Hydrogel antimicrobial capture coatings for endotracheal tubes; a pharmaceutical strategy designed to prevent ventilator-associated pneumonia.

This paper presents a novel strategy for the prevention of ventilator-associatedpneumonia that involves coating poly(vinyl chloride, PVC) endotracheal tubes (ET) withhydrogels that may be subsequently used to entrap nebulized antimicrobial solutions. Candidatehydrogels were prepared containing a range of ratios of hydroxyethyl methacrylate (HEMA) andmethacrylic acid (MAA) from 100:0 to 70:30 using free radical polymerization and, whenrequired, simultaneous attachment to PVC was performed. The mechanical properties, glasstransition temperatures, swelling kinetics, uptake of gentamicin from an aqueous medium, andgentamicin release were characterized. Increasing the MAA content of the hydrogels significantlydecreased the ultimate tensile strength, % elongation at break, Young’s modulus, and increasedthe glass transition temperature, the swelling ratio, and gentamicin uptake. Microbial(Staphylococcus aureus and Pseudomonas aeruginosa) adherence to control (drug-free) hydrogelswas observed; however, while adherence to gentamicin-containing p(HEMA) occurred, noadherence occurred to gentamicin-containing HEMA:MAA copolymers. Antimicrobialpersistence of gentamicin-containing hydrogels was examined by determining the zone ofinhibition against each microorganism on successive days. Hydrogel composition affected the observed antimicrobial persistence,with the hydrogel composed of 70:30 HEMA:MAA exhibiting >20 days persistence against S. aureus and P. aeruginosa,respectively. To simulate clinical use, the hydrogels (coated onto PVC) were first exposed to a nebulized solution of gentamicin(4 mL, 80 mg for 20 min), and then to nebulized bacteria (4 mL ca. 1 × 109 colony forming units mL−1, 30 min). Viable bacteriawere not observed on the gentamicin-treated p(HEMA: MAA) copolymers, whereas growth was observed on gentamicin-treatedp(HEMA). In light of the excellent antimicrobial activity and physicochemical properties, p(HEMA: MAA) copolymerscomposed of ratios of 80:20 or 70:30 HEMA: MAA were identified as potentially useful coatings of endotracheal tubes to be usedin conjunction with the clinical nebulization of gentamicin and designed for the prevention of ventilator-associated pneumonia

Eradication of endotracheal tube biofilm by nebulised gentamicin.

Objective: To compare the efficacy of gentamicin, nebulised via the endotracheal tube (ET), with that of parenteral cefotaxime or parenteral cefuroxime in preventing the formation of ET biofilm.

Setting: General intensive care units in two university teaching hospitals.

Design: The microbiology of ET biofilm from 36 ICU patients eligible to receive antibiotic prophylaxis was examined. Peak and trough tracheal concentrations of gentamicin, cefotaxime or cefuroxime were measured in each patient group, on the 2nd day of intubation.

Patients: Twelve patients received gentamicin (80 mg) nebulised in 4 ml normal saline every 8 h, 12 cefotaxime (1 g, 12 hourly) and 12 cefuroxime (750 mg, 8 hourly). Prophylaxis was continued for the duration of intubation.

Measurements and results: Samples of tracheal secretions were taken on the 2nd day of ventilation for determination of antibiotic concentrations. Following extubation, ETs were examined for the presence of biofilm. Pathogens considered to be common aetiological agents for VAP included Staphylococcus aureus, enterococci, Enterobacteriaceae and pseudomonads. While microbial biofilm was found on all ETs from the cephalosporin group, microbial biofilm of these micro-organisms was found on 7 of the 12 ET tubes from patients receiving cefotaxime [S. aureus (4), pseudomonads (1), Enterobacteriaceae (1), enterococcus (1)] and 8 of the 12 ET tubes from patients receiving cefuroxime [Enterobacteriaceae (6), P. aeruginosa (1) and enterococcus (1)]. While microbial biofilm was observed on five ETs from patients receiving nebulised gentamicin, none of these were from pathogens for ventilator-associated pneumonia (VAP). Tracheal concentrations of both cephalosporins were lower than those needed to inhibit the growth of pathogens recovered from ET tube biofilm. The median (and range) concentrations for cefotaxime were 0.90 (<0.23–1.31) mg/l and 0.28 (<0.23–0.58) mg/l for 2 h post-dose and trough samples, respectively. Two hours post-dose concentrations of cefuroxime (median and range) were 0.40 (0.34–0.83) mg/l, with trough concentrations of 0.35 (<0.22–0.47) mg/l. Tracheal concentrations (median and range) of gentamicin measured 1 h post-nebulisation were 790 (352–>1250) mg/l and then, before the next dose, were 436 (250–1000) mg/l.

Conclusion: Nebulised gentamicin attained high concentrations in the ET lumen and was more effective in preventing the formation of biofilm than either parenterally administered cephalosporin and therefore may be effective in preventing this complication of mechanical ventilation.

Broken symmetry and pseudogaps in ropes of carbon nanotubes

Since the discovery of carbon nanotubes, it has been speculated that these materials should behave like nanoscale wires with unusual electronic properties and exceptional strength. Recently, 'ropes' of close-packed single-wall nanotubes have been synthesized in high yield. The tubes in these ropes are mainly of the (10,10) type3, which is predicted to be metallic. Experiments on individual nanotubes and ropes indicate that these systems indeed have transport properties that qualify them to be viewed as nanoscale quantum wires at low temperature. It has been expected that the close-packing of individual nanotubes into ropes does not change their electronic properties significantly. Here, however, we present first-principles calculations which show that a broken symmetry of the (10,10) tube caused by interactions between tubes in a rope induces a pseudogap of about 0.1 eV at the Fermi level. This pseudogap strongly modifies many of the fundamental electronic properties: we predict a semimetal-like temperature dependence of the electrical conductivity and a finite gap in the infrared absorption spectrum. The existence of both electron and hole charge carriers will lead to qualitatively different thermopower and Hall-effect behaviours from those expected for a normal metal.

Broken symmetry and pseudogaps in ropes of carbon nanotubes

We investigate the influence of tube-tube interactions in ropes of (10,10) carbon nanotubes, and find that these effects induce a pseudogap in the density of state (DOS) of the rope of width 0.1 eV at the Fermi level. In an isolated (n,n) carbon nanotube there are two bands that cross in a linear fashion at the Fermi level, making the nanotube metallic with a DOS that is constant in a 1.5 eV wide window around the Fermi energy. The presence of the neighbouring tubes causes these two bands to repel, opening up a band gap that can be as large as 0.3 eV. The small dispersion in the plane perpendicular to the rope smears out this gap for a rope with a large cross-sectional area, and we see a pseudogap at the Fermi energy in the DOS where the DOS falls to one third of its value for the isolated tube. This phenomenon should affect many properties of the behavior of ropes of (n,n) nanotubes, which should display a more semimetallic character than expected in transport and doping experiments, with the existence of both hole and electron carriers leading to qualitatively different thermopower and Hall-effect behaviors from those expected for a normal metal. Band repulsion like this can be expected to occur for any tube perturbed by a sufficiently strong interaction, for example, from contact with a surface or with other tubes.

Nonlinear transport and localization in single-walled carbon nanotubes

We have measured the electrical transport properties of mats of single-walled carbon nanotubes (SWNT) as a function of applied electric and magnetic fields. We find that at low temperatures the resistance as a function of temperature R(T) follows the Mott variable range hopping (VRH) formula for hopping in three dimensions. Measurement of the electric field dependence of the resistance R(E) allows for the determination of the Bohr radius of a localized state a = 700nm. The magnetoresistance (MR) of SWNT mat samples is large and negative at all temperatures and fields studied. The low field negative MR is proportional to H2, in agreement with variable range hopping in two or three dimensions. 3D VRH indicates good intertube contacts, implying that the localization is due to the disorder experienced by the individual tubes. The 3D localization radius gives a measure of the ID localization length on the individual tubes, which we estimate to be >700 nm. Implications for the electron-phonon mean free path are discussed.

Quantized conductance of multiwalled carbon nanotubes

We report calculations of the transport properties of multiwalled carbon nanotubes based on a scattering-theoretic approach that takes into account scattering within each tube, between tubes, and at the metal contacts. We find that only the outer tube contributes to the conductance, as has been implied by experiments. Referring to experiments performed with liquid-metal contacts, we also explain why the measured conductance is close to an integer number of conductance quanta, when the tubes are immersed in the liquid metal for several hundreds of nanometers and is not an integer when they are immersed for only a few nanometers. Finally, we propose that the observed conductance of only one quantum

Significantly improved PCR-based clonality testing in B-cell malignancies by use of multiple immunoglobulin gene targets: Report of the BIOMED-2 Concerted Action BHM4-CT98-3936.

Polymerase chain reaction (PCR) assessment of clonal immunoglobulin (Ig) and T-cell receptor (TCR) gene rearrangements is an important diagnostic tool in mature B-cell neoplasms. However, lack of standardized PCR protocols resulting in a high level of false negativity has hampered comparability of data in previous clonality studies. In order to address these problems, 22 European laboratories investigated the Ig/TCR rearrangement patterns as well as t(14;18) and t(11;14) translocations of 369 B-cell malignancies belonging to five WHO-defined entities using the standardized BIOMED-2 multiplex PCR tubes accompanied by international pathology panel review. B-cell clonality was detected by combined use of the IGH and IGK multiplex PCR assays in all 260 definitive cases of B-cell chronic lymphocytic leukemia (n¼56), mantle cell lymphoma (n¼54), marginal zone lymphoma (n¼41) and follicular lymphoma (n¼109). Two of 109 cases of diffuse large B-cell lymphoma showed no detectable clonal marker. The use of these techniques to assign cell lineage should be treated with caution as additional clonal TCR gene rearrangements were frequently detected in all disease categories. Our study indicates that the BIOMED-2 multiplex PCR assays provide a powerful strategy for clonality assessment in B-cell malignancies resulting in high Ig clonality detection rates particularly when IGH and IGK strategies are combined.

Isotopic composition of tropospheric and soil N2O from successive depths of agricultural plots with contrasting crops and nitrogen amendments

Agricultural soils are the dominant contributor to increases in atmospheric nitrous oxide (N2O). Few studies have investigated the natural N and O isotopic composition of soil N2O. We collected soil gas samples using horizontal sampling tubes installed at successive depths under five contrasting agricultural crops (e.g., unamended alfalfa, fertilized cereal), and tropospheric air samples. Mean d 15N and d 18O values of soil N2O ranged from -28.0 to +8.9‰, and from +29.0 to +53.6‰. The mean d 15N and d 18O values of tropospheric N2O were +4.6 ± 0.7‰ and +48.3 ± 0.2‰, respectively. In general, d values were lowest at depth, they were negatively correlated to soil [N2O], and d 15N was positively correlated to d 18O for every treatment on all sampling dates. N2O from the different agricultural treatments had distinct d 15N and d 18O values that varied among sampling dates. Fertilized treatments had soil N2O with low d values, but the unamended alfalfa yielded N2O with the lowest d values. Diffusion was not the predominant process controlling N2O concentration profiles. Based on isotopic and concentration data, it appears that soil N2O was consumed, as it moved from deeper to shallower soil layers. To better assess the main process(es) controlling N2O within a soil profile, we propose a conceptual model that integrates data on net N2O production or consumption and isotopic data. The direct local impact of agricultural N2O on the isotopic composition of tropospheric N2O was recorded by a shift toward lower d values of locally measured tropospheric N2O on a day with very high soil N2O emissions.

A hierarchical physical model-based approach to predictive control of a thermal power plant for efficient plant-wide disturbance rejection

Extending the work presented in Prasad et al. (IEEE Proceedings on Control Theory and Applications, 147, 523-37, 2000), this paper reports a hierarchical nonlinear physical model-based control strategy to account for the problems arising due to complex dynamics of drum level and governor valve, and demonstrates its effectiveness in plant-wide disturbance handling. The strategy incorporates a two-level control structure consisting of lower-level conventional PI regulators and a higher-level nonlinear physical model predictive controller (NPMPC) for mainly set-point manoeuvring. The lower-level PI loops help stabilise the unstable drum-boiler dynamics and allow faster governor valve action for power and grid-frequency regulation. The higher-level NPMPC provides an optimal load demand (or set-point) transition by effective handling of plant-wide interactions and system disturbances. The strategy has been tested in a simulation of a 200-MW oil-fired power plant at Ballylumford in Northern Ireland. A novel approach is devized to test the disturbance rejection capability in severe operating conditions. Low frequency disturbances were created by making random changes in radiation heat flow on the boiler-side, while condenser vacuum was fluctuating in a random fashion on the turbine side. In order to simulate high-frequency disturbances, pulse-type load disturbances were made to strike at instants which are not an integral multiple of the NPMPC sampling period. Impressive results have been obtained during both types of system disturbances and extremely high rates of load changes, right across the operating range, These results compared favourably with those from a conventional state-space generalized predictive control (GPC) method designed under similar conditions.

Differential physico-chemical tolerances and intraguild predation among native and invasive amphipods (Crustacea); a field study

We used field surveys and transplant experiments to elucidate the relative roles of physico-chemical regime and intraguild predation in determining the generally mutually exclusive distributions of native and invader freshwater amphipod species. Field surveys showed that the native Gammarus duebeni celticus dominates the shoreline of Lough Neagh, N. Ireland, with some co-occurrence with the N. American invader G. tigrinus. However, the latter species dominates the deeper areas of the mid-Lough. Transplant experiments showed no difference in survival of the native and invader in single species 'bioassay tubes' placed along the shoreline. However, there was significantly higher survival of the invader compared with the native in single species tubes placed in the mid-Lough. In mixed species tubes on the shoreline, the native killed and ate the invader, with no reciprocal interaction, leading to significant reductions of the invader. However, the invader had significantly higher survival than the native in mixed species tubes in the mid-Lough, with no evidence. of predation between the two species. These results indicate that, whereas differential intraguild predation may determine domination of the shoreline by the native, differential physico-chemical tolerances may be major determinants of the domination of the mid-Lough by the invader. This study emphasises the need to consider the habitat template in conjunction with biotic interactions before attempting to draw conclusions about mechanisms determining relative distribution patterns of native and invasive species.

Differential physico-chemical tolerances of amphipod species revealed by field transplantations

Physico-chemical regimes of river systems are major determinants of the distributions and relative abundances of macroinvertebrate taxa. Other factors, however, such as biotic interactions, may co-vary with changes in physico-chemistry and concomitant changes in community composition. Thus, direct cause and effect relationships may not always be established from field surveys. Equally, however, laboratory studies may suffer from lack of realism in extrapolation to the field. Here, we use balanced field transplantation experiments to elucidate the role of physico-chemical regime in determining the generally mutually exclusive distributions of two amphipod taxa, Gammarus (two species) and Crangonyx pseudogracilis. Within two river systems in Ireland, the former species dominate stretches of well oxygenated, high-quality water, whereas the latter dominates stretches of poorly oxygenated, low-quality water. G. pulex and G. duebeni celticus did not survive in bioassay tubes in areas dominated by C. pseudogracilis, which itself survived in tubes in such areas. However, both C. pseudogracilis and Gammarus spp. survived equally well in tubes in areas dominated by Gammarus spp. Physicochemical regime thus limits the movement of Gammarus spp. into C. pseudogracilis areas, but some other factor excludes C. pseudogracilis from Gammarus spp. areas. Since previous laboratory experiments showed high predation rates of Gammarus spp. on C. pseudogracilis, we propose that predation by the former causes exclusion of the latter. Hence, presumed effects of physico-chemical regime on macroinvertebrate presence/abundance may often require experimental field testing and appreciation of alternative explanations.

Use of breakpoint combination sensitivity testing as a simple and convenient method to evaluate the combined effects of ceftazidime and tobramycin on Pseudomonas aeruginosa and Burkholderia cepacia complex isolates in vitro

An in vitro method of determining the activity of antibiotics in combination which is simple and convenient to perform and which could be used routinely in clinical microbiology laboratories is desirable. We investigated the activity, against Pseudomonas aeruginosa and Burkholderia cepacia complex clinical isolates, of ceftazidime and tobramycin in combination using a broth macrodilution sensitivity method based on breakpoint minimum inhibitory concentrations and compared the results obtained using this method with those obtained using the microtitre checkerboard method. There was good agreement in interpretation of results between the two methods for both P. aeruginosa (90%) and B. cepacia complex isolates (70%) with tobramycin and for P. aeruginosa isolates (70%) with ceftazidime. As the breakpoint combination sensitivity testing method employs only four tubes and does not require initial determination of individual antibiotic minimum inhibitory concentrations, it is simpler and more convenient for determining the activity of antibiotics in combination than the microtitre checkerboard method. The use of this method in routine microbiology laboratories to determine the activity of antibiotic combinations against clinical isolates should optimise treatment of infection by ensuring that appropriate antibiotic combinations are prescribed. (C) 2004 Elsevier B.V. All rights reserved.

A study of magnetic bright points in the Na I D1 line.

High-cadence, multiwavelength, optical observations of solar magnetic bright points (MBPs), captured at the disk center using the ROSA and IBIS imaging systems on the Dunn Solar Telescope, are presented. MBPs manifesting in the Na I D-1 core are found to preferentially exist in regions containing strong downflows, in addition to cospatial underlying photospheric magnetic field concentrations. Downdrafts within Na I D-1 bright points exhibit speeds of up to 7 km s(-1), with preferred structural symmetry in intensity, magnetic field, and velocity profiles about the bright point center. Excess intensities associated with G-band and Ca II K observations of MBPs reveal a power-law trend when plotted as a function of the magnetic flux density. However, Na I D-1 observations of the same magnetic features indicate an intensity plateau at weak magnetic field strengths below approximate to 150 G, suggesting the presence of a two-component heating process: one which is primarily acoustic and the other predominantly magnetic. We suggest that this finding is related to the physical expansion of magnetic flux tubes, with weak field strengths (approximate to 50 G) expanding by similar to 76%, compared to a similar to 44% expansion when higher field strengths (approximate to 150 G) are present. These observations provide the first experimental evidence of rapid downdrafts in Na I D-1 MBPs and reveal the nature of a previously unresolved intensity plateau associated with these structures.

Wideband measurement of the acoustic impedance of tubular objects

A method is discussed for measuring the acoustic impedance of tubular objects that gives accurate results for a wide range of frequencies. The apparatus that is employed is similar to that used in many previously developed methods; it consists of a cylindrical measurement duct fitted with several microphones, of which two are active in each measurement session, and a driver at one of its ends. The object under study is fitted at the other end. The impedance of the object is determined from the microphone signals obtained during excitation of the air inside the 1 duct by the driver, and from three coefficients that are pre-determined using four calibration measurements with closed cylindrical tubes. The calibration procedure is based on the simple mathematical relationships between the impedances of the calibration tubes, and does not require knowledge of the propagation constant. Measurements with a cylindrical tube yield an estimate of the attenuation constant for plane waves, which is found to differ from the theoretical prediction by less than 1.4% in the frequency range 1 kHz-20 kHz. Impedance measurements of objects with abrupt changes in diameter are found to be in good agreement with multimodal theory.

Two-phase flow regimes in microchannels

Capillary hydrodynamics has three considerable distinctions from macrosystems: first, there is an increase in the ratio of the surface area of the phases to the volume that they occupy; second, a flow is characterized by small Reynolds numbers at which viscous forces predominate over inertial forces; and third, the microroughness and wettability of the wall of the channel exert a considerable influence on the flow pattern. In view of these differences, the correlations used for tubes with a larger diameter cannot be used to calculate the boundaries of the transitions between different flow regimes in microchannels. In the present review, an analysis of published data on a gas-liquid two-phase flow in capillaries of various shapes is given, which makes it possible to systematize the collected body of information. The specific features of the geometry of a mixer and an inlet section, the hydraulic diameter of a capillary, and the surface tension of a liquid exert the strongest influence on the position of the boundaries of two-phase flow regimes. Under conditions of the constant geometry of the mixer, the best agreement in the position of the boundaries of the transitions between different hydrodynamic regimes in capillaries is observed during the construction of maps of the regimes with the use of the Weber numbers for a gas and a liquid as coordinate axes.