The Effects of Antenatal Betamethasone on Late Preterm Infants

Administration of steroids to mothers expected to deliver in the late preterm period has previously been found to decrease neonatal respiratory morbidity. In this retrospective chart review, there were no significant differences between groups in the primary outcome of required respiratory support for the neonate, incidence of periventricular hemorrhage or neonatal death. However, this study found that their rate of hyperbilirubinemia, need for phototherapy, and NICU stays were longer than their counterparts whose mothers did not receive steroids or who only received one dose.These findings may provide support for future protocols directed to improve neonatal morbidity secondary to jaundice

Community Resilience Management : Reflections and Strategies from Corporate Sustainability

Creating community resilience is a daunting task, both in scope and application, therefore it is useful to examine related efforts to inform our strategy. Sustainability, specifically corporate sustainability, has developed through similar challenges and provides insight into the possible trajectory of community resilience management. We find that both concepts reflect similar origins, developmental paths and merging goals at a scale that can be systematically managed. Therefore, we describe four strategies from corporate sustainability management that can be applied to community resilience 1) consider the community context while implementing an increasingly broad view of responsibility; 2) integrate and engage across constructs; 3) employ strategic approaches including performance measurement and assessment of progress; 4) communicate with and engage stakeholders; In doing this, we can leverage our efforts, experience, and successes to transform scorecards into strategies, programs into processes, results into sustained performance and engagement into capable, robust and resilient communities

Efeito do congelamento sobre a viabilidade de células leveduriformes

O controle de produtos de origem animal está diretamente associado à sanidade animal e à saúde pública. Na suspeita de mastite, tanto bacteriana quanto micótica, o congelamento de amostras de leite permite aumentar o período de tempo para análise microbiológica, permitindo um correto diagnóstico laboratorial. As leveduras são os principais agentes ambientais envolvidos na mastite micótica. O objetivo do presente trabalho foi verificar se o congelamento afeta a recuperação de leveduras potencialmente presentes no leite. Foram utilizados seis isolados:  Rhodotorula sp. (L1), Geotrichum sp. (L2), Cryptococcus sp. (L3), Candida tropicalis (L4) e Candida albicans (L5), oriundos de leite in natura, e um isolado de C. parapsilosis (ATCC 22019). Após a inoculação experimental, as amostras foram congeladas durante 10 dias, 3, 6 e 8 semanas. O congelamento do leite por períodos superiores a 10 dias causou redução no número de células viáveis. Sugerimos que sejam utilizados períodos mais curtos de congelamento para a análise micológica do leite

Plasmid-Mediated Transmission of KPC-2 Carbapenemase in Enterobacteriaceae in Critically III Patients

Carbapenem-resistant Enterobacteriaceae (CRE) cause health care-associated infections worldwide, and they are of severe concern due to limited treatment options. We report an outbreak of KPC-2-producing CRE that was caused by horizontal transmission of a promiscuous plasmid across different genera of bacteria and hospitals in Germany. Eleven isolates (8 Citrobacter freundii, 2 Klebsiella oxytoca, and 1 Escherichia coli) were obtained from seven critically ill patients during the six months of the outbreak in 2016. One patient developed a CRE infection while the other six patients were CRE-colonized. Three patients died in the course of the hospital stay. Six of the seven patients carried the same C. freundii clone; one K. oxytoca clone was found in two patients, and one patient carried E. coli and C. freundii. Molecular analysis confirmed the presence of a conjugative, blaKPC-2-carrying 70 kb-IncN plasmid in C. freundii and E. coli and an 80 kb-IncN plasmid in K. oxytoca. All transconjugants harbored either the 70 or 80 kb plasmid with blaKPC-2, embedded within transposon variant Tn4401g. Whole genome sequencing and downstream bioinformatics analyses of all plasmid sequences showed an almost perfect match when compared to a blaKPC-2-carrying plasmid of a large outbreak in another German hospital two years earlier. Differences in plasmid sizes and open reading frames point to the presence of inserted mobile genetic elements. There are few outbreak reports worldwide on the transmission of blaKPC-2-carrying plasmids across different bacterial genera. Our data suggest a regional and supraregional spread of blaKPC-2-carrying IncN-plasmids harboring the Tn4401g isoform in Germany.</p

Challenges and Outcomes of Posterior Wall Isolation for Ablation of Atrial Fibrillation

BACKGROUND: The left atrial posterior wall (PW) often contains sites required for maintenance of atrial fibrillation (AF). Electrical isolation of the PW is an important feature of all open surgeries for AF. This study assessed the ability of current ablation techniques to achieve PW isolation (PWI) and its effect on recurrent AF. METHODS AND RESULTS: Fifty-seven consecutive patients with persistent or high-burden paroxysmal AF underwent catheter ablation, which was performed using an endocardial-only (30) or a hybrid endocardial-epicardial procedure (27). The catheter ablation lesion set included pulmonary vein antral isolation and a box lesion on the PW (roof and posterior lines). Success in creating the box lesion was assessed as electrical silence of the PW (voltage <0.1 mV) and exit block in the PW with electrical capture. Cox proportional hazards models were used for analysis of AF recurrence. PWI was achieved in 21 patients (36.8%), more often in patients undergoing hybrid ablation than endocardial ablation alone (51.9% versus 23.3%, P=0.05). Twelve patients underwent redo ablation. Five of 12 had a successful procedural PWI, but all had PW reconnection at the redo procedure. Over a median follow-up of 302 days, 56.1% of the patients were free of atrial arrhythmias. No parameter including procedural PWI was a statistically significant predictor of recurrent atrial arrhythmias. CONCLUSIONS: PWI during catheter ablation for AF is difficult to achieve, especially with endocardial ablation alone. Procedural achievement of PWI in this group of patients was not associated with a reduction in recurrent atrial arrhythmias, but reconnection of the PW was common

Perinatal Depression and Its Impact on Infant Outcomes and Maternal-Nurse SMS Communication in a Cohort of Kenyan Women

Abstract: Background Perinatal depression is broadly defined as depressive symptoms during pregnancy or within the 12 months following delivery, affecting approximately 20-25% of pregnant and postpartum women in low- and middle-income countries. The wide accessibility of mobile phones allows mobile health (mHealth) interventions to be considered a solution to identify perinatal depression and provide appropriate referrals for treatment. This study, nested in a larger SMS communication project, examined the prevalence and correlates of perinatal depression, determined the association between antenatal depression and infant morbidity/mortality, and compared SMS communication patterns between women with and without perinatal depression. Methods This was a prospective longitudinal cohort of pregnant women seeking antenatal services at two public sector health clinics in Kenya. SMS messages were sent to participants with educational content related to their pregnancy and infant health and two-way SMS communication occurred with a nurse. Sociodemographic and obstetric characteristics, SMS messaging behaviors, infant health status, and depressive symptoms were assessed by a standardized questionnaire administered at enrollment (30-36 weeks gestation) and follow-up (14 weeks postpartum). Generalized estimating equation (GEE) with Poisson link was used to evaluate correlates of perinatal depressive symptoms, infant outcomes, and frequency of SMS messaging. Results Of the 572 women with complete follow-up information, 188 (32.9%) screened positive for elevated depressive symptoms (≥10 by EPDS scale) at some time point during pregnancy or postpartum. The strongest predictors of depressive symptoms included abuse during pregnancy, fewer years of schooling, and maternal unemployment. Antenatal depressive symptoms were associated with an increased risk of infant illness or hospitalization (RR = 1.12, 95% CI: 1.11, 1.13). Women with antenatal or persistent perinatal depressive symptoms sent fewer SMS messages during the study period than their counterparts without depression. Conclusions Prevalence of elevated perinatal depressive symptoms was high in this cohort of Kenyan women. Our findings highlight the importance of screening perinatal women for experiences of abuse and symptoms of depression. Differences in messaging frequency between women with vs. without depressive symptoms presents a potential opportunity to provide more support for those perinatal depression

Detecção de parvovírus suíno em fetos abortados através da técnica nested-PCR

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Unobscured Type 2 AGNs

Type 2 AGNs with intrinsically weak broad emission lines (BELs) would be exceptions to the unified model. After examining a number of proposed candidates critically, we find that the sample is contaminated significantly by objects with BELs of strengths indicating that they actually contain intermediate-type AGNs, plus a few Compton-thick sources as revealed by extremely low ratios of X-ray to nuclear IR luminosities. We develop quantitative metrics that show two (NGC 3147 and NGC 4594) of the remaining candidates to have BELs 2-3 orders of magnitude weaker than those of typical type-1 AGNs. Several more galaxies remain as candidates to have anomalously weak BELs, but this status cannot be confirmed with the existing information. Although the parent sample is poorly defined, the two confirmed objects are well under 1% of its total number of members, showing that the absence of a BEL is possible, but very uncommon in AGN. We evaluate these two objects in detail using multi-wavelength measurements. They have little X-ray extinction with N_H < 10^21 cm^{-2}. Their IR spectra show strong silicate emission (NGC 4594) or weak aromatic features on a generally power law continuum with a suggestion of silicates in emission (NGC 3147). No polarized BEL is detected in NGC 3147. These results indicate that the two unobscured type-2 objects have circumnuclear tori that are approximately face-on. Combined with their X-ray and optical/UV properties, this behavior implies that we have an unobscured view of the nuclei and thus that they have intrinsically weak BELs. We compare their properties with those of the other less-extreme candidates. We then compare the distributions of bolometric luminosities and accretion rates of these objects with theoretical models that predict weak BELs.Comment: Accepted for publication in ApJ, 17 pages, 13 figure

User needs elicitation via analytic hierarchy process (AHP). A case study on a Computed Tomography (CT) scanner

Background: The rigorous elicitation of user needs is a crucial step for both medical device design and purchasing. However, user needs elicitation is often based on qualitative methods whose findings can be difficult to integrate into medical decision-making. This paper describes the application of AHP to elicit user needs for a new CT scanner for use in a public hospital. Methods: AHP was used to design a hierarchy of 12 needs for a new CT scanner, grouped into 4 homogenous categories, and to prepare a paper questionnaire to investigate the relative priorities of these. The questionnaire was completed by 5 senior clinicians working in a variety of clinical specialisations and departments in the same Italian public hospital. Results: Although safety and performance were considered the most important issues, user needs changed according to clinical scenario. For elective surgery, the five most important needs were: spatial resolution, processing software, radiation dose, patient monitoring, and contrast medium. For emergency, the top five most important needs were: patient monitoring, radiation dose, contrast medium control, speed run, spatial resolution. Conclusions: AHP effectively supported user need elicitation, helping to develop an analytic and intelligible framework of decision-making. User needs varied according to working scenario (elective versus emergency medicine) more than clinical specialization. This method should be considered by practitioners involved in decisions about new medical technology, whether that be during device design or before deciding whether to allocate budgets for new medical devices according to clinical functions or according to hospital department