Variability in antifungal and antiviral use in hospitalized children

We analyzed antifungal and antiviral prescribing among high-risk children across freestanding children’s hospitals. Antifungal and antiviral days of therapy varied across hospitals. Benchmarking antifungal and antiviral use and developing antimicrobial stewardship strategies to optimize use of these high cost agents is needed.Infect Control Hosp Epidemiol2017;38:743–746</jats:p

Pandemic influenza preparedness: an ethical framework to guide decision-making

BACKGROUND: Planning for the next pandemic influenza outbreak is underway in hospitals across the world. The global SARS experience has taught us that ethical frameworks to guide decision-making may help to reduce collateral damage and increase trust and solidarity within and between health care organisations. Good pandemic planning requires reflection on values because science alone cannot tell us how to prepare for a public health crisis. DISCUSSION: In this paper, we present an ethical framework for pandemic influenza planning. The ethical framework was developed with expertise from clinical, organisational and public health ethics and validated through a stakeholder engagement process. The ethical framework includes both substantive and procedural elements for ethical pandemic influenza planning. The incorporation of ethics into pandemic planning can be helped by senior hospital administrators sponsoring its use, by having stakeholders vet the framework, and by designing or identifying decision review processes. We discuss the merits and limits of an applied ethical framework for hospital decision-making, as well as the robustness of the framework. SUMMARY: The need for reflection on the ethical issues raised by the spectre of a pandemic influenza outbreak is great. Our efforts to address the normative aspects of pandemic planning in hospitals have generated interest from other hospitals and from the governmental sector. The framework will require re-evaluation and refinement and we hope that this paper will generate feedback on how to make it even more robust

Wind Tunnel Flow Field Visualizations of the Space Launch System Vehicle Ascent

A series of wind tunnel tests were conducted to characterize the force-and-moment, and aeroacoustic environment of several configurations of the Space Launch System during ascent. The tests were conducted in the 11-by-11 foot transonic and 9-by-7 foot supersonic test sections at NASA Ames research center. Throughout these experiments data was collected from several types of instrumentation including: multicomponent force-and-moment strain gage balances, dynamic and steady-state pressure sensors, unsteady and steady pressure-sensitive paint, time-resolved shadowgraph and infrared imaging. The following details results and analysis from the time-resolved shadowgraph and infrared imaging data systems. The time-resolved shadowgraph and infrared imaging provided a qualitative measurement of the near-field turbulent fluctuations. These results helped provide context to the relative magnitude and frequency content of the fluid-structure-interaction driving the surface pressure phenomena characterized by the discrete pressure transducers and unsteady pressure sensitive paint

Testing and Data Recovery Excavations at 41BU51, Burleson County, Texas

Prewitt and Associates, Inc. (PAI), conducted archeological testing and data recovery excavations at prehistoric site 41BU51 in Burleson County, Texas, for the Texas Department of Transportation, Environmental Affairs Division, in three phases of investigation. The first phase of testing, conducted in Spring 2003, resulted in the discovery of a single human burial as well as diagnostic artifacts ranging from the Archaic period through the Late Prehistoric period. A second phase of testing was conducted to search for additional burials in January 2004. This work resulted in the discovery of three additional burials and two isolated human bones. Finally, data recovery to remove the human remains was conducted in June 2007. This report describes all three phases of work. Analysis of the data recovered indicates that 41BU51 has a Late Archaic component that contributed many or even most of the lithic artifacts, most of the burned rocks and burned clay, some or all of the ceramic artifacts, and probably all of the human burials. Materials representing Late Prehistoric period occupations also are present, and the possibility exists that large numbers of the lithic artifacts in the upper 60 cm of the deposits were left by these occupations. A small number of artifacts predating the Late Archaic period were recovered, but these are older items recycled into younger deposits. Radiocarbon dates indicate that the Late Archaic and Late Prehistoric use of the site occurred over perhaps 3,200 to 3,600 years. The vertical distributions of the temporally sensitive artifacts and the radiocarbon dates, while hinting at some remnant time-related stratification of the cultural materials, make it clear that there has been much mixing of the deposits, presumably through faunal turbation and other forms of disturbance. With this degree of mixing, it is impossible to segregate the remains by time period or more-discrete components. Nonetheless, the archeological remains recovered indicate that 41BU51 was used intermittently over a long span of time, probably as a residential campsite, with some occupations during the Late Archaic period perhaps being for extended periods of time

Organ-Specific Alterations in Fatty Acid De Novo Synthesis and Desaturation in a Rat Model of Programmed Obesity

<p>Abstract</p> <p>Background</p> <p>Small for gestational age (SGA) leads to increased risk of adult obesity and metabolic syndrome. Offspring exposed to 50% maternal food restriction <it>in utero </it>are born smaller than Controls (FR), catch-up in growth by the end of the nursing period, and become obese adults. The objective of the study was to determine stearoyl-CoA desaturase activity (SCD1) and rates of de novo fatty acid synthesis in young FR and Control offspring tissues at the end of the nursing period, as possible contributors to catch-up growth.</p> <p>Methods</p> <p>From gestational day 10 to term, dams fed ad libitum (Control) or were 50% food-restricted to produce small FR pups. Control dams nursed all pups. At postnatal day 1 (p1) and p21, offspring body tissues were analyzed by GC/MS, and desaturation indices of palmitoleate/palmitate and oleate/stearate were calculated. SCD1 gene expression was determined by real-time PCR on adipose and liver. Offspring were enriched with deuterium that was given to dams in drinking water during lactation and de novo synthesis of offspring body tissues was determined at p21. Primary adipocyte cell cultures were established at p21 and exposed to U¹³C-glucose.</p> <p>Results</p> <p>FR offspring exhibited higher desaturation index in p1 and p21 adipose tissue, but decreased desaturation index in liver at p21. SCD1 gene expression at p21 was correspondingly increased in adipose and decreased in liver. FR subcutaneous fat demonstrated increased de novo synthesis at p21. Primary cell cultures exhibited increased de novo synthesis in FR.</p> <p>Conclusions</p> <p>Adipose tissue is the first site to exhibit increased de novo synthesis and desaturase activity in FR. Therefore, abnormal lipogenesis is already present prior to onset of obesity during the period of catch-up growth. These abnormalities may contribute to future obesity development.</p

Eligibility Testing at 41BU75, Burleson County, Texas

Prewitt and Associates, Inc., conducted test excavations at site 41BU75 in Burleson County, Texas, to determine its eligibility for listing in the National Register of Historic Places and designation as a State Antiquities Landmark. The work was performed in 2007 under Texas Antiquities Permit No. 4525 for the Texas Department of Transportation, Environmental Affairs Division, in conjunction with a planned widening of FM 60, which will require up to 45 m of new right of way. The excavations consisted of six Gradall trenches and five 1x1-m hand-dug test units totaling 6.9 m3, all on state-owned land. Excavations yielded a small assemblage (ceramics, lithic tools, cores, and unmodified debitage) that is associated with Late Prehistoric and possibly earlier occupations. No cultural features were found. The artifacts were found throughout the sandy mantle, a mostly late Holocene colluvial depositional unit that varies greatly in thickness and is extensively bioturbated. It is recommended that 41BU75 be considered ineligible for listing in the National Register under Criterion D (36 CFR 60.4; 36 CFR 800.4, 5) or designation as a State Antiquities Landmark (13 TAC 26.2, 8) because interpretable components cannot be isolated and intact cultural features appear to be absent

Archeological Impact Evaluations and Surveys in the Texas Department of Transportation\u27s Abilene, Brownwood, Fort Worth, and Waco Districts, 2003-2006

This document constitutes the final report of work done by Prewitt and Associates, Inc. (PAI), under a contract from the Texas Department of Transportation (TxDOT) to provide archeological services in four TxDOT districts—Abilene, Brownwood, Fort Worth, and Waco. Under this contract, PAI completed Impact Evaluations and Surveys to assist TxDOT in meeting the requirements of their Memorandum of Understanding with the Texas Historical Commission and a Programmatic Agreement between the Advisory Council on Historic Preservation, the Federal Highway Administration, the Texas Historical Commission, and TxDOT. The contract began on 26 September 2003. A total of 77 projects were conducted. The 77 projects consisted of 25 Impact Evaluations and 52 Surveys. Combined, these entailed efforts at 52 bridge replacements, 14 road realignment or widening projects (many also involving bridge replacements), 1 new road construction project, 1 hike-and-bike trail construction project, 5 projects involving upgrading or replacing existing culverts, 1 project involving construction of drainage improvements, 2 unspecified road maintenance or improvement projects, and 1 project involving replacement of an interstate highway interchange. Of the 25 Impact Evaluations done, 8 led to recommendations that survey could be needed before construction. In 4 cases, the need for survey depended on whether new right of way would be acquired, which was unknown when the Impact Evaluations were done. The other 17 Impact Evaluations resulted in recommendations that no survey be required before construction based on the limited potential for sites with good integrity. Of the 52 Surveys done under this contract, 9 investigated six newly recorded and four previously recorded sites; eight of the sites are prehistoric, and two are of historic age. Four prehistoric sites were recommended for testing to assess eligibility for listing in the National Register of Historic Places and designation as State Archeological Landmarks, and one historic site was recommended for archival and oral history research. The other 43 Surveys did not find any archeological sites. All artifacts collected and records generated by projects done under this contract are curated at the Texas Archeological Research Laboratory (TARL), The University of Texas at Austin. Artifacts were collected from five sites (41BQ285, 41CV1636, 41HM53, 41LT307, and 41SV4). Those from 41HM53 and 41SV4 are from State-owned lands and thus are curated in a held-in-trust status at TARL. The artifacts from 41BQ285, 41CV1636, and 41LT307 are from private lands and are curated in a non-held-in-trust status

Community resilience for a 1.5 °C world

Ten essentials are presented for community resilience initiatives in the context of achieving a 1.5 °C world: enhance adaptability; take account of shocks and stresses; work horizontally across issues; work vertically across social scales; aggressively reduce carbon emissions; build narratives about climate change; engage directly with futures; focus on climate disadvantage; focus on processes and pathways; and encourage transformations for resilience. Together the essentials highlight that resilience initiatives seeking to retain the status quo will be detrimental when they enable societies to cling to unsustainable activities. Instead, climate resilience initiatives need to be viewed more as a process of transformative social change, where learning, power, inequities and relationships matter. Finally, there is an urgent need for researchers to shift focus away from examining the nature of resilience to accelerating learning about fostering resilience in practice

Relationship between a Weighted Multi-Gene Algorithm and Blood Pressure Control in Hypertension

Hypertension (HTN) is a complex disease with interactions among multiple organ systems, including the heart, vasculature, and kidney with a strong heritable component. Despite the multifactorial nature of HTN, no clinical guidelines utilize a multi-gene approach to guide blood pressure (BP) therapy. Non-smokers with a family history of HTN were included in the analysis (n = 384; age = 61.0 ± 0.9, 11% non-white). A total of 17 functional genotypes were weighted according to the previous effect size in the literature and entered into an algorithm. Pharmacotherapy was ranked from 1⁻4 as most to least likely to respond based on the algorithmic assessment of individual patient's genotypes. Three-years of data were assessed at six-month intervals for BP and medication history. There was no difference in BP at diagnosis between groups matching the top drug recommendation using the multi-gene weighted algorithm (n = 92) vs. those who did not match (n = 292). However, from diagnosis to nadir, patients who matched the primary recommendation had a significantly greater drop in BP when compared to patients who did not. Further, the difference between diagnosis to current 1-year average BP was lower in the group that matched the top recommendation. These data suggest an association between a weighted multi-gene algorithm on the BP response to pharmacotherapy.Geneticure Inc.Open access journalThis item from the UA Faculty Publications collection is made available by the University of Arizona with support from the University of Arizona Libraries. If you have questions, please contact us at [email protected]

Testing and Data Recovery Excavations at 41BU51, Burleson County, Texas

Prewitt and Associates, Inc. (PAI), conducted archeological testing and data recovery excavations at prehistoric site 41BU51 in Burleson County, Texas, for the Texas Department of Transportation, Environmental Affairs Division, in three phases of investigation. The first phase of testing, conducted in Spring 2003, resulted in the discovery of a single human burial as well as diagnostic artifacts ranging from the Archaic period through the Late Prehistoric period. A second phase of testing was conducted to search for additional burials in January 2004. This work resulted in the discovery of three additional burials and two isolated human bones. Finally, data recovery to remove the human remains was conducted in June 2007. This report describes all three phases of work. Analysis of the data recovered indicates that 41BU51 has a Late Archaic component that contributed many or even most of the lithic artifacts, most of the burned rocks and burned clay, some or all of the ceramic artifacts, and probably all of the human burials. Materials representing Late Prehistoric period occupations also are present, and the possibility exists that large numbers of the lithic artifacts in the upper 60 cm of the deposits were left by these occupations. A small number of artifacts predating the Late Archaic period were recovered, but these are older items recycled into younger deposits. Radiocarbon dates indicate that the Late Archaic and Late Prehistoric use of the site occurred over perhaps 3,200 to 3,600 years. The vertical distributions of the temporally sensitive artifacts and the radiocarbon dates, while hinting at some remnant time-related stratification of the cultural materials, make it clear that there has been much mixing of the deposits, presumably through faunal turbation and other forms of disturbance. With this degree of mixing, it is impossible to segregate the remains by time period or more-discrete components. Nonetheless, the archeological remains recovered indicate that 41BU51 was used intermittently over a long span of time, probably as a residential campsite, with some occupations during the Late Archaic period perhaps being for extended periods of time