Interprofessional Extracorporeal Membrane Oxygenation Cardiopulmonary Resuscitation Simulations Aimed at Decreasing Actual Cannulation Times: A Longitudinal Study

BACKGROUND

Since 2013, the cardiac intensive care unit (CICU) at Children's National has conducted annual extracorporeal membrane oxygenation cardiopulmonary resuscitation (ECPR) simulations that focus on team dynamics, room setup, and high-quality CPR. In 2019 and 2020, the simulations were expanded to include the surgical and extracorporeal membrane oxygenation (ECMO) teams in an effort to better understand and improve this process.

METHODS

During a 4-week period in 2019, 7 peripheral ECPR simulations were conducted, and through a 3-week period in 2020, 7 central ECPR simulations were conducted. Participants in each session included: 8 to 10 CICU nurses, 1 CICU attending, 1 to 2 ICU or cardiology fellows, 1 cardiovascular surgery fellow or attending, and 1 ECMO specialist. For each session, the scenario continued until the simulated patient was on full cardiopulmonary bypass. An ECMO trainer was used for peripheral simulations and a 3-dimensionally-printed heart was used for central cannulations. An ECMO checklist was used to objectively determine when the patient and room were fully prepared for surgical intervention, and simulated cannulation times were recorded for both groups. A retrospective chart review was conducted to compare actual cannulation times before and after the intervention period, and video was used to review the events and assist in dividing them into medical versus surgical phases. Control charts were used to trend the total ECPR times before and after the intervention period, and mean and P values were calculated for both ECPR times and for all other categorical data.

RESULTS

Mean peripheral ECPR times decreased significantly from 71.7 to 45.1 minutes ( P = 0.036) after the intervention period, and this was reflected by a centerline shift. Although we could not describe a similar decrease in central ECPR times because there were only 6 postintervention events, the times for each of these events were shorter than the historical mean of 37.8 minutes. There was a trend in improved survival, which did not meet significance both among patients undergoing peripheral ECPR (15.4% ± 10% to 43.8% ± 12.4%, P = 0.10) and central ECPR (36.4% ± 8.4% to 50% ± 25%, P = 0.60). The percentage of time dedicated to the medical phases of the actual versus simulated procedures was very consistent among both peripheral (33.0% vs. 31.9%) and central (39.6% vs. 39.8%) cannulations.

CONCLUSIONS

We observed a significant decrease in peripheral cannulation times at our institution after conducting interprofessional ECPR simulations taken to the establishment of full cardiopulmonary bypass. The use of an ECMO trainer and a 3-dimensionally-printed heart allowed for both the medical and surgical phases of the procedure to be studied in detail, providing opportunities to streamline and improve this complex process. Larger multisite studies will be needed in the future to assess the effect of efforts like these on patient survival.

Leukocyte Chemotactic Factor 2 Amyloidosis (ALECT2) Distribution in a Mexican Population

OBJECTIVES

To assess the prevalence of leukocyte cell-derived chemotactic 2 (LECT2), its organ involvement, and its clinical association in autopsies from an ethnically biased population.

METHODS

The tissues from all autopsies of individuals diagnosed with amyloidosis were reassessed and typed for amyloid light chain (AL) amyloidosis, amyloid A (AA) amyloidosis, transthyretin amyloidosis (ATTR), and leukocyte chemotactic factor 2 amyloidosis (ALECT2) by immunohistochemistry. Organ involvement was described and correlated with its clinical associations.

RESULTS

Of 782 autopsies, 27 (3.5%) had a confirmed diagnosis of amyloidosis. Of these, 14 (52%) corresponded to ALECT2, 5 (19%) to AL amyloidosis, 2 (7%) to ATTR amyloidosis, 1 (4%) to AA amyloidosis, and 5 (21%) as undetermined-type amyloidosis. The LECT2 amyloid deposits were found in the kidneys, liver, spleen, and adrenal glands in most individuals. Except for the kidneys, there were no clinical signs suggestive of amyloid deposition in most of the affected organs. LECT2 amyloidosis was not associated with the cause of death in any case. No cases had heart or brain involvement. Potential subclinical effects of amyloid deposition in organs such as adrenal glands and spleen require further study.

CONCLUSIONS

This autopsy study confirms the high prevalence of LECT2 amyloidosis in the Mexican population, with frequent amyloid deposition in the kidneys, liver, spleen, and adrenal glands.

Coagulation and hemolysis complications in neonatal ECLS: Role of devices

Neonatal extracorporeal life support (ECLS) has enjoyed a long history of successful patient support for both cardiac and respiratory failure. The small size of this patient population has provided many technical challenges from cannulation to pumps and oxygenators. This is further complicated by the relatively meager commercial options for equipment owing to the relatively low utilization of neonatal ECLS compared to adults, which has exploded following the H1N1 epidemic and the availability of the polymethylpentene oxygenator. This paper focuses on the impact of equipment choices on thrombosis and hemolysis in neonatal ECLS and the underlying mechanisms behind them. Based upon the available evidence, it is clear neonatal ECLS requires careful attention to the selection and operation of all parts of the ECLS system. Practitioners should also be aware of the factors that increase blood cell fragility, which can impact decisions around equipment and subsequent operation.

ELSO Guidelines for Adult and Pediatric Extracorporeal Membrane Oxygenation Circuits

DISCLAIMER

This guideline describes the ECMO circuit for all patient populations. These guidelines describe safe practice based on extensive experience and are considered consensus guidelines. These guidelines are not intended to define standard of care and are revised at regular intervals as new information, devices, medications, and techniques become available.

Evidence of weak Anderson localization revealed by the resistivity, transverse magnetoresistance and Hall effect measured on thin Cu films deposited on mica

We report the resistivity of 5 Cu films approximately 65 nm thick, measured between 5 and 290 K, and the transverse magnetoresistance and Hall effect measured at temperatures 5 K < T < 50 K. The mean grain diameters are D = (8.9, 9.8, 20.2, 31.5, 34.7) nm, respectively. The magnetoresistance signal is positive in samples where D > L/2 (where L = 39 nm is the electron mean free path in the bulk at room temperature), and negative in samples where D < L/2. The sample where D = 20.2 nm exhibits a negative magnetoresistance at B < 2 Tesla and a positive magnetoresistance at B > 3 Tesla. A negative magnetoresistance in Cu films has been considered evidence of charge transport involving weak Anderson localization. These experiments reveal that electron scattering by disordered grain boundaries found along L leads to weak Anderson localization, confirming the localization phenomenon predicted by the quantum theory of resistivity of nanometric metallic connectors. Anderson localization becomes a severe obstacle for the successful development of the circuit miniaturization effort pursued by the electronic industry, for it leads to a steep rise in the resistivity of nanometric metallic connectors with decreasing wire dimensions (D < L/2) employed in the design of Integrated Circuits.

Basal Ganglia Intracranial Mixed Germ Cell Tumor With Predominance of Yolk Sac Component

Introduction/Objective

Primary intracranial germ cell tumors (ICGCTs) represent a rare heterogenous group of neoplasms with an overall incidence of 3% of all pediatric brain tumors. ICGCTs are classified into germinomatous and non-germinomatous tumors and approximately 25% are mixed, and contain more than one histologic component. Most ICGCTs are located in suprasellar and pineal regions with some occurring in rare locations such as basal ganglia, thalamus and fourth ventricle.

Methods

In our case, A 9-year-old Asian-American male presented with headaches and a few weeks history of unilateral weakness. Imaging showed a left basal ganglia lesion with midline shift. Serum AFP was elevated at 17,974.5ng/ml.

Results

Histology revealed a biphasic tumor with a predominant yolk-sac component composed of sheets of pleomorphic cells with prominent nucleoli, focally arranged in a reticular pattern with hyaline globules, increased mitoses and foci of necrosis. A lesser component display features of germinoma, in the form of sheets and nests of large cells with clear vacuolated cytoplasm separated by fibrous septa with lymphocytic infiltrates. Tumor cells in yolk sac component were positive for AFP, while PLAP, CD117, D240 stained germinoma component. After receiving 6 courses of chemotherapy and radiation, MRI did not show any evidence of residual disease.

Conclusion

Pathogenesis of ICGCT is thought to be either from primordial germ cells that have migrated aberrantly during embryonic development or from pluripotent embryonic cells that have been entrapped into lateral mesoderm due to misfolding and misplacement and then undergo malignant transformation. The outcomes of ICGCTs differ among histological subtypes. Highest survival rates are seen in patients with germinomas or mature teratomas (10- year survival rate &gt;90% in both groups. The lowest survival rates are seen in choriocarcinoma, embryonal carcinoma and yolk sac tumor.

Improving multi-technique monitoring using Sentinel-1 and Cosmo-SkyMed data and upgrading groundwater model capabilities

Aquifer-systems have become a strategic source of fresh water in the present climatic conditions, especially under stress in arid regions like the Iberian Mediterranean Arc. Understanding the behavior of groundwater reservoirs is crucial to their well-management and mitigation of adverse consequences of overexploitation. In this work, we use space geodetic measurements from satellite interferometric synthetic aperture radar (InSAR) and Global Positioning System (GPS) data, covering the period 2011-2017, to predict and validate the ground surface displacement over the fastest subsiding basin due to groundwater withdrawal in Europe (>10 cm/year). The 2D decomposition of InSAR displacements from Cosmo-SkyMed and Sentinel-1 satellites allows us to detect horizontal deformation towards the basin center, with a maximum displacement of 1.5 cm/year. InSAR results were introduced in a newly developed methodology for aquifer system management to estimate unknown pumping rates for the 2012-2017 period. This study illustrates how the combination of InSAR data, groundwater flow and deformation models can be used to improve the aquifer-systems sustainable management.

Spontaneous Complete Regression of Testicular Germ Cell Tumor: A Case Report

Testicular germ cell tumors (TGCTs) may spontaneously regress, making it a diagnostic challenge. We present here a case of 39-year-old African American male with constant abdominal pain radiating into the back. Computed tomography identified bulky retroperitoneal lymphadenopathy. There was no history of testicular trauma. Ultrasonography of right testicle revealed multiple microcalcifications, and a laboratory test indicated elevated beta-hCG and LDH. Patient underwent right orchiectomy, which revealed a grossly well-demarcated white oval lesion (3.1 cm). Histologic examination identified a fibrotic lesion in a background of atrophic parenchyma consistent with scar tissue. The specimen was completely submitted for microscopic evaluation, but neoplasia was not identified. A placental alkaline phosphatase (PLAP) immunohistochemical stain failed to reveal residual germ cell neoplasm in situ. Biopsy of retroperitoneal lymph node identified malignant neoplastic cells expressing PLAP, CD117, CD30, and cytokeratin AE1/AE3. The morphology and immunophenotype were consistent with metastatic germ cell tumor. Spontaneous regression of TGCT is defined as partial or complete tumor disappearance without any treatment. The clinical presentation could be nonspecific. Histologically, tumor regression is indicated by formation of fibrous scar, testicular atrophy, microcalcification, lymphoplasmacytic infiltration, and hemosiderin-phagocytosed macrophages, all of which were present in the current case. However, similar histological features could be identified in testicular ischemia or infraction. Therefore, the diagnosis of complete regression of TGCT is challenging and frequently relies on the present of extragonadal germ cell tumor. In the current case, we reported a spontaneous complete regression of TGCT, supported by a spectrum of histological features and metastasis to retroperitoneal lymph node. Spontaneous regression of TGCT is rare, with less than 150 cases reported in the literature. Since there is a lack of definitive histologic criteria to diagnose complete spontaneous regression of TGCT, when scarring is seen in the testis, additional clinical and imaging evaluation should be followed.

Highly curved image sensors: a practical approach for improved optical performance

The significant optical and size benefits of using a curved focal surface for imaging systems have been well studied yet never brought to market for lack of a high-quality, mass-producible, curved image sensor. In this work we demonstrate that commercial silicon CMOS image sensors can be thinned and formed into accurate, highly curved optical surfaces with undiminished functionality. Our key development is a pneumatic forming process that avoids rigid mechanical constraints and suppresses wrinkling instabilities. A combination of forming-mold design, pressure membrane elastic properties, and controlled friction forces enables us to gradually contact the die at the corners and smoothly press the sensor into a spherical shape. Allowing the die to slide into the concave target shape enables a threefold increase in the spherical curvature over prior approaches having mechanical constraints that resist deformation, and create a high-stress, stretch-dominated state. Our process creates a bridge between the high precision and low-cost but planar CMOS process, and ideal non-planar component shapes such as spherical imagers for improved optical systems. We demonstrate these curved sensors in prototype cameras with custom lenses, measuring exceptional resolution of 3220 line-widths per picture height at an aperture of f/1.2 and nearly 100% relative illumination across the field. Though we use a 1/2.3" format image sensor in this report, we also show this process is generally compatible with many state of the art imaging sensor formats. By example, we report photogrammetry test data for an APS-C sized silicon die formed to a 30° subtended spherical angle. These gains in sharpness and relative illumination enable a new generation of ultra-high performance, manufacturable, digital imaging systems for scientific, industrial, and artistic use.

Interactive Effect of UVR and Phosphorus on the Coastal Phytoplankton Community of the Western Mediterranean Sea: Unravelling Eco-Physiological Mechanisms

Some of the most important effects of global change on coastal marine systems include increasing nutrient inputs and higher levels of ultraviolet radiation (UVR, 280-400 nm), which could affect primary producers, a key trophic link to the functioning of marine food webs. However, interactive effects of both factors on the phytoplankton community have not been assessed for the Mediterranean Sea. An in situ factorial experiment, with two levels of ultraviolet solar radiation (UVR+PAR vs. PAR) and nutrients (control vs. P-enriched), was performed to evaluate single and UVR×P effects on metabolic, enzymatic, stoichiometric and structural phytoplanktonic variables. While most phytoplankton variables were not affected by UVR, dissolved phosphatase (APAEX) and algal P content increased in the presence of UVR, which was interpreted as an acclimation mechanism of algae to oligotrophic marine waters. Synergistic UVR×P interactive effects were positive on photosynthetic variables (i.e., maximal electron transport rate, ETRmax), but negative on primary production and phytoplankton biomass because the pulse of P unmasked the inhibitory effect of UVR. This unmasking effect might be related to greater photodamage caused by an excess of electron flux after a P pulse (higher ETRmax) without an efficient release of carbon as the mechanism to dissipate the reducing power of photosynthetic electron transport.

Quantification of carbon and phosphorus co-limitation in bacterioplankton: new insights on an old topic

Because the nature of the main resource that limits bacterioplankton (e.g. organic carbon [C] or phosphorus [P]) has biogeochemical implications concerning organic C accumulation in freshwater ecosystems, empirical knowledge is needed concerning how bacteria respond to these two resources, available alone or together. We performed field experiments of resource manipulation (2×2 factorial design, with the addition of C, P, or both combined) in two Mediterranean freshwater ecosystems with contrasting trophic states (oligotrophy vs. eutrophy) and trophic natures (autotrophy vs. heterotrophy, measured as gross primary production:respiration ratio). Overall, the two resources synergistically co-limited bacterioplankton, i.e. the magnitude of the response of bacterial production and abundance to the two resources combined was higher than the additive response in both ecosystems. However, bacteria also responded positively to single P and C additions in the eutrophic ecosystem, but not to single C in the oligotrophic one, consistent with the value of the ratio between bacterial C demand and algal C supply. Accordingly, the trophic nature rather than the trophic state of the ecosystems proves to be a key feature determining the expected types of resource co-limitation of bacteria, as summarized in a proposed theoretical framework. The actual types of co-limitation shifted over time and partially deviated (a lesser degree of synergism) from the theoretical expectations, particularly in the eutrophic ecosystem. These deviations may be explained by extrinsic ecological forces to physiological limitations of bacteria, such as predation, whose role in our experiments is supported by the relationship between the dynamics of bacteria and bacterivores tested by SEMs (structural equation models). Our study, in line with the increasingly recognized role of freshwater ecosystems in the global C cycle, suggests that further attention should be focussed on the biotic interactions that modulate resource co-limitation of bacteria.

Synthesis, characterization and electrochemical properties of iron-zirconia solid solution nanoparticles prepared using a sol-gel technique

The range of compositions and temperatures at which single-phase tetragonal and monoclinic Fe-containing zirconia nanoparticles are stable is reported. Both types of iron-doped zirconia particles were synthesized by annealing dried gels FexZr1-xO2, with nominal compositions in the range 0 ≤ x ≤ 0.15, over the range of temperatures between 400 °C and 1300 °C. Monophasic crystalline specimens of Fe-ZrO2 solid solutions were characterized by different techniques including X-ray powder diffraction (XRD), infrared and Raman spectroscopies (IR and Raman), and transmission electron microscopy (TEM). Energy gaps were estimated from diffuse reflectance ultraviolet-visible spectra (DRUV-Vis) and compared with those obtained from electrochemical data. Upon increasing the amount of iron in both types of iron-containing zirconia-based structures the energy gaps slightly lowered. The electrochemical properties of those solid solutions obtained using the voltammetry of microparticles (VPM) technique indicated the presence of a small portion of iron as Fe(2+) in both types of crystalline Fe-doped ZrO2. Electrochemical data suggest that the monoclinic solid solutions provide a particularly high accessibility for promoting catalytic processes such as electrochemical oxygen reduction.

Establishment of population-based surveillance for invasive pneumococcal disease in Bangalore, India

BACKGROUND

Invasive pneumococcal disease (IPD) is vaccine-preventable but few data on the incidence of PD exist for Indian children.

AIMS

To assess the feasibility of implementing prospective, population-based surveillance for PD among children less than five years of age. Settings and Design :Hospitals and health agencies, Bangalore, India. Retrospective review and analysis of hospitalization records as well as public health and demographic data.

MATERIAL AND METHODS

Records for 2006 hospitalizations for pneumococcal disease-associated syndromes (meningitis, pneumonia and sepsis) were identified at three pediatric referral hospitals (Indira Gandhi Institute of Child Health, Kempegowda Institute of Child Health and Vani Vilas Hospital) in Bangalore using International Classification of Diseases, 9th revision codes. Hospital microbiology laboratory records were assessed to ensure capacity for identifying S. pneumoniae. Population data were identified from national census and polio surveillance data.

RESULTS

The Bangalore city southern zone includes 33 wards occupying 51 Km 2 with 150,945 children between 0-5 years of age served by three referral pediatric hospitals. From January--December 2006, records of these three hospitals showed 2,219 hospitalizations of children less than five years of age (967 pneumonia, 768 sepsis, and 484 meningitis) with PD-associated diagnoses (southern zone area incidence: 0.15/100,000 PD-associated hospitalizations, less than five years of age). There were 178 deaths in children less than five years of age, of which 87 were attributable to sepsis, 56 to pneumonia and 35 to meningitis.

CONCLUSION

Our analysis suggests that the PD-associated disease burden in Bangalore is high and local institutions have capacity for population-based surveillance. In a prospective study, systematic attention to potential barriers in identifying children with pneumococcal infections will improve estimation of IPD incidence in India.

Evidence for balancing selection at the DAB locus in the axolotl, Ambystoma mexicanum

The axolotl (Ambystoma mexicanum) has been characterized as immunodeficient, and the absence of major histocompatibility complex (MHC) class II polymorphism has been cited as a possible explanation. Here we present evidence for considerable allelic polymorphism at the MHC class II DAB locus for a sample of wild-caught axolotls. Evidence that these sequences are the product of balancing selection for disease resistance is discussed.

Incidence, complications, and risk factors for prolonged stay in children hospitalized with community-acquired influenza

OBJECTIVES

Few studies have examined the characteristics and clinical course of children hospitalized with laboratory-confirmed influenza. We sought to (1) estimate the age-specific incidence of influenza-related hospitalizations, (2) describe the characteristics and clinical course of children hospitalized with influenza, and (3) identify risk factors for prolonged hospitalization.

PATIENTS AND METHODS

Children < or = 21 years of age hospitalized with community-acquired laboratory-confirmed influenza at a large urban children's hospital were identified through review of laboratory records and administrative data sources. A neighborhood cohort embedded within our study population was used to estimate the incidence of community-acquired laboratory-confirmed influenza hospitalizations among children < 18 years old. Risk factors for prolonged hospitalization (> 6 days) were determined by using logistic regression.

RESULTS

We identified 745 children hospitalized with community-acquired laboratory-confirmed influenza during the 4-year study period. In this urban cohort, the incidence of community-acquired laboratory-confirmed influenza hospitalization was 7 per 10,000 child-years of observation. The median age was 1.8 years; 25% were infants < 6 months old, and 77% were children < 5 years old. Many children (49%) had a medical condition associated with an increased risk of influenza-related complications. The incidence of influenza-related complications was higher among children with a preexisting high-risk condition than for previously healthy children (29% vs 21%). However, only cardiac and neurologic/neuromuscular diseases were found to be independent risk factors for prolonged hospitalization.

CONCLUSIONS

Influenza is a common cause of hospitalization among both healthy and chronically ill children. Children with cardiac or neurologic/neuromuscular disease are at increased risk of prolonged hospitalization; therefore, children with these conditions and their contacts should be a high priority to receive vaccine. The impact on pediatric hospitalization of the new recommendation to vaccinate all children 6 months to < 5 years old should be assessed.

Global transmission of prolyliminopeptidase-negative Neisseria gonorrhoeae strains: implications for changes in diagnostic strategies

BACKGROUND

Species confirmation of Neisseria gonorrhoeae is commonly performed with biochemical kits, rely on the activity of the enzyme prolyliminopeptidase (PIP). This enzyme has previously been considered to be almost universally present in N gonorrhoeae. However, increasing numbers of N gonorrhoeae isolates lacking PIP activity have been identified.

OBJECTIVES

To investigate the possibility of a widespread transmission of one or several N gonorrhoeae PIP-negative strains among several countries worldwide.

METHODS

PIP-negative N gonorrhoeae isolates cultured from 2001 to 2004 in Australia, New Zealand and Scotland were comprehensively characterised and compared with previous data from England and Denmark. All isolates were characterised by antibiotic susceptibility testing, serovar determination, pulsed-field gel electrophoresis (PFGE), opa-typing, sequencing of the entire porB gene and N gonorrhoeae multiantigen sequence typing (NG-MAST).

RESULTS

Most (83%) of the viable Australian isolates, and all the New Zealand and Scottish isolates were assigned serovar IB-4, with similar antibiograms, nearly identical porB1b gene sequences, identical (ST210) or highly related (ST292, ST1259) NG-MAST STs, and indistinguishable or related PFGE fingerprints as well as opa-types. The isolates showed characteristics indistinguishable or highly related to the previously described English and Danish outbreak strain.

CONCLUSIONS

A comprehensive characterisation indicates a widespread dissemination, mainly among men who have sex with men (MSM), of indistinguishable and highly related genotypes that have evolved from a single N gonorrhoeae PIP-negative serovar IB-4 strain among several countries worldwide. An increased awareness of PIP-negative N gonorrhoeae strains is crucial and changes in the diagnostic strategies may need to be considered.

The underrecognized burden of influenza in young children

BACKGROUND

The disease burden of influenza infection among children is not well established. We conducted a population-based surveillance of medical visits associated with laboratory-confirmed influenza.

METHODS

Eligible children were younger than five years of age, resided in three U.S. counties, and had a medical visit for an acute respiratory tract infection or fever. Nasal and throat swabs were tested for the influenza virus by viral culture and polymerase-chain-reaction assay. Epidemiologic data were collected from parental surveys and chart reviews. Children who were hospitalized were enrolled prospectively from 2000 through 2004. Population-based rates of hospitalizations associated with influenza were calculated. Children who were seen in selected pediatric clinics and emergency departments during two influenza seasons (2002-2003 and 2003-2004) were systematically enrolled. The rates of visits to clinics and emergency departments associated with influenza were estimated.

RESULTS

The average annual rate of hospitalization associated with influenza was 0.9 per 1000 children. The estimated burden of outpatient visits associated with influenza was 50 clinic visits and 6 emergency department visits per 1000 children during the 2002-2003 season and 95 clinic visits and 27 emergency department visits per 1000 children during the 2003-2004 season. Few children who had laboratory-confirmed influenza were given a diagnosis of influenza by the treating physician in the inpatient (28 percent) or outpatient (17 percent) settings.

CONCLUSIONS

Among young children, outpatient visits associated with influenza were 10 to 250 times as common as hospitalizations. Few influenza infections were recognized clinically.

Neurological and neuromuscular disease as a risk factor for respiratory failure in children hospitalized with influenza infection

CONTEXT

The Advisory Committee on Immunization Practices (ACIP) recommends annual influenza vaccination for children with certain chronic medical conditions to prevent serious complications of influenza infection. Little is known about the relative contribution of each of these chronic medical conditions to the development of serious influenza-associated complications.

OBJECTIVE

To identify chronic medical conditions that are associated with respiratory failure in children hospitalized with community-acquired laboratory-confirmed influenza.

DESIGN, SETTING, AND PATIENTS

A retrospective cohort study of patients aged 21 years or younger hospitalized at The Children's Hospital of Philadelphia with community-acquired laboratory-confirmed influenza during 4 consecutive influenza seasons (June 2000 through May 2004). We examined 9 ACIP-designated high-risk chronic medical conditions and 3 additional chronic medical conditions (neurological and neuromuscular disease [NNMD], gastroesophageal reflux disease [GERD], and history of prematurity) that in recent studies have been associated with influenza hospitalization and severe influenza-related complications.

MAIN OUTCOME MEASURES

Rate and odds ratio (OR) of respiratory failure, defined as need for mechanical ventilation.

RESULTS

Of 745 children hospitalized with community-acquired laboratory-confirmed influenza, 322 (43%) had 1 or more ACIP-designated high-risk chronic medical conditions. Neurological and neuromuscular disease, GERD, and history of prematurity were present in 12%, 14%, and 3%, of children, respectively. Thirty-two children (4.3%) developed respiratory failure. In multivariate logistic regression analyses, conditions associated with respiratory failure included NNMD (OR, 6.0; 95% confidence interval [CI], 2.7-13.5), chronic pulmonary disease other than asthma (OR, 4.8; 95% CI, 1.5-15.1), and cardiac disease (OR, 4.0; 95% CI, 1.6-10.2). The predicted probabilities of respiratory failure derived from the multivariate model were 12% (95% CI, 7%-20%), 9% (95% CI, 3%-23%), and 8% (95% CI, 4%-18%) for children with NNMD, chronic pulmonary disease, and cardiac disease, respectively.

CONCLUSIONS

These results support the ACIP's recent decision to add NNMD to the list of conditions for which annual influenza vaccine is recommended in children. Neurologists and primary care pediatricians should be alerted to the increased risk of respiratory failure and the importance of influenza vaccination in children with NNMD.

Monitoring vaccine safety during an influenza pandemic

In the event that a vaccine is available during an influenza pandemic, vaccine safety monitoring will occur as part of comprehensive public health surveillance of the vaccination campaign. Though inactivated influenza vaccines have been widely used in the United States and much is known about their safety profile, attention will need to be paid to both common self-limited adverse reactions and rarer, more serious events that may or may not be causally related to vaccination. The primary surveillance systems used to generate and test hypotheses about vaccine safety concerns are the Vaccine Adverse Event Reporting System (VAERS) and the Vaccine Safety Datalink (VSD), respectively. Examples of recent use of these systems to investigate influenza vaccine safety and enhancements planned for use during a pandemic are presented. Ethical issues that will need to be addressed as part of an overall vaccine safety response include risk communication and injury compensation. Advance planning and the use of available technologic solutions are needed to respond to the scientific and logistic challenges involved in safely implementing mass vaccination during a pandemic.

Dalitz plot analysis of the decay D(+)-->K(-)pi(+)pi(+) and indication of a low-mass scalar Kpi resonance

We study the Dalitz plot of the decay D(+)-->K(-)pi(+)pi(+) with a sample of 15090 events from Fermilab experiment E791. Modeling the decay amplitude as the coherent sum of known Kpi resonances and a uniform nonresonant term, we do not obtain an acceptable fit. If we allow the mass and width of the K(*)(0)(1430) to float, we obtain values consistent with those from PDG but the chi(2) per degree of freedom of the fit is still unsatisfactory. A good fit is found when we allow for the presence of an additional scalar resonance, with mass 797+/-19+/-43 MeV/c(2) and width 410+/-43+/-87 MeV/c(2). The mass and width of the K(*)(0)(1430) become 1459+/-7+/-5 MeV/c(2) and 175+/-12+/-12 MeV/c(2), respectively. Our results provide new information on the scalar sector in hadron spectroscopy.

Biodegradation of phenolic industrial wastewater in a fluidized bed bioreactor with immobilized cells of Pseudomonas putida

The paper presents the main results obtained from the study of the biodegradation of phenolic industrial wastewaters by a pure culture of immobilized cells of Pseudomonas putida ATCC 17484. The experiments were carried out in batch and continuous mode. The maximum degradation capacity and the influence of the adaptation of the microorganism to the substrate were studied in batch mode. Industrial wastewater with a phenol concentration of 1000 mg/l was degraded when the microorganism was adapted to the toxic chemical. The presence in the wastewater of compounds other than phenol was noted and it was found that Pseudomonas putida was able to degrade these compounds. In continuous mode, a fluidized-bed bioreactor was operated and the influence of the organic loading rate on the removal efficiency of phenol was studied. The bioreactor showed phenol degradation efficiencies higher than 90%, even for a phenol loading rate of 0.5 g phenol/ld (corresponding to 0.54 g TOC/ld).

Estimated risk of HIV transmission by blood transfusion in Kenya

BACKGROUND

During the past decade, developing countries have received limited support for blood safety programmes. The Kenya Ministry of Health did a collaborative multicentre assessment to establish the risk of HIV transmission by transfusion in Kenya, to promote awareness of blood safety issues in this country with a mature HIV epidemic, and to identify methods to reduce the risk of HIV transmission by blood transfusion in Kenya.

METHODS

For 12 weeks, from April to July 1994, we collected information and blood samples from all blood donors, and pretransfusion samples were collected from all recipients in six government hospitals in Kenya. Blood donations were collected and screened for HIV according to standard practice in the hospital laboratories. Test results at a reference laboratory were compared with those of the hospital laboratories and risk of transfusion-associated HIV transmission was calculated.

FINDINGS

The prevalence of HIV among blood donors was 6.4% (120 of 1877) and varied by hospital (range 2-20%). HIV test results were available for 1290 donor-recipient pairs. Of these, 26 HIV-positive donations were given to HIV-negative patients. We estimate that 2.0% of transfusions transmitted HIV. Problems in the hospitals that contributed to transfusion risk included inconsistent refrigeration, data entry errors, equipment failure, and lack of a quality-assurance programme.

INTERPRETATION

A high proportion of blood transfusions transmitted HIV in this high-prevalence area of Africa, primarily because of erroneous laboratory practices. On the basis of these results, the Kenya Ministry of Health introduced a number of practical and inexpensive interventions to improve national blood safety.