A Systematic Review of Cases of Meningitis in the Absence of Cerebrospinal Fluid Pleocytosis on Lumbar Puncture

Background: Definitive diagnosis of meningitis is made by analysis of cerebrospinal fluid (CSF) culture or polymerase chain reaction (PCR) obtained from a lumbar puncture (LP), which may take days. A timelier diagnostic clue of meningitis is pleocytosis on CSF analysis. However, meningitis may occur in the absence of pleocytosis on CSF. Areas of Uncertainty: A diagnosis of meningitis seems less likely without pleocytosis on CSF, leading clinicians to prematurely exclude this. Further, there is little available literature on the subject.Methods: Ovid/Medline and Google Scholar search was conducted for cases of CSF culture-confirmed meningitis with lack of pleocytosis. Inclusion criterion was reported cases of CSF culture-positive or PCR positive meningitis in the absence of pleocytosis on LP. Exclusion criteria were pleocytosis on CSF, cases in which CSF cultures/PCR were not performed, and articles that did not include CSF laboratory values.Results: A total of 124 cases from 51 articles were included. Causative organisms were primarily bacterial (99 cases). Outcome was reported in 86 cases, 27 of which died and 59 survived. Mortality in viral, fungal and bacterial organisms was 0, 56 and 31%, respectively. The overall percentage of positive initial CSF PCR/culture for viral, fungal and bacterial organisms was 100, 89 and 82%, respectively. Blood cultures were performed in 79 of the 124 cases, 56 (71%) of which ultimately cultured the causative organism. In addition to bacteremia, concomitant sources of infection occurred in 17 cases.Conclusions: Meningitis in the absence of pleocytosis on CSF is rare. If this occurs, causative organism is likely bacterial. We recommend ordering blood cultures as an adjunct, and, if clinically relevant, concomitant sources of infection should be sought. If meningitis is suspected, empiric antibiotics/antifungals should be administered regardless of initial WBC count on lumbar puncture

Using the Internet to improve university education

Up to this point, university education has largely remained unaffected by the developments of novel approaches to web-based learning. The paper presents a principled approach to the design of problem-oriented, web-based learning at the university level. The principles include providing authentic contexts with multimedia, supporting collaborative knowledge construction, making thinking visible with dynamic visualisation, quick access to content resources via information and communication technologies, and flexible support by tele-tutoring. These principles are used in the MUNICS learning environment, which is designed to support students of computer science to apply their factual knowledge from the lectures to complex real-world problems. For example, students may model the knowledge management in an educational organisation with a graphical simulation tool. Some more general findings from a formative evaluation study with the MUNICS prototype are reported and discussed. For example, the students' ignorance of the additional content resources is discussed in the light of the well-known finding of insufficient use of help systems in software applications

Effective interaction between a colloid and a soft interface near criticality

Within mean-field theory we determine the universal scaling function for the effective force acting on a single colloid located near the interface between two coexisting liquid phases of a binary liquid mixture close to its critical consolute point. This is the first study of critical Casimir forces emerging from the confinement of a fluctuating medium by at least one soft interface, instead by rigid walls only as studied previously. For this specific system, our semi-analytical calculation illustrates that knowledge of the colloid-induced, deformed shape of the interface allows one to accurately describe the effective interaction potential between the colloid and the interface. Moreover, our analysis demonstrates that the critical Casimir force involving a deformable interface is accurately described by a universal scaling function, the shape of which differs from that one for rigid walls.Comment: 19 pages, 11 figure

Medical Toxicology for the Emergency Medicine Clerkship

Medical toxicology is frequently a weak subject area for medical students. This may be due to few fellowship-trained medical toxicologists at academic institutions, overshadowing of medical toxicology by “bread and butter” emergency medicine lectures, and material not being presented in an engaging manner. Power points are often used for lectures to deliver a large amount of content in a short time frame. However, students may become disengaged and experience a “death by power point” feeling

Adverse Effects of Trichothiodystrophy DNA Repair and Transcription Gene Abnormalities on Human Fetal Development

The effects of DNA repair and transcription genes in human prenatal life have never been studied. Trichothiodystrophy (TTD) is a rare (affected frequency of 10^-6^) recessive disorder caused by mutations in genes involved in the nucleotide excision repair (NER) pathway and in transcription. Based on our clinical observations, we conducted a genetic epidemiologic study to investigate gestational outcomes associated with TTD. We compared pregnancies resulting in TTD-affected offspring (N=24) with respect to abnormalities in their antenatal and neonatal periods to pregnancies resulting in their unaffected siblings (N=18), accounting for correlation, and to population reference values. Significantly higher incidence of several severe gestational complications was noted in TTD-affected pregnancies. Gestational complications were noted in nearly all pregnancies resulting in TTD-affected offspring with _XPD_ and _TTDN1_, but not _TTD-A_, gene mutations. Abnormal placental development may explain the constellation of observed complications; therefore, we hypothesize that some TTD genes play an important role in normal placental and fetal development. We investigated this hypothesis by analyzing the expression patterns of TTD genes. Expression of _TTDA_ was strongly negatively correlated (r=-0.7,P<0.0001) with gestational age, while _XPD, XPB_ and _TTDN1_ were consistently expressed from 14 to 40 weeks gestation. *Conclusion:* Our results indicate an important role for _XPD, XPB_ and _TTDN1_ gene products during normal human placental and fetal development

Scheduling Irregular Workloads on GPUs

This doctoral research aims at understanding the nature of the overhead for data irregular GPU workloads, proposing a solution, and examining the consequences of the result. We propose a novel, retry-free GPU workload scheduler for irregular workloads. When used in a Breadth First Search (BFS) algorithm, the proposed simple, monolithic concurrent queue scales to within 10% of ideal scalability on AMD’s Fiji GPU with 14,336 active threads. The dissertation presents an important finding that the retry overhead associated with Compare and Swap (CAS) operations is the principle reason why concurrent queues do not scale well as the number of clients increases in a massively multi-threaded environment

Convergent Evolution in Livebearing Fishes

The directionality and consistency of evolution has long been a subject of contention among evolutionary biologists since the days of Darwin. However, it is unknown how much can be quantified and how much results from more complex variables. It is also unknown whether evolution is consistent or whether it occurs differently in each system. My study focuses on predation and habitat as ecological gradients that may create convergent evolution in livebearing fishes. In Chapter I, I focus on predation as a mechanism for driving convergent evolution in Gambusia affinis. A suite of 7 microsatellite markers was used in order to determine independence of morphological evolution. Mantel tests were used to compare genetic, phenotypic, geographical and environmental distances among the six focal populations. These tests showed that there was a significant correlation between genetic and geographic distance but no significant correlation between genetic and phenotypic distances, which may indicate that phenotypic divergence has arisen independently in multiple instances. The second chapter focuses on a unique form of convergence that arose during speciation of three livebearing fishes, which we termed "convergent speciation." I focus on habitat type as a selective pressure in the lake system of Lake Catemaco, Mexico and the surrounding rivers. Lake Catemaco has been isolated from the surrounding rivers for approximately 1.2 million years and during that time several endemic species have evolved in the lake. This provides an excellent study system for studying convergent divergence. To test the theory of convergent speciation in this system, a MANOVA was conducted. The effect of habitat was an important source of variance in the system, indicating that habitat is a likely driving force responsible for convergent speciation in the system. Using discriminant functions I was able to correctly predict the habitat of fish of six different species between 68% and 71% of the time. This may indicate that evolutionary response to habitat is consistent across taxa (i.e., convergent divergence is taking place)

Defining the grazing season of restored natural grasslands

Grazing native plants is common in the western United States, but the limited amounts of grazing land in Iowa are dominated by exotic, cool-season grasses and legumes. This study explored the nutritional quality and yields of reconstructed native plant grassland and prairies