Results from a 13-Year Prospective Cohort Study Show Increased Mortality Associated with Bloodstream Infections Caused by Pseudomonas aeruginosa Compared to Other Bacteria

ABSTRACT The impact of bacterial species on outcome in bloodstream infections (BSI) is incompletely understood. We evaluated the impact of bacterial species on BSI mortality, with adjustment for patient, bacterial, and treatment factors. From 2002 to 2015, all adult inpatients with monomicrobial BSI caused by Staphylococcus aureus or Gram-negative bacteria at Duke University Medical Center were prospectively enrolled. Kaplan-Meier curves and multivariable Cox regression with propensity score models were used to examine species-specific bacterial BSI mortality. Of the 2,659 enrolled patients, 999 (38%) were infected with S. aureus , and 1,660 (62%) were infected with Gram-negative bacteria. Among patients with Gram-negative BSI, Enterobacteriaceae (81% [1,343/1,660]) were most commonly isolated, followed by non-lactose-fermenting Gram-negative bacteria (16% [262/1,660]). Of the 999 S. aureus BSI isolates, 507 (51%) were methicillin resistant. Of the 1,660 Gram-negative BSI isolates, 500 (30%) were multidrug resistant. The unadjusted time-to-mortality among patients with Gram-negative BSI was shorter than that of patients with S. aureus BSI ( P = 0.003), due to increased mortality in patients with non-lactose-fermenting Gram-negative BSI generally ( P < 0.0001) and Pseudomonas aeruginosa BSI ( n = 158) in particular ( P < 0.0001). After adjustment for patient demographics, medical comorbidities, bacterial antibiotic resistance, timing of appropriate antibiotic therapy, and source control in patients with line-associated BSI, P. aeruginosa BSI remained significantly associated with increased mortality (hazard ratio = 1.435; 95% confidence interval = 1.043 to 1.933; P = 0.02). P. aeruginosa BSI was associated with increased mortality relative to S. aureus or other Gram-negative BSI. This effect persisted after adjustment for patient, bacterial, and treatment factors

Quantum Effects in the Mechanical Properties of Suspended Nanomechanical Systems

We explore the quantum aspects of an elastic bar supported at both ends and subject to compression. If strain rather than stress is held fixed, the system remains stable beyond the buckling instability, supporting two potential minima. The classical equilibrium transverse displacement is analogous to a Ginsburg-Landau order parameter, with strain playing the role of temperature. We calculate the quantum fluctuations about the classical value as a function of strain. Excitation energies and quantum fluctuation amplitudes are compared for silicon beams and carbon nanotubes.Comment: RevTeX4. 5 pages, 3 eps figures. Submitted to Physical Review Letter

The quantum critical point in CeRhIn_5: a resistivity study

The pressure--temperature phase diagram of CeRhIn_5 has been studied under high magnetic field by resistivity measurements. Clear signatures of a quantum critical point has been found at a critical pressure of p_c = 2.5 GPa. The field induced magnetic state in the superconducting state is stable up to the highest field. At p_c the antiferromagnetic ground-state under high magnetic field collapses very rapidly. Clear signatures of p_c are the strong enhancement of the resistivity in the normal state and of the inelastic scattering term. No clear T2 temperature dependence could be found for pressures above T_c. From the analysis of the upper critical field within a strong coupling model we present the pressure dependence of the coupling parameter lambda and the gyromagnetic ratio g. No signatures of a spatially modulated order parameter could be evidenced. A detailed comparison with the magnetic field--temperature phase diagram of CeCoIn_5 is given. The comparison between CeRhIn_5 and CeCoIn_5 points out the importance to take into account the field dependence of the effective mass in the calculation of the superconducting upper critical field H_c2. It suggests also that when the magnetic critical field H_(0) becomes lower than H_c2 (0)$, the persistence of a superconducting pseudo-gap may stick the antiferromagnetism to H_c2 (0).Comment: 15 pages, 20 figures, to be published in J. Phys. Soc. Jp

A Case of Novel Coronavirus Disease 19 in a Chronic Hemodialysis Patient Presenting with Gastroenteritis and Developing Severe Pulmonary Disease.

Novel coronavirus disease 2019 (COVID-19) is a highly infectious, rapidly spreading viral disease with an alarming case fatality rate up to 5%. The risk factors for severe presentations are concentrated in patients with chronic kidney disease, particularly patients with end-stage renal disease (ESRD) who are dialysis dependent. We report the first US case of a 56-year-old nondiabetic male with ESRD secondary to IgA nephropathy undergoing thrice-weekly maintenance hemodialysis for 3 years, who developed COVID-19 infection. He has hypertension controlled with angiotensin receptor blocker losartan 100 mg/day and coronary artery disease status-post stent placement. During the first 5 days of his febrile disease, he presented to an urgent care, 3 emergency rooms, 1 cardiology clinic, and 2 dialysis centers in California and Utah. During this interval, he reported nausea, vomiting, diarrhea, and low-grade fevers but was not suspected of COVID-19 infection until he developed respiratory symptoms and was admitted to the hospital. Imaging studies upon admission were consistent with bilateral interstitial pneumonia. He was placed in droplet-eye precautions while awaiting COVID-19 test results. Within the first 24 h, he deteriorated quickly and developed acute respiratory distress syndrome (ARDS), requiring intubation and increasing respiratory support. Losartan was withheld due to hypotension and septic shock. COVID-19 was reported positive on hospital day 3. He remained in critical condition being treated with hydroxychloroquine and tocilizumab in addition to the standard medical management for septic shock and ARDS. Our case is unique in its atypical initial presentation and highlights the importance of early testing

Database Learning: Toward a Database that Becomes Smarter Every Time

In today's databases, previous query answers rarely benefit answering future queries. For the first time, to the best of our knowledge, we change this paradigm in an approximate query processing (AQP) context. We make the following observation: the answer to each query reveals some degree of knowledge about the answer to another query because their answers stem from the same underlying distribution that has produced the entire dataset. Exploiting and refining this knowledge should allow us to answer queries more analytically, rather than by reading enormous amounts of raw data. Also, processing more queries should continuously enhance our knowledge of the underlying distribution, and hence lead to increasingly faster response times for future queries. We call this novel idea---learning from past query answers---Database Learning. We exploit the principle of maximum entropy to produce answers, which are in expectation guaranteed to be more accurate than existing sample-based approximations. Empowered by this idea, we build a query engine on top of Spark SQL, called Verdict. We conduct extensive experiments on real-world query traces from a large customer of a major database vendor. Our results demonstrate that Verdict supports 73.7% of these queries, speeding them up by up to 23.0x for the same accuracy level compared to existing AQP systems.Comment: This manuscript is an extended report of the work published in ACM SIGMOD conference 201

High-resolution Ce 3d-edge resonant photoemission study of CeNi_2

Resonant photoemission (RPES) at the Ce 3d -> 4f threshold has been performed for alpha-like compound CeNi_2 with extremely high energy resolution (full width at half maximum < 0.2 eV) to obtain bulk-sensitive 4f spectral weight. The on-resonance spectrum shows a sharp resolution-limited peak near the Fermi energy which can be assigned to the tail of the Kondo resonance. However, the spin-orbit side band around 0.3 eV binding energy corresponding to the f_{7/2} peak is washed out, in contrast to the RPES spectrum at the Ce 3d -> 4f RPES threshold. This is interpreted as due to the different surface sensitivity, and the bulk-sensitive Ce 3d -> 4f RPES spectra are found to be consistent with other electron spectroscopy and low energy properties for alpha-like Ce-transition metal compounds, thus resolves controversy on the interpretation of Ce compound photoemission. The 4f spectral weight over the whole valence band can also be fitted fairly well with the Gunnarsson-Schoenhammer calculation of the single impurity Anderson model, although the detailed features show some dependence on the hybridization band shape and (possibly) Ce 5d emissions.Comment: 4 pages, 3 figur

Effective descriptions of branes on non-geometric tori

We investigate the low-energy effective description of non-geometric compactifications constructed by T-dualizing two or three of the directions of a T^3 with non-vanishing H-flux. Our approach is to introduce a D3-brane in these geometries and to take an appropriate decoupling limit. In the case of two T-dualities, we find at low energies a non-commutative T^2 fibered non-trivially over an S^1. In the UV this theory is still decoupled from gravity, but is dual to a little string theory with flavor. For the case of three T-dualities, we do not find a sensible decoupling limit, casting doubt on this geometry as a low-energy effective notion in critical string theory. However, by studying a topological toy model in this background, we find a non-associative geometry similar to one found by Bouwknegt, Hannabuss, and Mathai.Comment: 22 pages, 4 figures, references adde

Mechanisms of CFTR Functional Variants That Impair Regulated Bicarbonate Permeation and Increase Risk for Pancreatitis but Not for Cystic Fibrosis

CFTR is a dynamically regulated anion channel. Intracellular WNK1-SPAK activation causes CFTR to change permeability and conductance characteristics from a chloride-preferring to bicarbonate-preferring channel through unknown mechanisms. Two severe CFTR mutations (CFTRsev) cause complete loss of CFTR function and result in cystic fibrosis (CF), a severe genetic disorder affecting sweat glands, nasal sinuses, lungs, pancreas, liver, intestines, and male reproductive system. We hypothesize that those CFTR mutations that disrupt the WNK1-SPAK activation mechanisms cause a selective, bicarbonate defect in channel function (CFTRBD) affecting organs that utilize CFTR for bicarbonate secretion (e.g. the pancreas, nasal sinus, vas deferens) but do not cause typical CF. To understand the structural and functional requirements of the CFTR bicarbonate-preferring channel, we (a) screened 984 well-phenotyped pancreatitis cases for candidate CFTRBD mutations from among 81 previously described CFTR variants; (b) conducted electrophysiology studies on clones of variants found in pancreatitis but not CF; (c) computationally constructed a new, complete structural model of CFTR for molecular dynamics simulation of wild-type and mutant variants; and (d) tested the newly defined CFTRBD variants for disease in non-pancreas organs utilizing CFTR for bicarbonate secretion. Nine variants (CFTR R74Q, R75Q, R117H, R170H, L967S, L997F, D1152H, S1235R, and D1270N) not associated with typical CF were associated with pancreatitis (OR 1.5, p = 0.002). Clones expressed in HEK 293T cells had normal chloride but not bicarbonate permeability and conductance with WNK1-SPAK activation. Molecular dynamics simulations suggest physical restriction of the CFTR channel and altered dynamic channel regulation. Comparing pancreatitis patients and controls, CFTRBD increased risk for rhinosinusitis (OR 2.3, p<0.005) and male infertility (OR 395, p<<0.0001). WNK1-SPAK pathway-activated increases in CFTR bicarbonate permeability are altered by CFTRBD variants through multiple mechanisms. CFTRBD variants are associated with clinically significant disorders of the pancreas, sinuses, and male reproductive system.Fil: LaRusch, Jessica. Univeristy of Pittsburgh. School of Medicine; Estados UnidosFil: Jung, Jinsei. Yonsei University College of Medicine; Corea del SurFil: General, Ignacio. University of Pittsburgh; Estados Unidos. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Lewis, Michele D.. Mayo Clinic. Division of Gastroenterology and Hepatology; Estados UnidosFil: Park, Hyun Woo. Yonsei University College of Medicine; Corea del SurFil: Brand, Randall E.. Univeristy of Pittsburgh. School of Medicine; Estados UnidosFil: Gelrud, Andres. Univeristy of Pittsburgh. School of Medicine; Estados UnidosFil: Anderson, Michelle A.. University of Michigan; Estados UnidosFil: Banks, Peter A.. Brigham and Women’s Hospital. Division of Gastroenterology; Estados UnidosFil: Conwell, Darwin. Brigham and Women’s Hospital. Division of Gastroenterology; Estados UnidosFil: Lawrence, Christopher. Medical University of South Carolina; Estados UnidosFil: Romagnuolo, Joseph. Medical University of South Carolina; Estados UnidosFil: Baillie, John. University of Duke; Estados UnidosFil: Alkaade, Samer. St. Louis University. School of Medicine; Estados UnidosFil: Cote, Gregory. Indiana University; Estados UnidosFil: Gardner, Timothy B.. Dartmouth-Hitchcock Medical Center; Estados UnidosFil: Amann, Stephen T.. North Mississippi Medical Center; Estados UnidosFil: Slivka, Adam. Univeristy of Pittsburgh. School of Medicine; Estados UnidosFil: Sandhu, Bimaljit. Virginia Commonwealth University Medical Center; Estados UnidosFil: Aloe, Amy. Univeristy of Pittsburgh. School of Medicine; Estados UnidosFil: Kienholz, Michelle L.. Univeristy of Pittsburgh. School of Medicine; Estados UnidosFil: Yadav, Dhiraj. Univeristy of Pittsburgh. School of Medicine; Estados UnidosFil: Barmada, M. Michael. Univeristy of Pittsburgh. School of Medicine; Estados UnidosFil: Bahar, Ivet. Univeristy of Pittsburgh. School of Medicine; Estados UnidosFil: Lee, Min Goo. Yonsei University College of Medicine; Corea del SurFil: Whitcomb, David C.. Univeristy of Pittsburgh. School of Medicine; Estados UnidosFil: North American Pancreatitis Study Group. No especifica

‘Ethnic group’, the state and the politics of representation

The assertion, even if only by implication, that ‘ethnic group’ categories represent ‘real’ tangible entities, indeed identities, is commonplace not only in the realms of political and policy discourse but also amongst contemporary social scientists. This paper, following Brubaker (2002), questions this position in a number of key respects: of these three issues will dominate the discussion that follows. First, there is an interrogation of the proposition that those to whom the categories/labels refer constitute sociologically meaningful ‘groups’ as distinct from (mere) human collectivities. Secondly, there is the question of how these categories emerge, i.e. exactly what series of events, negotiations and contestations lie behind their construction and social acceptance. Thirdly, and as a corollary to the latter point, we explore the process of reification that leads to these categories being seen to represent ‘real things in the world’ (ibid.)