Apnea, bradycardia and desaturation spells in premature infants: impact of a protocol for the duration of 'spell-free' observation on interprovider variability and readmission rates.

ObjectiveTo study the impact of implementing a protocol to standardize the duration of observation in preterm infants with apnea/bradycardia/desaturation spells before hospital discharge on length of stay (LOS) and readmission rates.Study designA protocol to standardize the duration of in-hospital observation for preterm infants with apnea, bradycardia and desaturation spells who were otherwise ready for discharge was implemented in December 2013. We evaluated the impact of this protocol on the LOS and readmission rates of very low birth weight infants (VLBW). Data on readmission for apnea and an apparent life-threatening event (ALTE) within 30 days of discharge were collected. The pre-implementation epoch (2011 to 2013) was compared to the post-implementation period (2014 to 2016).ResultsThere were 426 and 368 VLBW discharges before and after initiation of the protocol during 2011 to 2013 and 2014 to 2016, respectively. The LOS did not change with protocol implementation (66±42 vs 64±42 days before and after implementation of the protocol, respectively). Interprovider variability on the duration of observation for apneic spells (F-8.8, P=0.04) and bradycardia spells (F-17.4, P<0.001) decreased after implementation of the protocol. The readmission rate for apnea/ALTE after the protocol decreased from 12.1 to 3.4% (P=0.01).ConclusionImplementing an institutional protocol for VLBW infants to determine the duration of apnea/bradycardia/ desaturation spell-free observation period as recommended by the American Academy of Pediatrics clinical report did not prolong the LOS but effectively reduced interprovider variability and readmission rates

Acute intermittent porphyria with syndrome of inappropriate antidiuretic hormone secretion (SIADH) and neurological crisis, successfully treated with haemodialysis

We report a 35 years old male, a case of Acute Intermittent Porphyria (AIP) with Syndrome of Inappropriate Antidiuretic Hormone secretion (SIADH) and neurological crisis for its rarity. Since specific parenteral medication (hemin) was not available, patient was empirically treated with haemodialysis with satisfactory outcome

Magnetoresistance behavior of a ferromagnetic shape memory alloy: Ni_1.75Mn_1.25Ga

A negative-positive-negative switching behavior of magnetoresistance (MR) with temperature is observed in a ferromagnetic shape memory alloy Ni_1.75Mn_1.25Ga. In the austenitic phase between 300 and 120 K, MR is negative due to s-d scattering. Curiously, below 120K MR is positive, while at still lower temperatures in the martensitic phase, MR is negative again. The positive MR cannot be explained by Lorentz contribution and is related to a magnetic transition. Evidence for this is obtained from ab initio density functional theory, a decrease in magnetization and resistivity upturn at 120 K. Theory shows that a ferrimagnetic state with anti-ferromagnetic alignment between the local magnetic moments of the Mn atoms is the energetically favoured ground state. In the martensitic phase, there are two competing factors that govern the MR behavior: a dominant negative trend up to the saturation field due to the decrease of electron scattering at twin and domain boundaries; and a weaker positive trend due to the ferrimagnetic nature of the magnetic state. MR exhibits a hysteresis between heating and cooling that is related to the first order nature of the martensitic phase transition.Comment: 17 pages, 5 figures. Accepted in Phys. Rev.

Coexisting tuneable fractions of glassy and equilibrium long-range-order phases in manganites

Antiferromagnetic-insulating(AF-I) and the ferromagnetic-metallic(FM-M) phases coexist in various half-doped manganites over a range of temperature and magnetic field, and this is often believed to be an essential ingredient to their colossal magnetoresistence. We present magnetization and resistivity measurements on Pr(0.5)Ca(0.5)Mn(0.975)Al(0.025)O(3) and Pr(0.5)Sr(0.5)MnO(3) showing that the fraction of the two coexisting phases at low-temperature in any specified measuring field H, can be continuously controlled by following designed protocols traversing field-temperature space; for both materials the FM-M fraction rises under similar cooling paths. Constant-field temperature variations however show that the former sample undergoes a 1st order transition from AF-I to FM-M with decreasing T, while the latter undergoes the reverse transition. We suggest that the observed path-dependent phase-separated states result from the low-T equilibrium phase coexisting with supercooled glass-like high temperature phase, where the low-T equilibrium phases are actually homogeneous FM-M and AF-I phases respectively for the two materials

Combinatorial activities of SHORT VEGETATIVE PHASE and FLOWERING LOCUS C define distinct modes of flowering regulation in Arabidopsis.

BACKGROUND: The initiation of flowering is an important developmental transition as it marks the beginning of the reproductive phase in plants. The MADS-box transcription factors (TFs) FLOWERING LOCUS C (FLC) and SHORT VEGETATIVE PHASE (SVP) form a complex to repress the expression of genes that initiate flowering in Arabidopsis. Both TFs play a central role in the regulatory network by conferring seasonal patterns of flowering. However, their interdependence and biological relevance when acting as a complex have not been extensively studied. RESULTS: We characterized the effects of both TFs individually and as a complex on flowering initiation using transcriptome profiling and DNA-binding occupancy. We find four major clusters regulating transcriptional responses, and that DNA binding scenarios are highly affected by the presence of the cognate partner. Remarkably, we identify genes whose regulation depends exclusively on simultaneous action of both proteins, thus distinguishing between the specificity of the SVP:FLC complex and that of each TF acting individually. The downstream targets of the SVP:FLC complex include a higher proportion of genes regulating floral induction, whereas those bound by either TF independently are biased towards floral development. Many genes involved in gibberellin-related processes are bound by the SVP:FLC complex, suggesting that direct regulation of gibberellin metabolism by FLC and SVP contributes to their effects on flowering. CONCLUSIONS: The regulatory codes controlled by SVP and FLC were deciphered at the genome-wide level revealing substantial flexibility based on dependent and independent DNA binding that may contribute to variation and robustness in the regulation of flowering

Anomalous First-order transition in Nd<SUB>0.5</SUB>Sr<SUB>0.5</SUB>MnO<SUB>3</SUB>: an interplay between kinetic arrest and thermodynamic transitions

A detailed investigation of the first-order antiferromagnetic insulator (AFI) to ferromagnetic metal (FMM) transition in Nd0.5Sr0.5MnO3 is carried out by resistivity and magnetization measurements. These studies reveal several anomalous features of thermomagnetic irreversibility across the first-order transition. We show that these anomalous features cannot be explained in terms of the supercooling effect alone and the H-T diagram based on isothermal M-H or R-H measurements alone does not reflect the true nature of the first-order transition in this compound. Our investigations reveal glass-like arrest of kinetics at low temperature which plays a dominant role in the anomalous thermomagnetic irreversibility observed in this system. The interplay between kinetic arrest and supercooling is investigated by following novel paths in the H-T space. It is shown that coexisting FMM and AFI phases can be tuned in a number of ways at low temperature. These measurements also show that kinetic arrest temperature and supercooling temperature are anticorrelated, i.e. regions which are arrested at low temperature have higher supercooling temperature and vice versa