Neonatal outcomes of extremely preterm infants from the NICHD Neonatal Research Network.

OBJECTIVE: This report presents data from the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network on care of and morbidity and mortality rates for very low birth weight infants, according to gestational age (GA). METHODS: Perinatal/neonatal data were collected for 9575 infants of extremely low GA (22-28 weeks) and very low birth weight (401-1500 g) who were born at network centers between January 1, 2003, and December 31, 2007. RESULTS: Rates of survival to discharge increased with increasing GA (6% at 22 weeks and 92% at 28 weeks); 1060 infants died at CONCLUSION: Although the majority of infants with GAs of >or=24 weeks survive, high rates of morbidity among survivors continue to be observed.

ANAPHYLACTICALLY - MEDIATED EPITHELIAL CHLORINE ION SECRETORY RESPONSE INISOLATED JEJUNUM OF PARASITIZED GUINEA PIGS (TRICHINELLA SPIRALIS)

Electrophysiological studies were conducted to test the hypothesis that alterations in intestinal epithelial function are associated with immunological responses directed against the enteric parasite, Trichinella spirals. Trichinella antigens were used to challenge sensitized jejunum from infected guinea pigs while monitoring ion transport properties of the tissue in an Ussing-type chamber. The addition of antigen caused increases in transepithelial PD and I(,sc) that were rapidly induced, peaked at 1.5 to 2 min after antigen-challenge, and lasted 10 to 20 min thereafter. The increase in I(,sc) ((DELTA)I(,sc)) varied in a dose-dependent manner until a maximal increase of 40 (mu)A/cm('2) was obtained by the addition of 13 (mu)g of antigenic protein per ml of serosal fluid in the Ussing chamber. Trichinella antigen did not elicit alterations in either PD or I(,sc) of nonimmune tissue. Jejunal tissue from guinea pigs immunized with ovalbumin according to a protocol that stimulated homocytotropic antibody production responded electrically to challenge with ovalbumin but not trichinella antigen. Jejunal tissue which was passively sensitized with immune serum having a passive cutaneous anaphylaxis (PCA) titer of 32 for both IgE and IgG(,1) anti-trichinella anti-bodies responded electrically after exposure to trichinella antigen. Heat treatment of immune serum abolished the anti-trichinella IgE titer as determined by the PCA test but did not decrease either the electrical response of passively sensitized tissue to antigen or the anaphylactically mediated intestinal smooth muscle contractile response to antigen in the classical Schultz-Dale assay. These results strongly support the hypothesis that immunological responses directed against Trichinella Spiralis alter intestinal epithelial function and suggest that immediate hypersensitivity is the immunological basis of the response.^ Additional studies were performed to test the hypothesis that histamine and prostaglandins that are released from mucosal mast cells during IgE or IgG(,1) - antigen stimulated degranulation mediate electrophysiological changes in the intestinal epithelium that are reflective of Cl('-) secretion and mediated intracellularly by cAMP. Pharmacological and biochemical studies were performed to determine the physiological messengers and ionic basis of electrical alterations in small intestinal epithelium of the guinea pig during in vitro anaphylaxis. Results suggest that Cl('-) secretion mediated, in part, by cAMP contributes to antigen-induced jejunal ion transport changes and that histamine and prostaglandins are involved in eliciting epithelial responses. ^

THE MECHANISM OF RETINOIC ACID REGULATION OF TISSUE TRANSGLUTAMINASE GENE EXPRESSION

Retinoic acid regulates cellular growth and differentiation by altering the expression of specific sets of genes, but the molecular mechanism by which this is achieved is unknown. We have used the rapid induction of a specific enzyme, tissue transglutaminase in mouse macrophages, human leukemia cells and a variety of other cell types to study the regulation of gene expression by retinoic acid. Soluble retinoic acid binding proteins, such as cellular Retinoic Acid Binding Protein (cRABP), have been proposed as specific mediators of retinoic acid regulation of gene expression. This thesis demonstrates the lack of cRABP in a number of cell lines which are sensitive to retinoic acid regulation of tissue transglutaminase expression. These cells are also devoid of other soluble retinoic acid binding activity. The level of retinoic acid binding activity that could have been detected (6 fmol) is far below that of most cells and tissues which are sensitive to the effects of retinoic acid on growth and differentiation. A mouse melanoma cell line, S91-C2, was found to contain an unusual retinoic acid binding protein which has a lower affinity for retinoic acid than mouse tissue cRABP and also behaves differently on gel filtration HPLC chromatography.^ The induction of tissue transglutaminase by retinoic acid in macrophages is specifically inhibited by pertussis toxin. Pertussis toxin ADP-riblosylates membrane GTP-binding proteins such as N(,i) and interferes with signalling from plasma membrane receptors to regulatory enzymes. Pertussis toxin inhibition of transglutaminase induction is due to inhibition of tissue transglutaminase mRNA accumulation and is paralleled by the ADP-ribosylation of a 41,000 dalton macrophage membrane protein. It is concluded that soluble retinoic acid binding proteins are not essential for retinoic acid induction of tissue transglutaminase and that a membrane GTP-binding protein is closely linked to the sensitive response of macrophages to retinoic acid. ^

Introduction to “A Compendium of Strategies to Prevent Healthcare-Associated Infections in Acute Care Hospitals: 2014 Updates”

Abstract Since the publication of "A Compendium of Strategies to Prevent Healthcare-Associated Infections in Acute Care Hospitals" in 2008, prevention of healthcare-associated infections (HAIs) has become a national priority. Despite improvements, preventable HAIs continue to occur. The 2014 updates to the Compendium were created to provide acute care hospitals with up-to-date, practical, expert guidance to assist in prioritizing and implementing their HAI prevention efforts. It is the product of a highly collaborative effort led by the Society for Healthcare Epidemiology of America (SHEA), the Infectious Diseases Society of America (IDSA), the American Hospital Association (AHA), the Association for Professionals in Infection Control and Epidemiology (APIC), and The Joint Commission, with major contributions from representatives of a number of organizations and societies with content expertise, including the Centers for Disease Control and Prevention (CDC), the Institute for Healthcare Improvement (IHI), the Pediatric Infectious Diseases Society (PIDS), the Society for Critical Care Medicine (SCCM), the Society for Hospital Medicine (SHM), and the Surgical Infection Society (SIS).

Willy Loman and the "Soul of a New Machine": Technology and the Common Man

As Death of a Salesman opens, Willy Loman returns home “tired to the death” (p. 13). Lost in reveries about the beautiful countryside and the past, he's been driving off the road; and now he wants a cheese sandwich. But Linda's suggestion that he try a new American-type cheese — “It's whipped” (p. 16) — irritates Willy: “Why do you get American when I like Swiss?” (p. 17). His anger at being contradicted unleashes an indictment of modern industrialized America: The street is lined with cars. There's not a breath of fresh air in the neighborhood. The grass don't grow any more, you can't raise a carrot in the back yard. (p. 17). In the old days, “This time of year it was lilac and wisteria.” Now: “Smell the stink from that apartment house! And another one on the other side…” (pp. 17–18). But just as Willy defines the conflict between nature and industry, he pauses and simply wonders: “How can they whip cheese?” (p. 18). The clash between the old agrarian ideal and capitalistic enterprise is well documented in the literature on Death of a Salesman, as is the spiritual shift from Thomas Jefferson to Andrew Carnegie to Dale Carnegie that the play reflects. The son of a pioneer inventor and the slave to broken machines, Willy Loman seems to epitomize the victim of modern technology.

Modeling Englacial Radar Attenuation at Siple Dome, West Antarctica, Using Ice Chemistry and Temperature Data

The radar reflectivity of an ice-sheet bed is a primary measurement for discriminating between thawed and frozen beds. Uncertainty in englacial radar attenuation and its spatial variation introduces corresponding uncertainty in estimates of basal reflectivity. Radar attenuation is proportional to ice conductivity, which depends on the concentrations of acid and sea-salt chloride and the temperature of the ice. We synthesize published conductivity measurements to specify an ice-conductivity model and find that some of the dielectric properties of ice at radar frequencies are not yet well constrained. Using depth profiles of ice-core chemistry and borehole temperature and an average of the experimental values for the dielectric properties, we calculate an attenuation rate profile for Siple Dome, West Antarctica. The depth-averaged modeled attenuation rate at Siple Dome (20.0 +/- 5.7 dB km(-1)) is somewhat lower than the value derived from radar profiles (25.3 +/- 1.1 dB km(-1)). Pending more experimental data on the dielectric properties of ice, we can match the modeled and radar-derived attenuation rates by an adjustment to the value for the pure ice conductivity that is within the range of reported values. Alternatively, using the pure ice dielectric properties derived from the most extensive single data set, the modeled depth-averaged attenuation rate is 24.0 +/- 2.2 dB km(-1). This work shows how to calculate englacial radar attenuation using ice chemistry and temperature data and establishes a basis for mapping spatial variations in radar attenuation across an ice sheet.

Faith as a Mustard Seed

Abstract: This investigation of the concept of faith is divided into two parts. Part One evaluates a topical philosophical interpretation of faith as irreducibly disjunctive, collecting the best fragmented ideas as to what constitutes faith in a recent family resemblance exposition as an objective for an adequate essentialist analysis of the concept of faith to achieve. Part Two offers a more extended essentialist analysis of the concept of faith as unconditional patience in the eventuality of a positive future state, and a detailed reduction of six supposedly disparate family resemblance senses of faith to this single definition. Criteria for a satisfactory analysis of faithfulness are considered and defended. In contrast with what has become a standard doxastic-epistemic interpretation of faith as persistent unjustified or even unjustifiable belief, a concept of faith is advanced that appears to satisfy the necessary and sufficient criteria identified. Systematic comparison with a variety of usages of the word “faith” suggests that the analysis agrees with many and arguably most applications of this sometimes loosely understood term. Implications of the analysis of the concept of faith are considered and defended against anticipated objections. Pascal’s wager is critically examined in relation to matters of religious faith, along with positivist meaningfulness requirements that seem to conflict especially with epistemically ungrounded belief, the power of faith, and the metaphorical size of mustard seeds. The inquiry concludes with a synthesis of five aspects of six supposedly distinct senses of faith under the single essentialist reductive umbrella of unconditional patience in the eventuality of a positive future state.