Neonatal, atopic and infectious disease outcomes among children born to mothers with latent tuberculosis infection

Amrita Dosanjh,1 Jamie Eridon,2 James Koziol31Department of Pediatrics, Scripps Hospital, San Diego, CA, USA; 2University of California, San Diego, School of Medicine, San Diego, CA, USA; 3Department of Biostatistics, Molecular and Experimental Medicine, The Scripps Research Institute, La Jolla, CA, USAAbstract: Exposure to microbes may result in maternal immune responses that can affect fetal immune development. Several lines of evidence have shown that mycobacterial antigens can change the onset of atopic disease. We hypothesized that infants born to mothers with a positive tuberculosis (TB) test and a negative chest radiograph, may exhibit differential development of atopic disease during early childhood. The study was designed as a case control study. Birth records for infants born to untreated mothers with a positive TB skin test (TST), as defined by &ge;10 mm induration were reviewed (n = 145 cases) and compared to a randomly selected unmatched control cohort of 46 women with a negative TST who delivered during the same time period at Scripps Hospital in San Diego, CA, USA. Childhood outcome parameters reviewed were: (1) the onset of physician diagnosed asthma; (2) lower respiratory tract infection (LRTI) with wheezing, latent tuberculosis infection/wheezing diagnosed on physical examination; (3) nonsurgical hospitalization; (4) atopic disease (eye/skin/nasal-sinus disease); (5) infections: ear, LRTI, sinus. LRTI was defined as an infection of the lower airways, eg, pneumonia. Outcomes at the end of years 1, 2, and 3&ndash;5 years combined were analyzed. Fisher exact test, Chi-square analysis or Poisson regression analysis were used as appropriate and a P-value of <0.05 was defined as significant. The cases and controls had similar birth weights, gestational ages, maternal ages: 3.34 versus 3.35 kg; 38.3 versus 39.2 weeks, 27.4 versus 26 years (P = non-significant). The childhood outcome parameters of the new onset of asthma was significantly higher than controls by age 2 years, but not at other ages studied, based on available clinic follow up data (P = 0.02). There was a difference in the risk for lung infection at age 2 and 3&ndash;5 years (P < 0.0001). There were no differences in the other outcome parameters studied (P = ns). There were no cases of infants with a positive TST, maternal Bacille Calmette-Guerin vaccination or active maternal TB, based on our study findings. There was a higher occurrence of asthma and lung infections at age 2 years among controls (P = 0.02). Our study defines for the first time a possible influence of maternal latent TB infection on fetal and childhood illness.Keywords: tuberculosis, fetal immune development, pediatric asthm

Metastable phase formation in nickel-aluminum alloys during ion beam mixing

Phase transformations induced by ion beam mixing of nickel-aluminum alloys with 500 keV krypton ions have been investigated over a range of temperatures, compositions, and initial structures. Samples were formed by alternate evaporation of layers of nickel and aluminum. A portion of these samples was subsequently annealed to form intermetallic compounds. Irradiations were performed at both room temperature and 80/sup 0/K using the 2 MV ion accelerator at ANL. Phase transformations were observed during both in-situ irradiations in the High Voltage Electron Microscope at Argonne and also in subsequent electron diffraction analysis of an array of irradiated samples. Metastable phases formed include disordered crystalline structures, an amorphous structure, and a hexagonal close-packed structure. These phase structures were modeled using the embedded atom method to compute energies of transition from stable to metastable states. The effects of both thermodynamics and kinetics on metastable phase formation are evaluated

Phase transformations in nickel-aluminum alloys during ion beam mixing

The effect of ion beam mixing of nickel-aluminum alloys with 500 keV krypton ions has been investigated over a range of temperature, composition, ion dose, and post-irradiation thermal treatments. Samples were formed by alternate evaporation of layers of aluminum and nickel. A portion of these samples was subsequently annealed to form intermetallic compounds. Irradiations were performed at both room temperature and 80/sup 0/K using the 2MV ion accelerator at Argonne National Laboratory. Phase transformations were observed during both in situ irradiations in the High Voltage Electron Microscope (HVEM) at Argonne, and also in subsequent analysis of an array of irradiated samples. Electron diffraction indicates the presence of metastable crystalline structures not present in the conventional nickel-aluminum phase diagram. Transformations occur at doses as low as 5 x 10/sup 14/ cm/sup -2/ and continue to develop as the irradiation progresses up to 2 x 10/sup 16/ cm/sup -2/. Layer mixing is followed through Rutherford Backscattering analysis. Samples are also checked with x-rays and Electron Energy Loss Spectroscopy (EELS). A thermodynamic argument is presented to explain the phase transformations in terms of movements on a free energy diagram. This analysis explains the interesting paradox concerning the radiation hardness of the NiAl phase and the amorphous structure of mixed Ni-50% Al layers

Analysis of the TMI-2 source range detector response

In the first few hours following the TMI-2 accident large variations (factors of 10-100) in the source range (SR) detector response were observed. The purpose of this analysis was to quantify the various effects which could contribute to these large variations. The effects evaluated included the transmission of neutrons and photons from the core to detector and the reduction in the multiplication of the Am-Be startup sources, and subsequent reduction in SR detector response, due to core voiding. A one-dimensional ANISN slab model of the TMI-2 core, core externals, pressure vessel and containment has been constructed for calculation of the SR detector response and is presented

On pandemics and pivots: A COVID-19 reflection on envisioning the future of medical education

The required adjustments precipitated by the coronavirus disease 2019 crisis have been challenging, but also represent a critical opportunity for the evolution and potential disruptive and constructive change of medical education. Given that the format of medical education is not fixed, but malleable and in fact must be adaptable to societal needs through ongoing reflexivity, we find ourselves in a potentially transformative learning phase for the field. An Association for Medical Education in Europe ASPIRE Academy group of 18 medical educators from seven countries was formed to consider this opportunity, and identified critical questions for collective reflection on current medical education practices and assumptions, with the attendant challenge to envision the future of medical education. This was achieved through online discussion as well as asynchronous collective reflections by group members. Four major themes and related conclusions arose from this conversation: Why we teach: the humanitarian mission of medicine should be reinforced; what we teach: disaster management, social accountability and embracing an environment of complexity and uncertainty should be the core; how we teach: open pathways to lean medical education and learning by developing learners embedded in a community context; and whom we teach: those willing to take professional responsibility. These collective reflections provide neither fully matured digests of the challenges of our field, nor comprehensive solutions; rather they are offered as a starting point for medical schools to consider as we seek to harness the learning opportunities stimulated by the pandemic