Różnice wartości zautomatyzowanej pupilometrii służą jako wskaźnik prognostyczny, nawet gdy mieszczą się w normalnym zakresie

Introduction. The pupillary light reflex (PLR) is an integral aspect of the neurologic exam. With the enhancement of automated infrared pupillometry (AIP), the Neurological Pupil index (NPi) is being increasingly used when performing a neurological examination. NPi difference (the absolute difference between paired NPi readings from the left and right eye) is a relatively unexplored variable in AIP assessment.Aim. This study evaluates the association between Glasgow Coma Scale (GCS) scores and NPi differences between the left and right eyes, when the NPi is normal, in patients enrolled in a multi-center prospective database.Material and Methods. Restricting observations to only include NPi values ≥ 3 (normal), there were 2,572 qualifying patients with 3,519 pupillometer readings linked to GCS values. Linear regression and ANOVA models were developed to investigate the relationship between GCS and NPi difference.Results. Subject mean age was 55.88 (16.95) years and 54.5% were female. Mean NPi difference was 0.36 and mean GCS was 12.06. Regression analysis indicated a slight negative association between NPi difference and GCS (r2 = 0.0696, P < .0001). When observations were dichotomized as either NPi difference ≥ 0.7 (large) or < 0.7 (small), there was a statistically significant difference in the mean GCS (10.76 [3.90]) for large NPi difference vs. small NPi difference (13.15 [2.68]; P < .0001).Conclusions. Even among patients with normal PLR, a large NPi difference is associated with lower GCS scores. Trending and evaluating the NPi difference may become an important aspect of patient assessment. (JNNN 2021;10(4):168–174)Wstęp. Odruch źreniczny na światło (PLR) jest integralną częścią badania neurologicznego. Wraz z udoskonaleniem automatycznej pupilometrii w podczerwieni (AIP), wskaźnik neurologiczny źrenicy (NPi) jest coraz częściej używany podczas wykonywania badań neurologicznych. Różnica NPi (bezwzględna różnica między sparowanymi odczytami NPi z lewego i prawego oka) jest stosunkowo niezbadaną zmienną w ocenie AIP.Cel. Niniejsze badanie ocenia związek między wynikami w skali Glasgow (GCS) a różnicami NPi między lewym i prawym okiem, gdy NPi jest prawidłowe, u pacjentów włączonych do wieloośrodkowej prospektywnej bazy danych.Materiał i metody. Ograniczając obserwacje tylko do wartości NPi ≥ 3 (normalne), zakwalifikowano 2572 pacjentów z 3519 odczytami z pupilometru powiązanymi z wartościami GCS. Opracowano modele regresji liniowej i ANOVA w celu zbadania związku między różnicami między GCS a NPi.Wyniki. Średnia wieku badanych wynosiła 55,88 (16,95) lat i 54,5% stanowiły kobiety. Średnia różnica NPi wynosiła 0,36, a średnia GCS 12,06. Analiza regresji wykazała niewielki negatywny związek między różnicą NPi a GCS (r2 = 0,0696, P < 0,0001). Gdy obserwacje zostały rozdzielone jako różnica NPi ≥ 0,7 (duża) lub < 0,7 (mała), wystąpiła statystycznie istotna różnica w średniej GCS (10,76 [3,90]) dla dużej różnicy NPi vs małej różnicy NPi (13,15 [2,68]); P < 0,0001).Wnioski. Nawet wśród pacjentów z prawidłowym PLR duża różnica w NPi wiąże się z niższymi wynikami GCS. Trendy i ocena różnicy NPi mogą stać się ważnym aspektem oceny pacjenta. (PNN 2021;10(4):168–174

Susceptibility Provision Enhances Effective De-escalation (SPEED): utilizing rapid phenotypic susceptibility testing in Gram-negative bloodstream infections and its potential clinical impact

Abstract Objectives We evaluated the performance and time to result for pathogen identification (ID) and antimicrobial susceptibility testing (AST) of the Accelerate Pheno™ system (AXDX) compared with standard of care (SOC) methods. We also assessed the hypothetical improvement in antibiotic utilization if AXDX had been implemented. Methods Clinical samples from patients with monomicrobial Gram-negative bacteraemia were tested and compared between AXDX and the SOC methods of the VERIGENE® and Bruker MALDI Biotyper® systems for ID and the VITEK® 2 system for AST. Additionally, charts were reviewed to calculate theoretical times to antibiotic de-escalation, escalation and active and optimal therapy Results ID mean time was 21 h for MALDI-TOF MS, 4.4 h for VERIGENE® and 3.7 h for AXDX. AST mean time was 35 h for VITEK® 2 and 9.0 h for AXDX. For ID, positive percentage agreement was 95.9% and negative percentage agreement was 99.9%. For AST, essential agreement was 94.5% and categorical agreement was 93.5%. If AXDX results had been available to inform patient care, 25% of patients could have been put on active therapy sooner, while 78% of patients who had therapy optimized during hospitalization could have had therapy optimized sooner. Additionally, AXDX could have reduced time to de-escalation (16 versus 31 h) and escalation (19 versus 31 h) compared with SOC. Conclusions By providing fast and reliable ID and AST results, AXDX has the potential to improve antimicrobial utilization and enhance antimicrobial stewardship

Rola zarejestrowanej objętości wyrzutu płynu mózgowo-rdzeniowego w przewidywaniu wyniku w zmodyfikowanej skali Rankina przy wypisie ze szpitala u pacjentów z krwawieniami podpajęczynówkowymi (DROPSS)

Introduction. External ventricular drain (EVD) placement is common among aneurysmal subarachnoid hemorrhage (aSAH). Draining cerebrospinal fluid (CSF) from the EVD is also common, yet little is known about how much to drain, the length of time to drain, or how drainage impacts patient outcomes. Aim. The purpose of this study is to correlate amount of CSF drainage to patient outcomes, via modified Rankin Score (mRS). Material and Methods. This retrospective review of data located in a local hospital-based registry and electronic medical record. A linear mixed effects model was constructed to examine CSF drainage volume as a predictor of mRS at discharge. Results. Data from 82 patients was included in this analysis. There was no statistically significant relationship between CSF totals and mRS at hospital discharge (p = 0.3614, r² = 0.01). After controlling for age, Hunt and Hess score, and subject as random effect, there was still no significant relationship between CSF drained and mRS score at hospital discharge (p = .9042). Conclusions. There is no correlation between the total volume of CSF drained and mRS at discharge. Future research should explore CSF drainage documentation practices. (JNNN 2022;11(2):43–48) Key Words: acute care, aneurysmal subarachnoid hemorrhage, cerebrospinal fluid, external ventricular drain, patient outcomesWstęp. Założenie drenu komorowego zewnętrznego (EVD) jest powszechne w przypadku tętniakowatego krwotoku podpajęczynówkowego (aSAH). Drenaż płynu mózgowo-rdzeniowego (cerebrospinal fluid, CSF) z EVD jest również powszechny, jednak niewiele wiadomo na temat ilości płynu, czasu trwania drenażu i wpływu drenażu na wyniki leczenia. Cel. Celem tego badania jest korelacja ilości drenażu płynu mózgowo-rdzeniowego z wynikami leczenia pacjentów w zmodyfikowanej skali Rankina (modified Rankin Score, mRS). Materiał i metody. Retrospektywny przegląd danych znajdujących się w lokalnym rejestrze szpitalnym i elektronicznej dokumentacji medycznej. W celu zbadania objętości drenażu płynu mózgowo-rdzeniowego jako predyktora mRS przy wypisie ze szpitala skonstruowano liniowy model efektów mieszanych. Wyniki. Do analizy włączono dane od 82 pacjentów. Nie stwierdzono istotnej statystycznie zależności między całkowitą objętością płynu mózgowo-rdzeniowego a mRS przy wypisie ze szpitala (p = 0,3614, r² = 0,01). Po uwzględnieniu wieku, punktacji w skali Hunta i Hessa oraz podmiotu jako efektu losowego, nadal nie było istotnej zależności między odsączonym płynem mózgowo-rdzeniowym a wynikiem mRS przy wypisie ze szpitala (p = .9042). Wnioski. Nie ma korelacji między całkowitą objętością zdrenowanego płynu mózgowo-rdzeniowego a mRS przy wypisie ze szpitala. W przyszłych badaniach należy przeanalizować sposób prowadzenia dokumentacji drenażu płynu mózgowo-rdzeniowego. (PNN 2022;11(2):43–48)

Machine learning reveals singing rhythms of male Pacific field crickets are clock controlled

Circadian rhythms are ubiquitous in nature and endogenous circadian clocks drive the daily expression of many fitness-related behaviors. However, little is known about whether such traits are targets of selection imposed by natural enemies. In Hawaiian populations of the nocturnally active Pacific field cricket (Teleogryllus oceanicus), males sing to attract mates, yet sexually selected singing rhythms are also subject to natural selection from the acoustically orienting and deadly parasitoid fly, Ormia ochracea. Here, we use T. oceanicus to test whether singing rhythms are endogenous and scheduled by circadian clocks, making them possible targets of se lection imposed by flies. We also develop a novel audio-to-circadian analysis pipeline, capable of extracting useful parameters from which to train machine learning algorithms and process large quantities of audio data. Singing rhythms fulfilled all criteria for endogenous circadian clock control, including being driven by photoschedule, self-sustained periodicity of approximately 24 h, and being robust to variation in temperature. Furthermore, singing rhythms varied across individuals, which might suggest genetic variation on which natural and sexual selection pressures can act. Sexual signals and ornaments are well-known targets of selection by natural enemies, but our findings indicate that the circadian timing of those traits’ expression may also determine fitnes

Direct antimicrobial susceptibility testing of positive blood cultures: A comparison of the accelerate Pheno™ and VITEK® 2 systems

Objectives To compare the performance and time-to-result (TTR) for antimicrobial susceptibility testing (AST) of positive blood cultures (PBC) using the Accelerate Pheno™ system (AXDX) and both a direct VITEK® 2 card inoculation workflow (DV2) and traditional FDA-approved VITEK® 2 workflow using subcultured isolates (V2). Methods Patient samples with monomicrobial Gram-negative rod bacteremia were tested on AXDX and DV2 in tandem, and compared to V2 AST results. Categorical agreement (CA) errors were adjudicated using broth microdilution. Instrumentation times and AST TTR were compared. Results AXDX and DV2 had a CA of 91.5% and 97.4%, respectively, compared to V2. Post-adjudication, AXDX, DV2, and V2 had CA of 94.7%, 95.7% and 96.5%, respectively. Instrument run times were 6.6 h, 9.4 h, and 9.2 h, and AST TTR were 8.9 h, 12.9 h and 35.5 h, respectively. Conclusions AXDX and DV2 AST is fast and reliable, which may have significant antimicrobial stewardship implications

DNA profile components predict malignant outcomes in select cases of intraductal papillary mucinous neoplasm with negative cytology

Predicting malignancy in intraductal papillary mucinous neoplasm remains challenging. Integrated molecular pathology combines pancreatic fluid DNA and clinical factors into a malignant potential score. We sought to determine the utility of DNA components alone in predicting high-grade dysplasia/invasive disease. Methods We reviewed prospectively the records from 1,106 patients with intraductal papillary mucinous neoplasm. We excluded non-intraductal papillary mucinous neoplasm cases and cases with definitive malignant cytology. A total 225 patients had 283 DNA profiles (98 followed by surgery, 185 followed by ≥23-month surveillance). High-grade dysplasia/invasive outcomes were high-grade dysplasia, intraductal papillary mucinous neoplasm-invasive, and adenocarcinoma on surgical pathology or mesenteric or vascular invasion, metastases, or biopsy with high-grade dysplasia or adenocarcinoma during surveillance. Results High-quantity DNA predicted (P = .004) high-grade dysplasia/invasive disease outcomes with sensitivity of 78.3%, but 52.7% specificity, indicating benign cases may exhibit high-quantity DNA. High clonality loss of heterozygosity of tumor suppressor genes was 98.0% specific, strongly predicted high-grade dysplasia/invasive disease but lacked sensitivity (20.0%). High-quantity DNA + high clonality loss of heterozygosity had 99.0% specificity for high-grade dysplasia/invasive disease. KRAS mutation alone did not predict high-grade dysplasia/invasive disease, but, when combined with high-quantity DNA (specificity 84.7%) and high clonality loss of heterozygosity (specificity 99.0%) strongly predicted high-grade dysplasia/invasive outcomes. Conclusion Certain DNA components are highly specific for high-grade dysplasia/invasive disease and may indicate aggressive lesions, requiring resection when cytology fails

2006 SQ372: A Likely Long-Period Comet from the Inner Oort Cloud

We report the discovery of a minor planet (2006 SQ372) on an orbit with a perihelion of 24 AU and a semimajor axis of 796 AU. Dynamical simulations show that this is a transient orbit and is unstable on a timescale of 200 Myrs. Falling near the upper semimajor axis range of the scattered disk and the lower semimajor axis range of the Oort Cloud, previous membership in either class is possible. By modeling the production of similar orbits from the Oort Cloud as well as from the scattered disk, we find that the Oort Cloud produces 16 times as many objects on SQ372-like orbits as the scattered disk. Given this result, we believe this to be the most distant long-period comet ever discovered. Furthermore, our simulation results also indicate that 2000 OO67 has had a similar dynamical history. Unaffected by the "Jupiter-Saturn Barrier," these two objects are most likely long-period comets from the inner Oort Cloud

Exploring the limits of ultracold atoms in space

Existing space-based cold atom experiments have demonstrated the utility of microgravity for improvements in observation times and for minimizing the expansion energy and rate of a freely evolving coherent matter wave. In this paper we explore the potential for space-based experiments to extend the limits of ultracold atoms utilizing not just microgravity, but also other aspects of the space environment such as exceptionally good vacuums and extremely cold temperatures. The tantalizing possibility that such experiments may one day be able to probe physics of quantum objects with masses approaching the Planck mass is discussed

Accurate Atmospheric Parameters at Moderate Resolution Using Spectral Indices: Preliminary Application to the MARVELS Survey

Studies of Galactic chemical and dynamical evolution in the solar neighborhood depend on the availability of precise atmospheric parameters (Teff, [Fe/H] and log g) for solar-type stars. Many large-scale spectroscopic surveys operate at low to moderate spectral resolution for efficiency in observing large samples, which makes the stellar characterization difficult due to the high degree of blending of spectral features. While most surveys use spectral synthesis, in this work we employ an alternative method based on spectral indices to determine the atmospheric parameters of a sample of nearby FGK dwarfs and subgiants observed by the MARVELS survey at moderate resolving power (R~12,000). We have developed three codes to automatically normalize the observed spectra, measure the equivalent widths of the indices and, through the comparison of those with values calculated with pre-determined calibrations, derive the atmospheric parameters of the stars. The calibrations were built using a sample of 309 stars with precise stellar parameters obtained from the analysis of high-resolution FEROS spectra. A validation test of the method was conducted with a sample of 30 MARVELS targets that also have reliable atmospheric parameters from high-resolution spectroscopic analysis. Our approach was able to recover the parameters within 80 K for Teff, 0.05 dex for [Fe/H] and 0.15 dex for log g, values that are lower or equal to the typical external uncertainties found between different high-resolution analyzes. An additional test was performed with a subsample of 138 stars from the ELODIE stellar library and the literature atmospheric parameters were recovered within 125 K for Teff, 0.10 dex for [Fe/H] and 0.29 dex for log g. These results show that the spectral indices are a competitive tool to characterize stars with the intermediate resolution spectra.Comment: Accepted for publication in AJ. Abstract edited to comply with arXiv standards regarding the number of character