Impact of time to appropriate therapy on mortality in patients with vancomycin-intermediate Staphylococcus aureus infection

Despite the increasing incidence of vancomycin-intermediate Staphylococcus aureus (VISA) infections, few studies have examined the impact of delay in receipt of appropriate antimicrobial therapy on outcomes in VISA patients. We examined the effects of timing of appropriate antimicrobial therapy in a cohort of patients with sterile-site methicillin-resistant S. aureus (MRSA) and VISA infections. In this single-center, retrospective cohort study, we identified all patients with MRSA or VISA sterile-site infections from June 2009 to February 2015. Clinical outcomes were compared according to MRSA/VISA classification, demographics, comorbidities, and antimicrobial treatment. Thirty-day all-cause mortality was modeled with Kaplan-Meier curves. Multivariate logistic regression analysis (MVLRA) was used to determine odds ratios for mortality. We identified 354 patients with MRSA (n = 267) or VISA (n = 87) sterile-site infection. Fifty-five patients (15.5%) were nonsurvivors. Factors associated with mortality in MVLRA included pneumonia, unknown source of infection, acute physiology and chronic health evaluation (APACHE) II score, solid-organ malignancy, and admission from skilled care facilities. Time to appropriate antimicrobial therapy was not significantly associated with outcome. Presence of a VISA infection compared to that of a non-VISA S. aureus infection did not result in excess mortality. Linezolid use was a risk for mortality in patients with APACHE II scores of ≥14. Our results suggest that empirical vancomycin use in patients with VISA infections does not result in excess mortality. Future studies should (i) include larger numbers of patients with VISA infections to confirm the findings presented here and (ii) determine the optimal antibiotic therapy for critically ill patients with MRSA and VISA infections

It's not what you play, it's how you play it: timbre affects perception of emotion in music.

Salient sensory experiences often have a strong emotional tone, but the neuropsychological relations between perceptual characteristics of sensory objects and the affective information they convey remain poorly defined. Here we addressed the relationship between sound identity and emotional information using music. In two experiments, we investigated whether perception of emotions is influenced by altering the musical instrument on which the music is played, independently of other musical features. In the first experiment, 40 novel melodies each representing one of four emotions (happiness, sadness, fear, or anger) were each recorded on four different instruments (an electronic synthesizer, a piano, a violin, and a trumpet), controlling for melody, tempo, and loudness between instruments. Healthy participants (23 young adults aged 18-30 years, 24 older adults aged 58-75 years) were asked to select which emotion they thought each musical stimulus represented in a four-alternative forced-choice task. Using a generalized linear mixed model we found a significant interaction between instrument and emotion judgement with a similar pattern in young and older adults (p < .0001 for each age group). The effect was not attributable to musical expertise. In the second experiment using the same melodies and experimental design, the interaction between timbre and perceived emotion was replicated (p < .05) in another group of young adults for novel synthetic timbres designed to incorporate timbral cues to particular emotions. Our findings show that timbre (instrument identity) independently affects the perception of emotions in music after controlling for other acoustic, cognitive, and performance factors

The Speech-to-Song Illusion Is Reduced in Speakers of Tonal (vs. Non-Tonal) Languages.

The speech-to-song illusion has attracted interest as a probe of the perceptual interface between language and music. One might anticipate differential speech-to-song effects in tonal vs. non-tonal languages, since these language classes differ importantly in the linguistic value they assign to tones. Here we addressed this issue for the first time in a cohort of 20 healthy younger adults whose native language was either tonal (Thai, Mandarin) or non-tonal (German, Italian) and all of whom were also fluent in English. All participants were assessed using a protocol designed to induce the speech-to-song illusion on speech excerpts presented in each of the five study languages. Over the combined participant group, there was evidence of a speech-to-song illusion effect for all language stimuli and the extent to which individual participants rated stimuli as "song-like" at baseline was significantly positively correlated with the strength of the speech-to-song effect. However, tonal and non-tonal language stimuli elicited comparable speech-to-song effects and no acoustic language parameter was found to predict the effect. Examining the effect of the listener's native language, tonal language native speakers experienced significantly weaker speech-to-song effects than non-tonal native speakers across languages. Both non-tonal native language and inability to understand the stimulus language significantly predicted the speech-to-song illusion. These findings together suggest that relative propensity to perceive prosodic structures as inherently linguistic vs. musical may modulate the speech-to-song illusion

Time relations and structural-stratigraphic patterns in ophiolite accretion, west central Klamath Mountains, California

New geochronological data and published structural and stratigraphic data show that two distinctly different ophiolitic assemblages formed in general proximity to one another at nearly the same time and were subsequently imbricated along a regional thrust zone. The Josephine ophiolite constitutes a complete oceanic crust and upper mantle sequence which lies within the western Jurassic belt of the Klamath province. Within the study area the Josephine ophiolite was formed by seafloor spreading at about 157 m.y. before present. It was immediately covered by a thin pelagic and hemipelagic sequence which grades into a thick flysch sequence, both of which comprise the Galice Formation. The Galice flysch was derived from volcanic arc and uplifted continental margin orogenic assemblages. A major nonvolcanic source for the Galice flysch appears to have been the western Paleozoic and Triassic belt of the Klamath province exposed to the east. Proximal volcanic arc activity migrated to the site of the Josephine-Galice section by 151 m.y. and is represented by numerous dikes and sills which intrude the ophiolite and Galice Formation. The Preston Peak ophiolite is a polygenetic assemblage consisting of (1) a pre-mid-Jurassic tectonitic peridotite-amphibolite substrate which represents disrupted and unroofed basement of the western Paleozoic and Triassic belt and (2) an upper mafic complex which was intruded through and constructed above the tectonite substrate at about 160 m.y. The mafic complex consists primarily of diabase hypabyssal rocks that are overlain by diabase-clast breccia and hemipelagic deposits. A major arc-plutonic complex was emplaced into the Preston Peak ophiolite in at least two pulses at 153 and 149 m.y. Major phases of this complex consist of wehrlite, gabbro, pyroxene diorite, and hornblende diorite. The Josephine ophiolite is interpreted as the remnants of interarc basin crust. The Preston Peak ophiolite is interpreted as either a primitive remnant arc complex or a rift edge facies for the Josephine interarc basin. The Galice Formation represents a submarine fan complex that was built on juvenile crust of the Josephine basin floor. During the time interval of 153 to 149 m.y. the locus or arc magmatism migrated to an area which included the interarc basin floor and the remnant arc or basin edge. The basin shortly thereafter closed by convergent tectonics during the Nevadan orogeny resulting in the imbrication of the Josephine and Preston Peak ophiolites and their superimposed arc assemblages. The transition from seafloor spreading generation of Josephine ophiolite to its tectonic accretion by convergence and basin closure occurred within 5 to 10 m.y. The process of rifting and ophiolite formation in series with convergence and ophiolite accretion is considered an important mechanism for generating and displacing allocthonous terranes in the Klamath Mountains-Sierra Nevada region, and perhaps throughout the western cordillera

Reproduction and Dispersal of Biological Soil Crust Organisms

Biological soil crusts (BSCs) consist of a diverse and highly integrated community of organisms that effectively colonize and collectively stabilize soil surfaces. BSCs vary in terms of soil chemistry and texture as well as the environmental parameters that combine to support unique combinations of organisms—including cyanobacteria dominated, lichen-dominated, and bryophyte-dominated crusts. The list of organismal groups that make up BSC communities in various and unique combinations include—free living, lichenized, and mycorrhizal fungi, chemoheterotrophic bacteria, cyanobacteria, diazotrophic bacteria and archaea, eukaryotic algae, and bryophytes. The various BSC organismal groups demonstrate several common characteristics including—desiccation and extreme temperature tolerance, production of various soil binding chemistries, a near exclusive dependency on asexual reproduction, a pattern of aerial dispersal over impressive distances, and a universal vulnerability to a wide range of human-related perturbations. With this publication, we provide literature-based insights as to how each organismal group contributes to the formation and maintenance of the structural and functional attributes of BSCs, how they reproduce, and how they are dispersed. We also emphasize the importance of effective application of molecular and microenvironment sampling and assessment tools in order to provide cogent and essential answers that will allow scientists and land managers to better understand and manage the biodiversity and functional relationships of soil crust communities

Lung volumes identify an at-risk group in persons with prolonged secondhand tobacco smoke exposure but without overt airflow obstruction.

IntroductionExposure to secondhand smoke (SHS) is associated with occult obstructive lung disease as evident by abnormal airflow indices representing small airway disease despite having preserved spirometry (normal forced expiratory volume in 1 s-to-forced vital capacity ratio, FEV1/FVC). The significance of lung volumes that reflect air trapping in the presence of preserved spirometry is unclear.MethodsTo investigate whether lung volumes representing air trapping could determine susceptibility to respiratory morbidity in people with SHS exposure but without spirometric chronic obstructive pulmonary disease, we examined a cohort of 256 subjects with prolonged occupational SHS exposure and preserved spirometry. We elicited symptom prevalence by structured questionnaires, examined functional capacity (maximum oxygen uptake, VO2max) by exercise testing, and estimated associations of those outcomes with air trapping (plethysmography-measured residual volume-to-total lung capacity ratio, RV/TLC), and progressive air trapping with exertion (increase in fraction of tidal breathing that is flow limited on expiration during exercise (per cent of expiratory flow limitation, %EFL)).ResultsRV/TLC was within the predicted normal limits, but was highly variable spanning 22%±13% and 16%±8% across the increments of FEV1/FVC and FEV1, respectively. Respiratory complaints were prevalent (50.4%) with the most common symptom being ≥2 episodes of cough per year (44.5%). Higher RV/TLC was associated with higher OR of reporting respiratory symptoms (n=256; r2=0.03; p=0.011) and lower VO2max (n=179; r2=0.47; p=0.013), and %EFL was negatively associated with VO2max (n=32; r2=0.40; p=0.017).ConclusionsIn those at risk for obstruction due to SHS exposure but with preserved spirometry, higher RV/TLC identifies a subgroup with increased respiratory symptoms and lower exercise capacity

An Optimal Application of Swine Effluent in Texas and Oklahoma Panhandle Determined by Bayesian Stochastic Dynamic Programming

Swine Effluent Irrigation, Environmental Economics and Policy,

Mahi-mahi (Coryphaena hippurus) life development: morphological, physiological, behavioral and molecular phenotypes.

BackgroundMahi-mahi (Coryphaena hippurus) is a commercially and ecologically important fish species that is widely distributed in tropical and subtropical waters. Biological attributes and reproductive capacities of mahi-mahi make it a tractable model for experimental studies. In this study, life development of cultured mahi-mahi from the zygote stage to adult has been described.ResultsA comprehensive developmental table has been created reporting development as primarily detailed observations of morphology. Additionally, physiological, behavioral, and molecular landmarks have been described to significantly contribute in the understanding of mahi life development.ConclusionRemarkably, despite the vast difference in adult size, many developmental landmarks of mahi map quite closely onto the development and growth of Zebrafish and other warm-water, active Teleost fishes

Neurological eponyms? Take your Pick

The neuropsychiatrist Arnold Pick (1851-1924) lent his name to a disease, but in his centenary year, it is timely to ask whether this and the many other eponyms that populate neurology are more help than hindrance. Here, I survey some neurological eponyms, propose criteria for judging their helpfulness (and unhelpfulness) and consider their future prospects in our increasingly mechanistic, contemporary neurological practice

Perforation in a patient with stercoral colitis and diverticulosis: who did it?

Stercoral colitis with perforation of the colon is an uncommon, yet life-threatening cause of the acute abdomen. No one defining symptom exists for stercoral colitis; it may present asymptomatically or with vague symptoms. Diagnostic delay may result in perforation of the colon resulting in complications, even death. Moreover, stercoral perforation of the colon can also present with localized left lower quadrant abdominal pain masquerading as diverticulitis. Diverticular diseases and stercoral colitis share similar pathophysiology; furthermore, they may coexist, further complicating the diagnostic dilemma. The ability to decide the cause of perforation in a patient with both stercoral colitis and diverticulosis has not been discussed. We, therefore, report this case of stercoral perforation in a patient with diverticulosis and include a discussion of the epidemiology, clinical presentation, and a review of helpful diagnostic clues for a rapid differentiation to allow for accurate diagnosis and treatment