Antibiotic stewardship in pediatric head and neck surgery

OBJECTIVE: This study seeks to determine the rate of postoperative surgical site infections (SSI) among clean head and neck surgeries and review perioperative antibiotic administration practices. STUDY DESIGN: Retrospective review. SETTING: Pediatric tertiary care institution in New Orleans over a ten-year period. METHODS: A retrospective review was undertaken to identify clean head and neck surgical procedures performed at Manning Family Children\u27s between 2013 and 2023. EPIC SlicerDicer™ was used to identify patients between ages 0-18 who underwent clean head and neck surgeries. Each chart was reviewed for perioperative antibiotic administration and occurrence of postoperative SSI. Rates of SSI were compared between the control group that received no perioperative antibiotics and the study group that received perioperative antibiotics using Chi-square test. Exact Binomial proportion confidence intervals were obtained. RESULTS: 99 patients were identified for the control group, while 93 patients were included in the study group. In the control group, the infection rate was determined to be 3.03 %, with 95 % CI = (0.0063, 0.086). In the study group, the infection rate was found to be 0 with 95 % CI = (0, 0.0389). There was no statistically significant difference in infection rate between the groups (p = 0.2468). CONCLUSION: There are no current pediatric studies to guide evidence-based antibiotic prophylaxis in clean head and neck procedures. This small study did not find a statistically significant difference in infection rate between groups, and that empiric perioperative antibiotic treatment may not change the rate of SSI development in pediatric clean head and neck surgeries. Further studies with larger sample sizes are needed to confirm these findings

Abundance And Vertical Flux Of Pseudo-Nitzschia In The Northern Gulf Of Mexico

Many species of the ubiquitous pennate diatom genus Pseudo-nitzschia have recently been discovered to produce domoic acid, a potent neurotoxin which causes Amnesic Shellfish Poisoning (ASP). Pseudo-nitzschia spp. were extremely abundant (up to 10(8) cells l(-1); present in 67% of 2195 samples) from 1990 to 1994 on the Louisiana and Texas, USA, continental shelves and moderately abundant (up to 10(5) cells l(-1); present in 18% of 192 samples) over oyster beds in the Terrebonne Bay estuary in Louisiana in 1993 and 1994. On the shelf there was a strong seasonal cycle with maxima every spring for 5 yr and sometimes in the fall, which were probably related to river flow, water column stability, and nutrient availability. In contrast, in the estuary there was no apparent seasonal cycle in abundance, but the time series of data is relatively short and the environment highly variable. At one site on the shelf, where sediment traps were deployed from spring to fall and sampled at frequent intervals in both 1990 and 1991, approximately 50% of the Pseudo-nitzschia spp. cells present in the water sank into sediment traps. Pseudo-nitzschia spp. were also abundant in surficial sediments. The species of Pseudo-nitzschia present, during this study were not routinely identified with the methods employed. However, toxin-producing P. multiseries has been identified previously from Galveston Bay, Texas, and cells from a bloom on the shelf in June 1993 were identified by scanning electron microscopy as P. pseudodelicatissima, which is sometimes toxic. Although there have been no known outbreaks of ASP in this area, historical data suggests that Pseudo-nitzschia spp,abundance may have increased on the shelf since the 1950s. It is hypothesized that the increase is due to doubling of the nutrient loading from the Mississippi and Atchafalaya rivers and increased eutrophication on the shelf

Gene co-regulation by Fezf2 selects neurotransmitter identity and connectivity of corticospinal neurons

The neocortex contains an unparalleled diversity of neuronal subtypes, each defined by distinct traits that are developmentally acquired under the control of subtype-specific and pan-neuronal genes. The regulatory logic that orchestrates the expression of these unique combinations of genes is unknown for any class of cortical neuron. Here, we report that Fezf2 is a selector gene able to regulate the expression of gene sets that collectively define mouse corticospinal motor neurons (CSMN). We find that Fezf2 directly induces the glutamatergic identity of CSMN via activation of Vglut1 (Slc17a7) and inhibits a GABAergic fate by repressing transcription of Gad1. In addition, we identify the axon guidance receptor EphB1 as a target of Fezf2 necessary to execute the ipsilateral extension of the corticospinal tract. Our data indicate that co-regulated expression of neuron subtype–specific and pan-neuronal gene batteries by a single transcription factor is one component of the regulatory logic responsible for the establishment of CSMN identity

Diagnostic and clinical experience of patients with pantothenate kinase-associated neurodegeneration

BACKGROUND: Pantothenate kinase-associated neurodegeneration (PKAN) is an autosomal recessive neurodegenerative disorder with brain iron accumulation (NBIA). OBJECTIVES: To assess PKAN diagnostic pathway, history, and burden across the spectrum of PKAN severity from patient and/or caregiver perspectives. METHODS: Caregivers of patients (n = 37) and patients themselves (n = 2) were interviewed in a validation study of the PKAN-Activities of Daily Living (ADL) scale. The current study used quartiles of the PKAN-ADL total score to divide patients by severity of impairment (Lowest, Second Lowest, Third Lowest, Highest). Diagnostic and treatment history, healthcare utilization, disease burden, and caregiver experience were compared between groups. RESULTS: The analyses included data from 39 patients. Mean age at PKAN symptom onset (P = 0.0007), initial MRI (P = 0.0150), and genetic testing (P = 0.0016) generally decreased across the PKAN severity spectrum. The mean duration of illness did not differ among PKAN severity groups (range, 9.7-15.2 years; P = 0.3029). First MRI led to diagnosis in 56.4% of patients (range, 30.0-90.0%). A mean (SD) of 13.0 (13.1) medical and 55.2 (78.5) therapy visits (eg, physical, speech) occurred in the past year. More patients in the higher PKAN severity groups experienced multiple current functional losses and/or earlier onset of problems (P-values \u3c 0.0500). Over half (56.8%) of caregivers experienced a change in employment because of caregiving. The percentage of patients requiring full-time caregiving increased across the PKAN severity spectrum (range, 11.1-100%; P = 0.0021). CONCLUSIONS: PKAN diagnosis was often delayed, most probably due to low awareness. Considerable burden of functional impairment and high healthcare utilization were found across the PKAN severity spectrum

Vaccine-Elicited Mucosal and Systemic Antibody Responses Are Associated with Reduced Simian Immunodeficiency Viremia in Infant Rhesus Macaques

ABSTRACT Despite significant progress in reducing peripartum mother-to-child transmission (MTCT) of human immunodeficiency virus (HIV) with antiretroviral therapy (ART), continued access to ART throughout the breastfeeding period is still a limiting factor, and breast milk exposure to HIV accounts for up to 44% of MTCT. As abstinence from breastfeeding is not recommended, alternative means are needed to prevent MTCT of HIV. We have previously shown that oral vaccination at birth with live attenuated Mycobacterium tuberculosis strains expressing simian immunodeficiency virus (SIV) genes safely induces persistent SIV-specific cellular and humoral immune responses both systemically and at the oral and intestinal mucosa. Here, we tested the ability of oral M. tuberculosis vaccine strains expressing SIV Env and Gag proteins, followed by systemic heterologous (MVA-SIV Env/Gag/Pol) boosting, to protect neonatal macaques against oral SIV challenge. While vaccination did not protect infant macaques against oral SIV acquisition, a subset of immunized animals had significantly lower peak viremia which inversely correlated with prechallenge SIV Env-specific salivary and intestinal IgA responses and higher-avidity SIV Env-specific IgG in plasma. These controller animals also maintained CD4 + T cell populations better and showed reduced tissue pathology compared to noncontroller animals. We show that infants vaccinated at birth can develop vaccine-induced SIV-specific IgA and IgG antibodies and cellular immune responses within weeks of life. Our data further suggest that affinity maturation of vaccine-induced plasma antibodies and induction of mucosal IgA responses at potential SIV entry sites are associated with better control of viral replication, thereby likely reducing SIV morbidity. IMPORTANCE Despite significant progress in reducing peripartum MTCT of HIV with ART, continued access to ART throughout the breastfeeding period is still a limiting factor. Breast milk exposure to HIV accounts for up to 44% of MTCT. Alternative measures, in addition to ART, are needed to achieve the goal of an AIDS-free generation. Pediatric HIV vaccines constitute a core component of such efforts. The results of our pediatric vaccine study highlight the potential importance of vaccine-elicited mucosal Env-specific IgA responses in combination with high-avidity systemic Env-specific IgG in protection against oral SIV transmission and control of viral replication in infant macaques. The induction of potent mucosal IgA antibodies by our vaccine is remarkable considering the age-dependent development of mucosal IgA responses postbirth. A deeper understanding of postnatal immune development may inform the design of improved vaccine strategies to enhance systemic and mucosal SIV/HIV antibody responses

Efficient algorithms for reconstructing gene content by co-evolution

<p>Abstract</p> <p>Background</p> <p>In a previous study we demonstrated that co-evolutionary information can be utilized for improving the accuracy of ancestral gene content reconstruction. To this end, we defined a new computational problem, the Ancestral Co-Evolutionary (ACE) problem, and developed algorithms for solving it.</p> <p>Results</p> <p>In the current paper we generalize our previous study in various ways. First, we describe new efficient computational approaches for solving the ACE problem. The new approaches are based on reductions to classical methods such as linear programming relaxation, quadratic programming, and min-cut. Second, we report new computational hardness results related to the ACE, including practical cases where it can be solved in polynomial time.</p> <p>Third, we generalize the ACE problem and demonstrate how our approach can be used for inferring parts of the genomes of <it>non-ancestral</it> organisms. To this end, we describe a heuristic for finding the portion of the genome ('dominant set’) that can be used to reconstruct the rest of the genome with the lowest error rate. This heuristic utilizes both evolutionary information and co-evolutionary information.</p> <p>We implemented these algorithms on a large input of the ACE problem (95 unicellular organisms, 4,873 protein families, and 10, 576 of co-evolutionary relations), demonstrating that some of these algorithms can outperform the algorithm used in our previous study. In addition, we show that based on our approach a ’dominant set’ cab be used reconstruct a major fraction of a genome (up to 79%) with relatively low error-rate (<it>e.g.</it> 0.11). We find that the ’dominant set’ tends to include metabolic and regulatory genes, with high evolutionary rate, and low protein abundance and number of protein-protein interactions.</p> <p>Conclusions</p> <p>The <it>ACE</it> problem can be efficiently extended for inferring the genomes of organisms that exist today. In addition, it may be solved in polynomial time in many practical cases. Metabolic and regulatory genes were found to be the most important groups of genes necessary for reconstructing gene content of an organism based on other related genomes.</p

Adaptive Radiation in Mediterranean Cistus (Cistaceae)

lineage consists of 12 species primarily distributed in Mediterranean habitats and is herein subject to analysis. lineages), which display asymmetric characteristics: number of species (2 vs. 10), leaf morphologies (linear vs. linear to ovate), floral characteristics (small, three-sepalled vs. small to large, three- or five-sepalled flowers) and ecological attributes (low-land vs. low-land to mountain environments). A positive phenotype-environment correlation has been detected by historical reconstructions of morphological traits (leaf shape, leaf labdanum content and leaf pubescence). Ecological evidence indicates that modifications of leaf shape and size, coupled with differences in labdanum secretion and pubescence density, appear to be related to success of new species in different Mediterranean habitats.

Television device ecologies, prominence and datafication: the neglected importance of the set-top box

A key element of the infrastructure of television now consists of various Internet-connected devices, which play an increasingly important role in the distribution, selection and recommendation of content to users. The aim of this article is to locate the emergence of streaming devices within a longer timeframe of television hardware devices and infrastructures, by focusing on the evolution of one crucial category of such devices, television set-top boxes (STBs). STBs are a taken-for-granted part of many people’s homes across the world, and their global presence and importance are still growing. However, they (and television hardware devices more generally) have been very rarely analysed in television and media studies. To address this lacuna, we trace the development of STBs, delineate changing patterns of ownership and control in STB markets and outline the diverse forms and functions of STBs. We then show how analysis of STBs enriches understanding of two key recent developments in television: increasing battles over prominence and discoverability in a newly abundant video landscape and the collection, analysis and exchange of viewer data by businesses. In doing so, the article shows the importance of television hardware in shaping television as a social and cultural institution