiology and details of shunt revision history. All data are entered under a coded identifier. RESULTS: 293 shunt samples were collected from 228 pediatric patients starting from May 2015 to September 2019. We saw a significant difference in the number of revisions per patient between centers (Kruskal-Wallis H test, p value \u3c 0.001). The leading etiology at all centers was post-hemorrhagic hydrocephalus, a fisher\u27s exact test showed there to be statistically significant differences in etiology between center (p = 0.01). Regression showed age (p \u3c 0.01), race (p = 0.038) and hospital-center (p \u3c 0.001) to explain significant variance in the number of revisions. Our model accounted for 31.9% of the variance in revisions. Generalized linear modeling showed hydrocephalus etiology (p \u3c 0.001), age (p \u3c 0.001), weight and physician (p \u3c 0.001) to impact the number of ventricular obstructions. CONCLUSION: The retrospective analysis identified that differences exist between currently enrolled centers, although further work is needed before clinically actionable recommendations can be made. Moreover, the variables collected from this chart review explain a meaningful amount of variance in the number of revision surgeries. Future work will expand on the contribution of different site-specific and patient-specific factors to identify potential cause and effect relationships

Electronic absorption studies on CO²⁺ doped lithium phosphate glasses

331-335The optical absorption studies on cobalt doped binary lithium phosphate glasses yLi2O-(100-y)P2O5 reveal a mixed octahedral and tetrahedral coordination for the cation sites through the characteristic bands 4T1 (F) → 4T1 (P) at ~530 nm and 4A­2 (F) → 4T1 (P) at ~580 nm. The glasses show an increase in the number of tetrahedral sites as the modifier concentration increases which may be attributed to the increased optical basicity of the glasses. An enhancement in the ionic conductivity with increase in the dopant (Co2+) concentration is observed in the glasses which may be due to Co2+ entering Li+ sites resulting in the generation of cation vacancies

The Validity of the ROX Index and APACHE II in Predicting Early, Late, and Non-Responses to Non-Invasive Ventilation in Patients with COVID-19 in a Low-Resource Setting

The use of the Ratio of Oxygen Saturation (ROX) index to predict the success of high-flow nasal oxygenation (HFNO) is well established. The ROX can also predict the need for intubation, mortality, and is easier to calculate compared with APACHE II. In this prospective study, the primary aim is to compare the ROX (easily administered in resource limited setting) to APACHE II for clinically relevant outcomes such as mortality and the need for intubation. Our secondary aim was to identify thresholds for the ROX index in predicting outcomes such as the length of ICU stay and failure of non-invasive respiratory support therapies and to assess the effectiveness of using the ROX (day 1 at admission, day 2, and day 3) versus Acute physiology and chronic health evaluation (APACHE) II scores (at admission) in patients with Coronavirus Disease 2019 (COVID-19) pneumonia and Acute Respiratory Distress Syndrome (ARDS) to predict early, late, and non-responders. After screening 208 intensive care unit patients, a total of 118 COVID-19 patients were enrolled, who were categorized into early (n = 38), late (n = 34), and non-responders (n = 46). Multinomial logistic regression, receiver operating characteristic (ROC), Multivariate Cox regression, and Kaplan–Meier analysis were conducted. Multinomial logistic regressions between late and early responders and between non- and early responders were associated with reduced risk of treatment failures. ROC analysis for early vs. late responders showed that APACHE II on admission had the largest area under the curve (0.847), followed by the ROX index on admission (0.843). For responders vs. non-responders, we found that the ROX index on admission had a slightly better AUC than APACHE II on admission (0.759 vs. 0.751). A higher ROX index on admission [HR (95% CI): 0.29 (0.13–0.52)] and on day 2 [HR (95% CI): 0.55 (0.34–0.89)] were associated with a reduced risk of treatment failure. The ROX index can be used as an independent predictor of early response and mortality outcomes to HFNO and NIV in COVID-19 pneumonia, especially in low-resource settings, and is non-inferior to APACHE II

MoS₂ Quantum Dots: Effect of Hydrogenation on Surface Stability and H₂S Release

We employ density functional theory to investigate effects of hydrogenation on the energetic stability and electronic properties of triangular MoS₂ nanoclusters with S-edges. Excess edge sulfur atoms relative to the bulk stoichiometry along the edges are passivated by hydrogen atoms. We find that the hydrogen coverage for maximum stability can be calculated by (<i>n</i> – 2)/2­(<i>n</i> – 1), where <i>n</i> is the number of S atoms along an edge. The energetics reveal a preference for the zigzag arrangement of adsorbed hydrogen atoms on the edges. Our calculations show vanishing HOMO–LUMO gaps mainly due to the presence of dangling bonds at the edges and can be considered metal-like. We find that the activation energy required to release H₂S lies in between 0.47 and 0.62 eV, and this value is in good agreement with the recently reported experimental value

Theoretical progresses in silicon anode substitutes for Lithium-ion batteries

Lithium-ion batteries (LIBs) have become the preferred power source for various consumer devices such as electronic gadgets due to their high energy density and extended cycle life. Generally, graphite is used as an anode material due to its flat voltage plateau and economic viability. However, in addition to graphite's limited capacity, certain difficulties limit its future perspectives for usage in sophisticated batteries. Silicon has rather shown remarkable potential as a replacement for graphite mainly because of its high theoretical gravimetric capacity. Moreover, the capability of inserting/de-inserting lithium ions is way more in Si than graphite in current LIBs. However, it is seen that after a few cycles of charge and discharge, they get vulnerable to pulverizing mainly due to expansion of volume which happens during the alloying/dealloying. These issues can be addressed by incorporating novel mechanisms. Improvements in the anodes can be brought by binders, additives, composite electrodes, nanomaterials, and electrolyte solvents, to name a few. The solid electrolyte interphase (SEI) is another factor that needs to be taken into account. This review aims to enhance the effectiveness of the anode using the methodologies mentioned and extend this very strategy to design futuristic anode materials for LIBs in the future

Activity of cefepime/zidebactam against MDR Escherichia coli isolates harbouring a novel mechanism of resistance based on four-amino-acid inserts in PBP3

BACKGROUND: Recent reports reveal the emergence of Escherichia coli isolates harbouring a novel resistance mechanism based on four-amino-acid inserts in PBP3. These organisms concomitantly expressed ESBLs or/and serine-/metallo-carbapenemases and were phenotypically detected by elevated aztreonam/avibactam MICs. OBJECTIVES: The in vitro activities of the investigational antibiotic cefepime/zidebactam and approved antibiotics (ceftazidime/avibactam, ceftolozane/tazobactam, imipenem/relebactam and others) were determined against E. coli isolates harbouring four-amino-acid inserts in PBP3. METHODS: Whole-genome sequenced E. coli isolates (n = 89) collected from a large tertiary care hospital in Southern India (n = 64) and from 12 tertiary care hospitals located across India (n = 25) during 2016-18, showing aztreonam/avibactam MICs ≥1 mg/L (≥4 times the aztreonam epidemiological cut-off) were included in this study. The MICs of antibiotics were determined using the reference broth microdilution method. RESULTS: Four-amino-acid inserts [YRIK (n = 30) and YRIN (n = 53)] were found in 83/89 isolates. Among 83 isolates, 65 carried carbapenemase genes [blaNDM (n = 39), blaOXA-48-like (n = 11) and blaNDM + blaOXA-48-like (n = 15)] and 18 isolates produced ESBLs/class C β-lactamases only. At least 16 unique STs were noted. Cefepime/zidebactam demonstrated potent activity, with all isolates inhibited at ≤1 mg/L. Comparator antibiotics including ceftazidime/avibactam and imipenem/relebactam showed limited activities. CONCLUSIONS: E. coli isolates concurrently harbouring four-amino-acid inserts in PBP3 and NDM are an emerging therapeutic challenge. Assisted by the PBP2-binding action of zidebactam, the cefepime/zidebactam combination overcomes both target modification (PBP3 insert)- and carbapenemase (NDM)-mediated resistance mechanisms in E. coli