Minor head trauma in infants - how accurate is cranial ultrasound performed by trained radiologists?

Correct management of infants after minor head trauma is crucial to minimize the risk to miss clinically important traumatic brain injury (ciTBI). Current practices typically involve CT or in-hospital surveillance. Cranial ultrasound (CUS) provides a radiation-free and fast alternative. This study examines the accuracy of radiologist-performed CUS to detect skull fracture (SF) and/or intracranial hemorrhage (ICH). An inconspicuous CUS followed by an uneventful clinical course would allow exclusion of ciTBI with a great certainty. This monocentric, retrospective, observational study analyzed CUS in infants (< 12 months) after minor head trauma at Bern University Children's Hospital, between 7/2013 and 8/2020. The primary outcome was the sensitivity and specificity of CUS in detecting SF and/or ICH by comparison to the clinical course and to additional neuroimaging. Out of a total of 325 patients, 73% (n = 241) had a normal CUS, 17% (n = 54) were found with SF, and ICH was diagnosed in 2.2% patients (n = 7). Two patients needed neurosurgery and three patients deteriorated clinically during surveillance. Additional imaging was performed in 35 patients. The sensitivity of CUS was 93% ([0.83, 0.97] 95% CI) and the specificity 98% ([0.95, 0.99] 95% CI). All false-negative cases originated in missed SF without clinical deterioration; no ICH was missed.  Conclusion: This study shows high accuracy of CUS in exclusion of SF and ICH, which can cause ciTBI. Therefore, CUS offers a reliable method of neuroimaging in infants after minor head trauma and gives reassurance to reduce the duration of in-hospital surveillance. What is Known: • Minor head trauma can cause clinically important traumatic brain injury in infants, and the management of these cases is a challenge for the treating physician. • Cranial ultrasound (CUS) is regularly used in neonatology, but its accuracy after head trauma in infants is controversial. What is New: • CUS performed by a trained radiologist can exclude findings related to clinically important traumatic brain injury (ciTBI) with high sensitivity and specificity. It therefore offers reassurance in the management of infants after minor head trauma.

Comprehensive Evaluation of Titanium, Zirconia, and Ceramic Dental Implant Materials: A Comparative Analysis of Mechanical and Esthetic Properties.

BACKGROUND: Dental implant materials play a pivotal role in the success of restorative dentistry. This study comprehensively compares the mechanical and esthetic properties of three commonly used dental implant materials: titanium, zirconia, and ceramic. OBJECTIVE: This study aimed to provide insights into the suitability of titanium, zirconia, and ceramic for various clinical applications within implant dentistry. METHODS: Ninety dental implants, 30 for each material, were selected based on their well-established usage in dental implantology. Mechanical properties, including tensile strength, modulus of elasticity, and fatigue resistance, were assessed using state-of-the-art testing machines. Esthetic properties, such as color stability and translucency, were scrutinized through immersion in staining solutions and spectrophotometer measurements. Fracture properties and biocompatibility were also evaluated. RESULTS: Mechanical testing revealed that titanium exhibited the highest tensile strength (810 ± 55 MPa), while zirconia demonstrated the highest modulus of elasticity (208 ± 8 GPa). Titanium also displayed the greatest fatigue resistance (1,010,000 ± 95,000 cycles), whereas zirconia had the highest hardness (1190 ± 45 Vickers hardness number (VHN)). Esthetically, zirconia showed superior color stability (ΔE: 1.7 ± 0.2), while ceramic exhibited the highest translucency (TP%: 15.3 ± 1.7). Zirconia presented the lowest surface roughness (0.28 ± 0.04 µm). CONCLUSION: This study provides insights into potential dental implant material performance, with zirconia emerging as a promising alternative. Future research should validate these findings in clinical settings, considering a broader array of variables and long-term outcomes.

Antibiotic resistance pattern in urine cultures from community-dwelling women in southern Brazil - a cross-sectional study short communication.

OBJECTIVE: The increase in antibiotic resistance (AR) is a global phenomenon with regional variation. This survey aims to describe the AR in urine cultures of women from the community in a southern Brazil city. METHODS: A retrospective cross-sectional single-center study in urine cultures of community dwelling individuals. The main outcome was the AR profile of bacterial isolates from women in outpatient care. RESULTS: From 4,011 urine cultures, 524 were positive (91% from women). The most frequently isolated bacteria were Escherichia coli (E. coli) (67.0%) and Klebsiella spp. (19.4%). E. coli presented low resistance to nitrofurantoin (3.7%), moderate to levofloxacin (15.6%), amoxacillin-clavulonate (16.4%) and ciprofloxacin (17.4%), and high to trimethoprim-sulfamethoxazole (26.9%). CONCLUSIONS: Nitrofurantoin seems to be the best choice for the empirical treatment of low urinary tract infections in women, whereas sulfonamides are no longer an option, since E. coli resistance to this drug is above 20%.

High capacity rock salt type Li2MnO3-δ thin film battery electrodes.

Recent investigations of layered, rock salt and spinel-type manganese oxides in composite powder electrodes revealed the mutual stabilization of the Li-Mn-O compounds during electrochemical cycling. A novel approach of depositing such complex compounds as an active cathode material in thin-film battery electrodes is demonstrated in this work. It shows the maximum capacity of 226 mA h g-1 which is superior in comparison to that of commercial LiMn2O4 powder as well as thin films. Reactive ion beam sputtering is used to deposit films of a Li2MnO3-δ composition. The method allows for tailoring of the active layer's crystal structure by controlling the oxygen partial pressure during deposition. Electron diffractometry reveals the presence of layered monoclinic and defect rock salt structures, the former transforms during cycling and results in thin films with extraordinary electrochemical properties. X-ray photoelectron spectroscopy shows that a large amount of disorder on the cation sub-lattices has been incorporated in the structure, which is beneficial for lithium migration and cycle stability.

Antibiotic resistance pattern in urine cultures from community-dwelling women in southern Brazil - a cross-sectional study short communication / Patrón de resistencia a los antibióticos en cultivos de orina de mujeres que viven en la comunidad en el sur de Brasil - un estudio transversal comunicación corta / Padrão de resistência antimicrobiana em culturas ambulatoriais de urina em mulheres no sul do Brasil - comunicação breve de um estudo transversal

ABSTRACT Objective The increase in antibiotic resistance (AR) is a global phenomenon with regional variation. This survey aims to describe the AR in urine cultures of women from the community in a southern Brazil city. Methods A retrospective cross-sectional single-center study in urine cultures of community dwelling individuals. The main outcome was the AR profile of bacterial isolates from women in outpatient care. Results From 4,011 urine cultures, 524 were positive (91% from women). The most frequently isolated bacteria were Escherichia coli (E. coli) (67.0%) and Klebsiella spp. (19.4%). E. coli presented low resistance to nitrofurantoin (3.7%), moderate to levofloxacin (15.6%), amoxacillin-clavulonate (16.4%) and ciprofloxacin (17.4%), and high to trimethoprim-sulfamethoxazole (26.9%). Conclusions Nitrofurantoin seems to be the best choice for the empirical treatment of low urinary tract infections in women, whereas sulfonamides are no longer an option, since E. coli resistance to this drug is above 20%.

RESUMEN Objetivo El aumento de la resistencia a los antibióticos (AR) es un fenómeno global con variaciones regionales. Esta investigación tiene como objetivo describir la AR en cultivos de orina de mujeres de la comunidad de una ciudad del sur de Brasil. Métodos Un estudio retrospectivo transversal, de un solo centro, de cultivos de orina de la comunidad. El resultado principal fue el perfil de AR de bacterias aisladas de estos cultivos de orina. Resultados De 4.011 cultivos de orina, 524 fueron positivos (91% de las mujeres). Las bacterias más frecuentemente aisladas en mujeres fueron Escherichia coli (67,0%) y Klebsiella spp. (19,4%). E. coli mostró baja resistencia a nitrofurantoína (3,7%), moderada a levofloxacina (15,6%), amoxacilina-clavulonato (16,4%) y ciprofloxacina (17,4%) y alta a trimetoprima-sulfametoxazol (26,9%) entre las mujeres. Conclusiones La nitrofurantoína parece ser la mejor opción para el tratamiento empírico de la infección de las vías urinarias inferiores en mujeres, mientras que las sulfonamidas ya no son una opción, ya que la resistencia de E. coli a este fármaco es superior al 20%.

RESUMO Objetivo O aumento da resistência aos antibióticos (AR) é um fenômeno global com variações regionais. Esta pesquisa tem como objetivo descrever a AR em culturas de urina de mulheres oriundas da comunidade em uma cidade sul-brasileira. Métodos Um estudo de centro único, transversal e retrospectivo em culturas de urina oriundas da comunidade. O principal desfecho foi o perfil de AR de bactérias isoladas de uroculturas ambulatoriais. Resultados De 4.011 culturas de urina, 524 foram positivas (91% de mulheres). As bactérias mais frequentemente isoladas em mulheres foram Escherichia coli (67,0%) e Klebsiella spp. (19,4%). E. coli apresentou baixa resistência à nitrofurantoína (3,7%), moderada a levofloxacina (15,6%), amoxacilina-clavulonato (16,4%) e ciprofloxacina (17,4%) e alta ao trimetoprim-sulfametoxazol (26,9%) entre mulheres. Conclusões A nitrofurantoína parece ser a melhor escolha para o tratamento empírico das infecções do trato urinário inferior em mulheres, enquanto as sulfonamidas não são mais uma opção, uma vez que a resistência de E. coli a essa droga é superior a 20%.

Learning--whose responsibility is it?

Nursing programs continue to experience alarmingly high attrition rates. To offset the attrition rate, the author describes a shifting paradigm between the traditional faculty advisor role and the innovative faculty coach role. The new faculty coach role includes teaching at-risk students to use learning and motivational strategies and self-management skills to improve academic success. The author provides readers with successful strategies to improve student retention by developing active learners who take responsibility for their own learning.