Outcomes in culture positive and culture negative ascitic fluid infection in patients with viral cirrhosis: cohort study

<p>Abstract</p> <p>Background</p> <p>Ascitic fluid infection (AFI) in cirrhotic patients has a high morbidity and mortality. It has two variants namely, spontaneous bacterial peritonitis (SBP) and culture negative neutrocytic ascites (CNNA). The aim of this study was to determine the outcome in cirrhotic patients with culture positive (SBP) and culture negative neutrocytic ascites.</p> <p>Methods</p> <p>We analyzed 675 consecutive hepatitis B and/or C related cirrhosis patients with ascites admitted in our hospital from November 2005 to December 2007. Of these, 187 patients had AFI; clinical and laboratory parameters of these patients including causes of cirrhosis, Child Turcotte Pugh (CTP) score were recorded.</p> <p>Results</p> <p>Out of 187 patients with AFI, 44 (23.5%) had SBP while 143 (76.4%) had CNNA. Hepatitis C virus (HCV) infection was the most common cause of cirrhosis in 139 (74.3%) patients. Patients with SBP had high CTP score as compared to CNNA (12.52 ± 1.45 vs. 11.44 ± 1.66); p < 0.001. Platelets count was low in patients with SBP (101 ± 53 × 10⁹/L) as compared to CNNA (132 ± 91 × 10⁹/L), p = 0.005. We found a high creatinine (mg/dl) (1.95 ± 1.0 vs. 1.44 ± 0.85), (p = 0.003) and high prothrombin time (PT) in seconds (24.8 ± 6.6 vs. 22.4 ± 7.2) (p = 0.04) in SBP as compared to CNNA. More patients with SBP (14/44; 31.8%) had blood culture positivity as compare to CNNA (14/143; 9.8%), p = 0.002. Escherichia. Coli was the commonest organism in blood culture in 15/28 (53.5%) patients. SBP group had a higher mortality (11/44; 25%) as compared to CNNA (12/143; 8.4%), p = 0.003. On multiple logistic regression analysis, creatinine >1.1 mg/dl and positive blood culture were the independent predictors of mortality in patients with SBP.</p> <p>Conclusion</p> <p>Patients with SBP have a higher mortality than CNNA. Independent predictors of mortality in SBP are raised serum creatinine and a positive blood culture.</p

Integrated analysis of topographically high Mafic exposures at Apollo-17 landing site using data from imaging sensors of Chandrayaan-1

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Two Regional Mental Health Treatment Facilities

One of the major social programs of the 1960s was the development of community mental health centers. As with most early attempts at evaluation, the results were pessimistic. This article reanalyzes one of the earliest, and best-known, evaluations of a community-based treatment facility. Following the conceptual framework of Campbell and his associates, it was found that the various threats to the validity of the findings indicate a consistent and systematic bias against detecting a positive effect for the new mental health center. In light of recent federal legislation mandating formal evaluations, appropriate procedures are discussed.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/68090/2/10.1177_0193841X7900300403.pd

Curie: Constraining Solar System Bombardment Using In Situ Radiometric Dating

The Curie mission would constrain the existence of the putative cataclysm by determining the age of samples directly sourced from the impact melt sheet of a major pre-Imbrium lunar basin. The measurements would also enable further understanding of lunar evolution by characterizing new lunar lithologies far from the Apollo and Luna landing sites, including the very low-Ti basalts in Mare Crisium and potential olivine rich lithologies in the margins of both Mare Nectaris and Mars Crisium. Equipped with a mass spectrometer and a LIBS, Curie would also be well-placed to survey volatile components of the lunar regolith, including surface-bound hydrogen

Inferring Airflow Across Martian Dunes From Ripple Patterns and Dynamics

Large ripples form striking patterns on the slopes of martian sand dunes which can be mapped and tracked using high-resolution optical images. The ripples vary in orientation, wavelength, plan-view morphology, and rates of migration. The variations in the ripple patterns are recognized to signal the effects of the regional and local winds and feedbacks between winds and dune topography. We examine the ripple patterns and the motion of these ripples to interpret airflow dynamics around dunes in the dune field at Nili Patera. We find that coincident changes in ripple patterns and migration rates in dune wakes indicate reattachment lengths of 4–7 brink heights. This reattachment length is similar to length scales of flow reattachment for airflow over dunes measured on Earth despite the differences in aeolian environment. Furthermore, ripples on dune flanks are shown to behave according to terrestrial models for ripple development on steep slopes. Compensating for these slope effects allows them to act as indicators of dune-modified and regional wind directions. Changes in ripple patterns and migration rates also signal the response of dunes and airflow during dune collisions. Collectively, we find that differences in ripple patterns connected to changes in migration rate provide information on airflow over and around dunes. This detailed assessment of ripple measurement and ripple migration rates advances the use of ripples on martian dunes and sand sheets to infer dune- and field-scale wind dynamics. These measurements also indicate that the low density atmosphere on Mars does not significantly modify the behavior of wind-topography interactions compared to Earth. Such observations provide targets for computational fluid dynamic and large-eddy simulation models seeking to reveal complex airflows across dune fields both on Earth and on Mars

Safety and efficacy of an oxycodone vaccine: Addressing some of the unique considerations posed by opioid abuse

Among vaccines aimed at treating substance use disorders, those targeting opioids present several unique medication development challenges. 1) Opioid overdose is a common complication of abuse, so it is desirable for an opioid vaccine to block the toxic as well as the addictive effects of opioids. 2) It is important that an opioid vaccine not interfere with the action of opioid antagonists used to reverse opioid overdose or treat addiction. 3) Some opioids are immunosuppressive and chronic ongoing opioid use could interfere with vaccine immunogenicity. 4) Although antibody-bound oxycodone is unable to enter the brain because of its size, it might still be able to activate peripheral opioid receptors. To assess vaccine impact on opioid toxicity, rats vaccinated with oxycodone conjugated to keyhole limpet hemocyanin subunit dimer (OXY-dKLH) adsorbed to alum or controls vaccinated with dKLH were compared with regard to oxycodone-induced hotplate analgesia and oxycodone-induced respiratory depression and bradycardia. Vaccination shifted the dose-response curves to the right, representing protection, for each of these endpoints. Naloxone was equally effective in both OXY-dKLH and control groups, providing complete and rapid reversal of respiratory depression. The administration of a long-acting naltrexone formulation during vaccination did not impair vaccine immunogenicity in mice. Similarly, serum anti-oxycodone antibody titers were not altered by continuous morphine infusion during vaccination compared to opioid-naïve controls. Competitive ELISA assay showed negligible or low affinity of immune antiserum for endogenous opioids or opioid antagonists. In vitro receptor binding assays showed that antibody-bound oxycodone does not activate mu opioid receptors. These data support further study of OXY-dKLH as a potential treatment for oxycodone abuse and suggest that vaccination might also reduce the severity of oxycodone overdose

Premixed methane oxycombustion in nitrogen and carbon dioxide atmospheres: measurement of operating limits, flame location and emissions. Proceedings of the Combustion Institute

AbstractThe influence of O2 concentration on a premixed swirling flame was investigated for changes in discrete levels of CO2 and N2 dilution, with application to carbon capture in gas turbine systems. Chemical kinetic models were utilised to support and analyse generic burner experiments at 37.5kW. O2 mole fraction in the oxygen-diluent stream was varied between 0.21 and 0.70 and careful measurement of velocity field data using particle image velocimetry, representative heat release (OH* chemiluminescence) and flame location (OH planar laser-induced fluorescence) was undertaken. Results show that under lean N2-diluted operating conditions there is a minor change in burner operation for all O2 concentrations considered. CO2 dilution has a far more substantial impact than N2 on flame location, heat release and operational response, which is attributed to the fundamental differences in thermodynamic and transport properties between the two gases. This also resulted in increased CO concentrations sampled from the exhaust stream with a rise in diluent CO2, which is attributed to lower flame temperatures as opposed to thermal dissociation, whilst increased N2 dilution resulted in increasing NOX emissions

Dissociative influence of H2O vapour/spray on lean blowoff and NOx reduction for heavily carbonaceous syngas swirling flames

Recent studies have described and evidenced the enhancement of fundamental combustion parameters such as laminar flame speed due to the catalytic influence of H2O with heavily carbonaceous syngas mixtures. In this study, the potential benefits of these subtle changes in water loading and hence reaction pathways are explored in terms of delayed lean blowoff, and primary emission reduction in a premixed turbulent swirling flame (Ø = 0.6–0.8), scaled for practical relevance. Chemical kinetic models initially confirm that H2O has a substantial impact on the employed fuel behaviour; increasing flame speed by up to 60% across an experimental range representative of fluctuation in atmospheric humidity (∼1.8 mol%). OH* chemiluminescence and OH planar laser induced fluorescence (PLIF) were employed to analyse the changes in heat release structure resulting from the experimental addition of H2O vapour to the combustor. Equivalent concentrations of liquid H2O were introduced into the central recirculation zone of the premixed flame as an atomised spray, to investigate the influence of phase changes on the catalytic effect. Near the lean stability limit, H2O addition compresses heat release to shorten the elongated flame structure. Whereas with a stable and well-defined flame structure, the addition triggers a change in axial heat release location, causing the flame front to retract upstream toward the burner outlet. Higher quantities of two-phase flow were combined to explore the possibility of employing the spray as a stabilising mechanism, effectively dampening the observed influence of humidity. The chemical enhancement induced by the controlled supply was shown to reduce the lean blowoff stability limit, enabling an increase in additional air flow of almost 10%. However, the catalytic effect of H2O diminishes with excessive supply and thermal quenching prevails. There is a compound benefit of NOx reduction from the use of H2O as a flame stabiliser with the practically-relevant syngas: First NOx production decreases due to thermal effect of H2O addition, with potential for further reduction from the change in lean stability limit; leanest experimental concentrations reduced by up to a factor of four with two-phase flow at the highest rates of supply. Hence, the catalytic effect of H2O on reaction pathways and reaction rate predicted and observed in the laminar environment, is shown to translate into practical benefits in the challenging environment of turbulent, swirl-stabilised flames