Risk factors for chest infection in acute stroke: a prospective cohort study

<p><b>Background and Purpose:</b> Pneumonia is a major cause of morbidity and mortality after stroke. We aimed to determine key characteristics that would allow prediction of those patients who are at highest risk for poststroke pneumonia.</p> <p><b>Methods:</b> We studied a series of consecutive patients with acute stroke who were admitted to hospital. Detailed evaluation included the modified National Institutes of Health Stroke Scale; the Abbreviated Mental Test; and measures of swallow, respiratory, and oral health status. Pneumonia was diagnosed by set criteria. Patients were followed up at 3 months after stroke.</p> <p><b>Results:</b> We studied 412 patients, 391 (94.9%) with ischemic stroke and 21 (5.1%) with hemorrhagic stroke; 78 (18.9%) met the study criteria for pneumonia. Subjects who developed pneumonia were older (mean±SD age, 75.9±11.4 vs 64.9±13.9 years), had higher modified National Institutes of Health Stroke Scale scores, a history of chronic obstructive pulmonary disease, lower Abbreviated Mental Test scores, and a higher oral cavity score, and a greater proportion tested positive for bacterial cultures from oral swabs. In binary logistic-regression analysis, independent predictors (P<0.05) of pneumonia were age >65 years, dysarthria or no speech due to aphasia, a modified Rankin Scale score ≥4, an Abbreviated Mental Test score <8, and failure on the water swallow test. The presence of 2 or more of these risk factors carried 90.9% sensitivity and 75.6% specificity for the development of pneumonia.</p> <p><b>Conclusions:</b> Pneumonia after stroke is associated with older age, dysarthria/no speech due to aphasia, severity of poststroke disability, cognitive impairment, and an abnormal water swallow test result. Simple assessment of these variables could be used to identify patients at high risk of developing pneumonia after stroke.</p&gt

Simple Vortex States in Films of Type-I Ginzburg-Landau Superconductor

Sufficiently thin films of type-I superconductor in a perpendicular magnetic field exhibit a triangular vortex lattice, while thick films develop an intermediate state. To elucidate what happens between these two regimes, precise numerical calculations have been made within Ginzburg-Landau theory at $\kappa=0.5$ and 0.25 for a variety of vortex lattice structures with one flux quantum per unit cell. The phase diagram in the space of mean induction and film thickness includes a narrow wedge in which a square lattice is stable, surrounded by the domain of stability of the triangular lattice at thinner films/lower fields and, on the other side, rectangular lattices with continuously varying aspect ratio. The vortex lattice has an anomalously small shear modulus within and close to the square lattice phase.Comment: 21 pages, 6 figure

Impact of alloy disorder on the band structure of compressively strained GaBiAs

The incorporation of bismuth (Bi) in GaAs results in a large reduction of the band gap energy (E$_g$) accompanied with a large increase in the spin-orbit splitting energy ($\bigtriangleup_{SO}$), leading to the condition that $\bigtriangleup_{SO} > E_g$ which is anticipated to reduce so-called CHSH Auger recombination losses whereby the energy and momentum of a recombining electron-hole pair is given to a second hole which is excited into the spin-orbit band. We theoretically investigate the electronic structure of experimentally grown GaBi$_x$As$_{1-x}$ samples on (100) GaAs substrates by directly comparing our data with room temperature photo-modulated reflectance (PR) measurements. Our atomistic theoretical calculations, in agreement with the PR measurements, confirm that E$_g$ is equal to $\bigtriangleup_{SO}$ for $\textit{x} \approx$ 9$$. We then theoretically probe the inhomogeneous broadening of the interband transition energies as a function of the alloy disorder. The broadening associated with spin-split-off transitions arises from conventional alloy effects, while the behaviour of the heavy-hole transitions can be well described using a valence band-anticrossing model. We show that for the samples containing 8.5% and 10.4% Bi the difficulty in identifying a clear light-hole-related transition energy from the measured PR data is due to the significant broadening of the host matrix light-hole states as a result of the presence of a large number of Bi resonant states in the same energy range and disorder in the alloy. We further provide quantitative estimates of the impact of supercell size and the assumed random distribution of Bi atoms on the interband transition energies in GaBi$_{x}$As$_{1-x}$. Our calculations support a type-I band alignment at the GaBi$_x$As$_{1-x}$/GaAs interface, consistent with recent experimental findings

The impact of the climate change on discharge of Suir River Catchment (Ireland) under different climate scenarios

International audienceThe impact of climate change on local discharge variability is investigated in the Suir River Catchment which is located in the south-east of Ireland. In this paper, the Rossby Centre Regional Atmospheric Model (RCA) is driven by different global climate data sets. For the past climate (1961?2000), the model is driven by ECMWF reanalysis (ERA-40) data as well as by the output of the general circulation models (GCM's) ECHAM4 and ECHAM5. For the future simulation (2021?2060), the model is driven by two GCM scenarios: ECHAM4_B2 and ECHAM5_A2. To investigate the influence of changed future climate on local discharge, the precipitation of the model output is used as input for the HBV hydrological model. The calibration and validation results of our ERA-40 driven present day simulation shows that the HBV model can reproduce the discharge fairly well, except the extreme discharge is systematically underestimated by about 15?20%. Altogether the application of a high resolution regional climate model in connection with a conceptual hydrological model is capable of capturing the local variability of river discharge for present-day climate using boundary values assimilated with observations such as ERA-40 data. However, using GCM data to drive RCA and HBV suggests, that there is still large uncertainty connected with the GCM formulation: For present day climate the validation of the ECHAM4 and ECHAM5 driven simulations indicates stronger discharge compared to the observations due to overprediction of precipitation, especially for the ECHAM5 driven simulation in the summer season. Whereas according to the ECHAM4_B2 scenario the discharge generally increases ? most pronounced in the wet winter time, there are only slight increases in winter and considerable decreases in summer according to the ECHAM5_A2 scenario. This also leads to a different behaviour in the evolution of return levels of extreme discharge events: Strong increases according to the ECHAM4_B2 scenario and slight decreases according to the ECHAM5_A2 scenario

The case for early use of rapid whole-genome sequencing in management of critically ill infants: late diagnosis of Coffin-Siris syndrome in an infant with left congenital diaphragmatic hernia, congenital heart disease, and recurrent infections.

Congenital diaphragmatic hernia (CDH) results from incomplete formation of the diaphragm leading to herniation of abdominal organs into the thoracic cavity. CDH is associated with pulmonary hypoplasia, congenital heart disease, and pulmonary hypertension. Genetically, it is associated with aneuploidies, chromosomal copy-number variants, and single gene mutations. CDH is the most expensive noncardiac congenital defect. Management frequently requires implementation of extracorporeal membrane oxygenation (ECMO), which increases management expenditures 2.4-3.5-fold. The cost of management of CDH has been estimated to exceed $250 million per year. Despite in-hospital survival of 80%-90%, current management is imperfect, as a great proportion of surviving children have long-term functional deficits. We report the case of a premature infant prenatally diagnosed with CDH and congenital heart disease, who had a protracted and complicated course in the intensive care unit with multiple surgical interventions, including postcardiac surgery ECMO, gastrostomy tube placement with Nissen fundoplication, tracheostomy for respiratory failure, recurrent infections, and developmental delay. Rapid whole-genome sequencing (rWGS) identified a de novo, likely pathogenic, c.3096_ 3100delCAAAG (p.Lys1033Argfs*32) variant in ARID1B, providing a diagnosis of Coffin-Siris syndrome. Her parents elected palliative care and she died later that day

Theory and design of Inx_{x}Ga1−x_{1-x}As1−y_{1-y}Biy_{y} mid-infrared semiconductor lasers: type-I quantum wells for emission beyond 3 μ\mum on InP substrates

We present a theoretical analysis and optimisation of the properties and performance of mid-infrared semiconductor lasers based on the dilute bismide alloy In$_{x}$Ga$_{1-x}$As$_{1-y}$Bi$_{y}$, grown on conventional (001) InP substrates. The ability to independently vary the epitaxial strain and emission wavelength in this quaternary alloy provides significant scope for band structure engineering. Our calculations demonstrate that structures based on compressively strained In$_{x}$Ga$_{1-x}$As$_{1-y}$Bi$_{y}$ quantum wells (QWs) can readily achieve emission wavelengths in the 3 -- 5 $\mu$m range, and that these QWs have large type-I band offsets. As such, these structures have the potential to overcome a number of limitations commonly associated with this application-rich but technologically challenging wavelength range. By considering structures having (i) fixed QW thickness and variable strain, and (ii) fixed strain and variable QW thickness, we quantify key trends in the properties and performance as functions of the alloy composition, structural properties, and emission wavelength, and on this basis identify routes towards the realisation of optimised devices for practical applications. Our analysis suggests that simple laser structures -- incorporating In$_{x}$Ga$_{1-x}$As$_{1-y}$Bi$_{y}$ QWs and unstrained ternary In$_{0.53}$Ga$_{0.47}$As barriers -- which are compatible with established epitaxial growth, provide a route to realising InP-based mid-infrared diode lasers.Comment: Submitted versio

From ‘other’ to involved: User involvement in research: An emerging paradigm

This article has been made available through the Brunel Open Access Publishing Fund. Copyright @ 2013 The Author(s). This is an Open Access article. Non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly attributed, cited, and is not altered, transformed, or built upon in any way, is permitted. The moral rights of the named author(s) have been asserted.This article explores the issue of ‘othering’ service users and the role that involving them, particularly in social policy and social work research may play in reducing this. It takes, as its starting point, the concept of ‘social exclusion’, which has developed in Europe and the marginal role that those who have been included in this construct have played in its development and the damaging effects this may have. The article explores service user involvement in research and is itself written from a service user perspective. It pays particular attention to the ideological, practical, theoretical, ethical and methodological issues that such user involvement may raise for research. It examines problems that both research and user involvement may give rise to and also considers developments internationally to involve service users/subjects of research, highlighting some of the possible implications and gains of engaging service user knowledge in research and the need for this to be evaluated

Host-specific symbioses and the microbial prey of a pelagic tunicate (Pyrosoma atlanticum)

Pyrosomes are widely distributed pelagic tunicates that have the potential to reshape marine food webs when they bloom. However, their grazing preferences and interactions with the background microbial community are poorly understood. This is the first study of the marine microorganisms associated with pyrosomes undertaken to improve the understanding of pyrosome biology, the impact of pyrosome blooms on marine microbial systems, and microbial symbioses with marine animals. The diversity, relative abundance, and taxonomy of pyrosome-associated microorganisms were compared to seawater during a Pyrosoma atlanticum bloom in the Northern California Current System using high-throughput sequencing of the 16S rRNA gene, microscopy, and flow cytometry. We found that pyrosomes harbor a microbiome distinct from the surrounding seawater, which was dominated by a few novel taxa. In addition to the dominant taxa, numerous more rare pyrosome-specific microbial taxa were recovered. Multiple bioluminescent taxa were present in pyrosomes, which may be a source of the iconic pyrosome luminescence. We also discovered free-living marine microorganisms in association with pyrosomes, suggesting that pyrosome feeding impacts all microbial size classes but preferentially removes larger eukaryotic taxa. This study demonstrates that microbial symbionts and microbial prey are central to pyrosome biology. In addition to pyrosome impacts on higher trophic level marine food webs, the work suggests that pyrosomes also alter marine food webs at the microbial level through feeding and seeding of the marine microbial communities with their symbionts. Future efforts to predict pyrosome blooms, and account for their ecosystem impacts, should consider pyrosome interactions with marine microbial communities

Performance of an environmental test to detect Mycobacterium bovis infection in badger social groups

A study by Courtenay and others (2006) demonstrated that the probability of detecting Mycobacterium bovis by PCR in soil samples from the spoil heaps of main badger setts correlated with the prevalence of excretion (infectiousness) of captured badgers belonging to the social group. It has been proposed that such a test could be used to target badger culling to setts containing infectious animals (Anon 2007). This short communication discusses the issues surrounding this concept, with the intention of dispelling any misconceptions among relevant stakeholders (farmers, policy makers and conservationists)