Impact of simulation on multidisciplinary NICU teamwork during delivery and transport of extremely preterm infants

BACKGROUND AND OBJECTIVES

Multidisciplinary teamwork during delivery room (DR) resuscitation and timely transport to the neonatal intensive care unit (NICU) can reduce morbidity and mortality for infants born Extremely Preterm (EP). We aimed to assess the impact of a multidisciplinary high-fidelity simulation curriculum on teamwork during resuscitation and transport of EP infants.

METHODS

In a prospective study conducted at a Level III academic center, seven teams (each consisting of one NICU fellow, two NICU nurses, and one respiratory therapist) performed three high-fidelity simulation scenarios. Videotaped scenarios were graded by three independent raters using the Clinical Teamwork Scale (CTS). Times of completion of key resuscitation and transport tasks were recorded. Pre- and post- intervention surveys were obtained.

RESULTS

Overall, time of completion of key resuscitation and transport tasks decreased, with significant decreases in the time to attach the pulse oximeter, transfer of the infant to the transport isolette, and exit the DR. There was no significant difference in CTS scores from Scenario 1 to 3. Scenarios led by first-year fellows showed a trend towards improvement in all CTS categories. A comparison of teamwork scores pre- and post-simulation curriculum during direct observation of high-risk deliveries in real time revealed a significant increase in each CTS category.

CONCLUSION

A high-fidelity teamwork-based simulation curriculum decreased time to complete key clinical tasks in the resuscitation and transport of EP infants, with a trend towards increased teamwork in scenarios led by junior fellows. There was improvement of teamwork scores during high-risk deliveries on pre-post curriculum assessment.

Mosquito Diversity in an Experimental Township in Tamil Nadu, India

To glean more information on mosquito diversity and distribution in Auroville, a cross-sectional study was carried out by mapping the distribution of water bodies and habitats supporting immature stages on the one hand and the distribution of water bodies/habitats supporting mosquito immature stages on the other. A satellite image covering an area of 8.08 km2 was overlaid with a grid of 500 × 500 m. Fifteen modules were selected and the area of each module served as the sampling site for the entomological survey. Adult and larval stages were sampled. Diversity indices were analyzed to compare mosquito diversity. Rarefaction estimations were used to compare abundance and richness of the mosquito species between different zones. In total, 750 mosquito larvae and 84 resting adults were sampled. Eighteen species of mosquitoes belonging to 11 subgenera and 7 genera were documented. Genera included Aedes (Johann Wilhelm Meigen 1818, Diptera, Culicidae), Anopheles (Johann Wilhelm Meigen 1818, Diptera, Culicidae), Armigeres (Theobald 1901, Diptera, Culicidae), Culex (Carl Linnaeus 1758, Diptera, Culicidae), Lutzia (Theobald 1903, Diptera, Culicidae), and Mimomyia (Theobald 1903, Diptera, Culicidae). Of the 18 mosquito species identified, 8 species are new records for Auroville. The Alpha (α) biodiversity indices show that the mosquito fauna is diverse (S = 18; DMg = 2.732 [95% CI: 2.732-2.732]). The Shannon-Weiner (H' = 2.199 [95% CI: 2.133-2.276]) and Simpson indices (λ = 0.8619 [95% CI: 0.8496-0.8723]) measured species richness, evenness, and dominance. The values of these indices suggest high species richness, evenness, and dominance. Prevailing conditions can provide suitable environment for establishment of different mosquito species in this ecosystem. Given the sociodemographic characteristics of this area, research on mosquito diversity and risk of vector-borne diseases will be of great use.

Heizmannia rajagopalani n. sp. (Diptera: Culicidae) in Kerala, India, a species previously misidentified as Hz. metallica (Leicester)

The original description of Heizmannia (Heizmannia) metallica (Leicester) from Malaysia, and specimens collected in India that were provisionally identified as Hz. metallica, were re-examined for their taxonomic status. Heizmannia metallica from Malaysia was found by Mattingly (1970) to be a junior synonym of Hz. indica (Theobald), whereas we found the specimens identified as Hz. metallica from India to differ distinctly from the holotype of Hz. metallica. We collected adults near Malabar Coast, Western Ghats which corresponded with Indian Hz. metallica sensu auctorum and here describe the previously misidentified species as Hz. (Hez.) rajagopalani n. sp. The adult male and female of the new species, and their genitalia, are described and illustrated.

Description of a new species of the genus Paraedes (Diptera: Culicidae) in Assam, India

A new species, Paraedes jambulingami, is described from Assam, northeastern India. The adult male and female are described in detail and an illustration of the male is provided. This species is easily distinguished from all known species of the genus Paraedes by the presence of broad silvery or golden scales on the paratergite and the outer arm of the basal mesal lobe of the male genitalia bearing a long, flattened blade-like seta. Dichotomous keys are provided for the identification of the adult females and males of the five species of the genus that are known to occur in India.

Description of the adult male, larva and pupa of Topomyia (Topomyia) aureoventer (Diptera: Culicidae) in India

The original description of Topomyia aureoventer by Theobald (1910) included only the adult female. Description of the adult male, pupa and larva, with figures of the male genitalia, pupa and larva, are provided. The larva is predacious with well-developed mandibles and inhabits leaf axils of Colocasia plants.

Uranotaenia pseudostricklandi, a new species in subgenus Pseudoficalbia (Diptera: Culicidae) from Kerala, India

The female and male adults, male genitalia, pupa and larva of Uranotaenia (Pseudoficalbia) pseudostricklandi sp. nov. (Diptera: Culicidae) are described from specimens collected in India.

Oxidative Stress and Cardiovascular Risk in Type 1 Diabetes Mellitus: Insights From the DCCT/EDIC Study

Background

Hyperglycemia leading to increased oxidative stress is implicated in the increased risk for the development of macrovascular and microvascular complications in patients with type 1 diabetes mellitus.

Methods and Results

A random subcohort of 349 participants was selected from the DCCT / EDIC (Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications) cohort. This included 320 controls and 29 cardiovascular disease cases that were augmented with 98 additional known cases to yield a case cohort of 447 participants (320 controls, 127 cases). Biosamples from DCCT baseline, year 1, and closeout of DCCT , and 1 to 2 years post‐ DCCT ( EDIC years 1 and 2) were measured for markers of oxidative stress, including plasma myeloperoxidase, paraoxonase activity, urinary F 2α isoprostanes, and its metabolite, 2,3 dinor‐8 iso prostaglandin F 2α . Following adjustment for glycated hemoblobin and weighting the observations inversely proportional to the sampling selection probabilities, higher paraoxonase activity, reflective of antioxidant activity, and 2,3 dinor‐8 iso prostaglandin F 2α , an oxidative marker, were significantly associated with lower risk of cardiovascular disease (−4.5% risk for 10% higher paraoxonase, P <0.003; −5.3% risk for 10% higher 2,3 dinor‐8 iso prostaglandin F 2α , P =0.0092). In contrast, the oxidative markers myeloperoxidase and F 2α isoprostanes were not significantly associated with cardiovascular disease after adjustment for glycated hemoblobin. There were no significant differences between DCCT intensive and conventional treatment groups in the change in all biomarkers across time segments.

Conclusions

Heightened antioxidant activity (rather than diminished oxidative stress markers) is associated with lower cardiovascular disease risk in type 1 diabetes mellitus, but these biomarkers did not change over time with intensification of glycemic control.

Clinical Trial Registration

URL : https://www.clinicaltrials.gov . Unique identifiers: NCT 00360815 and NCT 00360893.

Bilateral arthrodesis of the distal tibiofibular joint for deforming osteochondromatas

The first case of bilateral distal tibiofibular joint fusions for osteochondromas is reported with excellent long-term outcomes.

Descriptions of three new species of <i>Uranotaenia</i> (Pseudoficalbia) Diptera: Culicidae) from India

Female and male adults, male genitalia, pupa and larva of Uranotaenia (Pseudoficalbia) maikalensis, Ur. (Pfc.) dandakaranyensis and Ur. (Pfc.) satpuraensis, three new mosquito species, are described from India.

Description of a new species of the genus Hulecoeteomyia (Diptera: Culicidae) from Meghalaya, India

Female and male adults, female and male genitalia, pupa and larva of Hulecoeteomyia cherrapunjiensis, a new mosquito species, are described from Meghalaya, India. Keys to separate larvae and adults are provided.

Morphological and molecular characterization of the ecological, biological and behavioural variants of the JE vector Culex tritaeniorhynchus: an assessment of its taxonomic status

BACKGROUND & OBJECTIVES

Culex tritaeniorhynchus (Diptera: Culicidae), an important vector of Japanese encephalitis belongs to the Culex vishnui subgroup which includes two other vector species namely, Cx. Vishnui and Cx. pseudovishnui. Many varieties and types of Cx. tritaeniorhynchus have been reported, besides populations that exhibit behavioural and biological differences. This study was undertaken to find out whether Cx. tritaeniorhynchus populations exhibiting behavioural and biological variations, and those from different geographical areas, are comprised of more than one taxon or belong to a single taxon.

METHODS

Morphological characterization was done by examining 153 morphological and morphometric characters in the larval (75), pupal (60) and adult stages (18) of five geographical populations of Cx. tritaeniorhynchus. Molecular characterization was done by PCR amplification of mitochondrial cytochrome c oxidase (COI) gene sequences (DNA barcodes) and another hypervariable genetic marker, the ribosomal DNA (16S). One-way ANOVA, principal component analysis (PCA) and discriminant factor analysis (DFA) were done for statistical analyses using the statistical package SPSS IBM version 19.0.

RESULTS

Morphological characterization showed that no intraspecific differentiation can be made among the five geographical populations of Cx. tritaeniorhynchus. Molecular characterization done by DNA barcoding also showed that the COI sequences of all the five populations of Cx. tritaeniorhynchus grouped into a single taxonomic clade plus the genetic differentiation among these was non-significant and the overall gene flow among the populations was very high. Analysis of the ribosomal DNA also confirmed that the Cx. tritaeniorhynchus populations belonged to a single taxon.

INTERPRETATION & CONCLUSION

Culex tritaeniorhynchus is a taxon that does not involve cryptic species.

Fractalkine and its receptor mediate extracellular matrix accumulation in diabetic nephropathy in mice

AIMS/HYPOTHESIS

Fractalkine (FKN) is a unique chemokine that works as a chemoattractant and an adhesion molecule. Previous studies have demonstrated that FKN plays a role in ischaemic and protein-overload renal injury via its cognate receptor chemokine (C-X3-C motif) receptor 1 (CX3CR1). However, involvement of the FKN/CX3CR1 system in diabetic nephropathy remains unclear. We examined the role of FKN/CX3CR1 in diabetic mice and mouse mesangial cells (MMCs).

METHODS

Streptozotocin (50 mg kg(-1) day(-1)) was intraperitoneally administered for 5 days to male Cx3cr1-knockout (KO) mice and wild-type (WT) mice. MMCs transfected with Fkn (also known as Cx3cl1) or Cx3cr1 siRNA, respectively, were used to elucidate the role of FKN/CX3CR1 in extracellular matrix (ECM) synthesis.

RESULTS

At 12 weeks, diabetic Cx3cr1 KO mice showed no significant changes in plasma glucose, but markers of renal inflammation, fibrosis and ECM, such as the fractional mesangial area, fibronectin and collagen, were significantly lower in diabetic Cx3cr1 KO mice compared with diabetic WT mice. High glucose, oleic acid and TGF-β1 stimulated FKN and CX3CR1 expression, together with the expression of ECM proteins in MMCs, but the effects were significantly attenuated by Fkn or Cx3cr1 siRNA. More importantly, FKN itself increased mesangial ECM through CX3CR1 and subsequent activation of reactive oxygen species and mitogen-activated protein kinases. A neutralising TGF-β antibody inhibited FKN/CX3CR1 in MMCs treated with diabetic stimuli and decreased FKN-induced ECM accumulation.

CONCLUSIONS/INTERPRETATION

These results demonstrate that FKN/CX3CR1 may play an important role in diabetic renal injury through upregulation of ECM synthesis and could therefore be a therapeutic target for preventing diabetic nephropathy.

Thermal Decomposition of Nitrated Tri-n-Butyl Phosphate in a Flow Reactor

Tri-n-butyl phosphate (TBP) is a universal nuclear extractant, commercially used in the PUREX process for the last 60 years. However, it is prone to nitration and thermal degradation, and as a consequence a red-oil event may be initiated under several operating conditions resulting in severe pressurization of vessel/cell if venting is inadequate. In this work, an attempt was made to understand the reaction pathway of thermal decomposition of nitrated TBP in a flow reactor at atmospheric pressure. Many reaction products were identified and quantified by instrumental methods like HPLC-RI and GC-TCD. The experimental data was analysed with a power law model and the apparent rate constants were estimated. The activation energy for thermal decomposition of nitrated TBP, assuming an Arrhenius type of temperature dependency, was estimated to be 47.39 ± 0.25 kJ·mol−1. The effect of both varying temperature and concentration of nitric acid on conversion of TBP into degradation products and products distribution was experimentally studied. Based on the experimental observations, a reaction mechanism framework for thermal decomposition of nitrated TBP is proposed.