Extranasal Staphylococcus aureus colonization predisposes to bloodstream infections in patients on hemodialysis with noncuffed internal jugular vein catheters

Introduction: Staphylococcal infection of endogenous origin is an important cause of morbidity and mortality in patients who receive hemodialysis (HD). The risk of such infections in nasal carriers of the organism is well defined. Extranasal carriage of the organism at extranasal sites may pose similar risks. Methods: A total of 70 patients about to undergo internal jugular vein catheterization for HD were enrolled in this prospective observational study. Swab cultures were obtained from anterior nares, posterior pharynx, axillae, toe web spaces, and vascular access sites at baseline and 1 week later. A patient was defined as a persistent carrier when the same organism was grown in both samples. Staphylococcus aureus bloodstream infections were assessed by blood and catheter tip cultures over a 90‐day period. Findings: The mean age of the patients was 43.71 ± 16.2 years. Persistent S. aureus carriage at anterior nares, throat, axilla, toe web spaces, vascular access site, and all sites was documented in 27.9%, 11.4%, 40%, 32.9%, 4.3%, and 64.2% of patients, respectively. Fifteen patients developed S. aureus infections. Catheter related S. aureus infections (CRI) were more likely in persistent carriers than nonpersistent carriers with odds ratios (95% CI) of 10.2 (2.8–37.1), 8.6 (1.7–42.2), 17.3 (3.4–86.0), 3.0 (0.9–9.8), and 1.9 (0.2–22.4) for anterior nares, throat, axilla, toe web spaces, and vascular access site carriers, respectively. The probability of developing CRI in persistent S. aureus carriers was 55% compared to none in noncarriers at 90 days (P = 0.04). Discussion: Extranasal S. aureus carriage is as significant a risk factor as nasal carriage for staphylococcal infections in patients on HD through catheters. The study is limited by lack of molecular phenotyping.     

Substitution Effects on Rare-Earth Ions-Doped Nickel-Zinc Ferrite Nanoparticles

Rare-earth ions (RE³⁺)-doped Ni-Zn ferrite nanoparticles with a structural formula of Ni_0.5Zn_0.5Fe_1.8RE_0.2O₄ (RE³⁺ = Nd, Ce, La and Pr) were synthesized at room temperature by a sol-gel auto-combustion method. The structural and magnetic properties of Ni-Zn ferrite samples were carried out by XRD, vibrating sample magnetometer (VSM), field emission scanning electron microscopy (FE-SEM) and FT-IR spectroscopy. XRD pattern of Ni-Zn ferrite revealed that all the diffraction planes are in agreement with cubic spinel phase and the addition of Fe₂O₃ phase was also observed. In the case of RE ions-doped Ni-Zn ferrite in addition to the Fe₂O₃ phase, very low intensity peaks corresponding to some secondary phase are also present. The average crystallite sizes were found to be from 42 to 56 nm using the Scherer formula. The lattice constant (a) values are gradually decreased from 8.378 to 8.349 Å with different substitutions of RE³⁺ ions in the Ni-Zn ferrite samples. VSM analysis revealed that saturation magnetization values are decreased and coercivity values are increased with substitution of different RE³⁺ ions. FE-SEM images exhibits that particles are spherical in shape. FT-IR interpretation revealed that two main metal oxygen bands (564 and 411 cm^?1) are observed in all the substituted Ni-Zn ferrite samples.     

Automated detection of glioblastoma tumor in brain magnetic imaging using ANFIS classifier

This article proposes a novel and efficient methodology for the detection of Glioblastoma tumor in brain MRI images. The proposed method consists of the following stages as preprocessing, Non‐subsampled Contourlet transform (NSCT), feature extraction and Adaptive neuro fuzzy inference system classification. Euclidean direction algorithm is used to remove the impulse noise from the brain image during image acquisition process. NSCT decomposes the denoised brain image into approximation bands and high frequency bands. The features mean, standard deviation and energy are computed for the extracted coefficients and given to the input of the classifier. The classifier classifies the brain MRI image into normal or Glioblastoma tumor image based on the feature set. The proposed system achieves 99.8% sensitivity, 99.7% specificity, and 99.8% accuracy with respect to the ground truth images available in the dataset.     

Intrusion Detection Based on Bidirectional Long Short-Term Memory with Attention Mechanism

With the recent developments in the Internet of Things (IoT), the amount of data collected has expanded tremendously, resulting in a higher demand for data storage, computational capacity, and real-time processing capabilities. Cloud computing has traditionally played an important role in establishing IoT. However, fog computing has recently emerged as a new field complementing cloud computing due to its enhanced mobility, location awareness, heterogeneity, scalability, low latency, and geographic distribution. However, IoT networks are vulnerable to unwanted assaults because of their open and shared nature. As a result, various fog computing-based security models that protect IoT networks have been developed. A distributed architecture based on an intrusion detection system (IDS) ensures that a dynamic, scalable IoT environment with the ability to disperse centralized tasks to local fog nodes and which successfully detects advanced malicious threats is available. In this study, we examined the time-related aspects of network traffic data. We presented an intrusion detection model based on a two-layered bidirectional long short-term memory (Bi-LSTM) with an attention mechanism for traffic data classification verified on the UNSW-NB15 benchmark dataset. We showed that the suggested model outperformed numerous leading-edge Network IDS that used machine learning models in terms of accuracy, precision, recall and F1 score.     

Correction on link relative based approach to CUSUM chart

Link relative-based approach was used in an article (see reference 1) to enhance the performance of the cumulative sum (CUSUM) control chart. This technique involves the use of firstly, the link relative variable to convert the process observations in a relative to the mean form and secondly, optimal constants to define a new variable which is used as the plotting statistic of the link relative CUSUM chart. In this article, it is proven through simulation study that the optimal constants with fixed values, as reported in the aforementioned article, give different results. Instead, if the regression technique is used, then the same results will be obtained.     

Effect of carbide ceramics and coke on the properties of dispersion strengthened aluminium-silicon7-magnesium hybrid composites

In this study, aluminium-silicon7-magnesium alloy was reinforced with carbide ceramics (silicon carbide and boron carbide) and coke microparticles. The composite samples (S1, S2, and S3) with 4 %, 8 %, and 12 % by weight of silicon carbide and boron carbide microparticles and 8 % by weight of coke micro particles respectively, were prepared through the ultrasonic assisted melt-stir casting route. It was observed from the literature that only a few research works reported the cumulative effect of adding these micro-particulate reinforcements within aluminium-silicon7-magnesium alloy. The microstructural evaluation revealed uniform dispersion of particulate reinforcements. Area energy dispersive x-ray spectroscopy scan results proved the presence of the reinforcement particles as heterogeneous phases at distinct zones. The samples undergone tensile tests failed under the brittle fracture mode. The ultimate tensile strength of the composites improved by about 27.4 %, the % elongation improved by about 6.8 %, and Vickers microhardness dropped 1.9 % to the maximum. Dimples were observed in the fracture morphology analysis and it was mainly due to the mixed ductility of the sample S2. An abrasive wear mechanism was observed in the worn-out sample S2. The wear rate decreased significantly with an increase in weight fraction of the reinforcements.     

Focus groups reveal perils and promises of managed care for nurse practitioners

Decades of practice and research suggest that nurse practitioners (NPs) provide cost-effective and high-quality care. Managed care's emphasis on prevention and cost savings led some policy makers to view NPs as a way to meet the need for primary care providers. However, access to and utilization of NPs has increasingly been controlled by managed care organizations (MCOs) through their selection of providers for primary care panels. This study employed qualitative methodology to examine NPs' experiences with MCOs. Three focus groups, comprising 27 NPs in New York and Connecticut, revealed NPs' mixed reactions to managed care and a range of sentiments regarding NPs' efforts to be listed as primary care providers. The results reflected NPs' concerns about their perceived "invisibility," as well as their sense of "invincibility" in the ways in which NPs are responding to the barriers posed by MCOs. They identified barriers to, as well as ways to facilitate, being listed by MCOs, and described the importance of NPs working individually and collectively in negotiating with MCOs.     

Juvenile myoclonic epilepsy

CONCLUSION: We conclude that despite inevitable variability the clinical picture of JME is characteristic. It is easy to diagnose JME if one thinks of it while the history should be thoroughly analyzed. An EEG recording during sleep confirms the diagnosis. An early diagnosis of JME permits adequate prognosis of the subsequent course of epilepsy, and adequate therapy brings remission in most of the patients. If treatment starts following the large number of severe GTC seizures, the response to therapy is incomplete. The persistency of the illness throughout the life, the need for continuous medication and therapeutic unresponsiveness in cases with late diagnosis, do not justify the increasing misconception that JME is of benign nature. Diagnosis of JME is rare because of insufficient familiarily of physicians with the illness. BACKGROUND: Juvenile myoclonic epilepsy (JME) is an idiopathic generalized epileptic syndrome characterized with the combination of myoclonic, generalized tonic-clonic (GTC) and absence seizures that are readily provoked by sleep deprivation. PATIENTS: Forty-three patients, aged from 14 to 51 years, participated in a 5-year follow-up study. Diagnosis was made according to the criteria (Table 1) for diagnosis of JME set by Panayiotopoulos et al. (1994). Nineteen patients made their first contact with a neurologist at the Institute of Neurology and were diagnosed as JME, while the remaining 24 were referred to from other medical institutions with a diagnosis of therapy resistant to focal epilepsy. All patients underwent a somatic and neurological examination, "mini mental test," EEG in waking and CT scan of the brain. Some patients had EEG performed during sleep and some had MRI of the head. RESULTS: JME began between 9 and 26 (average 17) years. All patients had myoclonic seizures, 98% had GTC and 23% absence seizures. The first myoclonic seizure occurred between 9 and 24 years while the frst GTC seizure occurred between 10 and 32 years. Myoclonic seizures (83% of patients) and GTC seizures (70% of patients) occurred most often immediately after awaking. The most frequent provocative factors were insufficient sleep, alcohol abuse and tiredness. Epilepsy in the family was present in 39%, focal neurological deficiency in 9% and pathological findings on of CT and MRI in 7% of patients. Waking EEG was pathological in 77% of patients; it included generalized spike-wave discharges in 73%, multiple spike-wave complexes in 33% and focal discharges in 12% of patients, respectively. In all 26 patients tested, sleep EEG was pathological most often with multiple spike-wave complexes in 85% and 3-4 Hz spike-wave complexes in 57% of patients. The correct diagnosis of JME following a comprehensive examination was made in 24 (56%) patients after a delay of 1 to 35 years. In 24 patients with delayed diagnosis of JME the replacement of earlier medication with valproic acid (VPA) induced remission in 18 patients (75%) while 1 patient (4%) experienced a reduction in the number of seizures. Five patients (21%) did not respond to VPA medication: 2 due to a weak compliance, another 2 due to inefficient medication and 1 because of the preexistent malabsorption syndrome. In 19 patients (44%) with initial diagnosis of JME, VPA was introduced immediately upon diagnosis. Of them, 15 (79%) had excellent response to VPA, 1 refused therapy and for 3 patients there is no information. In 2 patients VPA was substituted due to side effects (hepatotoxicity and alopetia) with lamotrigine (low doses), which brought about decrease in frequency and mitigation in myoclonic seizures.     

Low back exercises: evidence for improving exercise regimens

Despite the wide variety of exercises that are prescribed for the low back, the scientific foundation to justify their choice is not as complete as one may think, or expect. Thus, the clinician must often call upon "clinical opinion" when selecting exercise. Given that low back tissues may need stressing to enhance their health but too much loading can be detrimental, choosing the optimal exercise requires judgment based on clinical experience and scientific evidence. To assist in developing better exercise programs, this review documents some recent biomechanical evidence from my laboratory and from laboratories of other researchers that has been reported in various publications in an attempt to update clinicians on issues of low back exercise. Among the issues examined are mechanisms of injury; the relative importance of "strength" (ie, maximum force a muscle can produce during a single exertion to create joint torque), "flexibility," and "endurance"; and training to enhance stability. Finally, some specific exercises are described that have been shown to challenge muscle and enhance performance but that are performed in such a way as to minimize loading of the spine to reduce the risk of injury exacerbation. These exercises form a basic program for rehabilitation and maintenance of low back health.     

Congenital fibrosis of the extraocular muscles type 2, an inherited exotropic strabismus fixus, maps to distal 11q13

The extraocular fibrosis syndromes are congenital ocular-motility disorders that arise from dysfunction of the oculomotor, trochlear, and abducens nerves and/or the muscles that they innervate. Each is marked by a specific form of restrictive paralytic ophthalmoplegia with or without ptosis. Individuals with the classic form of congenital fibrosis of the extraocular muscles (CFEOM1) are born with bilateral ptosis and a restrictive infraductive external ophthalmoplegia. We previously demonstrated that CFEOM1 is caused by an autosomal dominant locus on chromosome 12 and results from a developmental absence of the superior division of the oculomotor nerve. We now have mapped a variant of CFEOM, exotropic strabismus fixus ("CFEOM2"). Affected individuals are born with bilateral ptosis and restrictive ophthalmoplegia with the globes "frozen" in extreme abduction. This autosomal recessive disorder is present in members of three consanguineous Saudi Arabian families. Genetic analysis of 70 individuals (20 affected individuals) reveals linkage to markers on chromosome 11q13, with a combined LOD score of 12.3 at the single nonrecombinant marker, D11S1314. The 2.5-cM CFEOM2 critical region is flanked by D11S4196/D11S4162 and D11S4184/1369. Two of the three families share a common disease-associated haplotype, suggesting a founder effect for CFEOM2. We hypothesize that CFEOM2 results from an analogous developmental defect to CFEOM1, one that affects both the superior and inferior divisions of the oculomotor nerve and their corresponding alpha motoneurons and extraocular muscles.