Airway management education and retraining: an unresolved paradigm.

Simulation is a cornerstone of medical education for difficult airway management. The lack of standards regarding the frequency of retraining that would ensure the maintenance of skills and competencies over time still needs to be solved.

Respiratory and allergic outcomes among 5-year-old children exposed to pesticides.

BACKGROUND: Little is known about the effects of pesticides on children's respiratory and allergic outcomes. We evaluated associations of prenatal and current pesticide exposures with respiratory and allergic outcomes in children from the Infants' Environmental Health Study in Costa Rica. METHODS: Among 5-year-old children (n=303), we measured prenatal and current specific gravity-corrected urinary metabolite concentrations of insecticides (chlorpyrifos, pyrethroids), fungicides (mancozeb, pyrimethanil, thiabendazole) and 2,4-D. We collected information from caregivers on respiratory (ever doctor-diagnosed asthma and lower respiratory tract infections (LRTI), wheeze and cough during last 12 months) and allergic (nasal allergies, itchy rash, ever eczema) outcomes. We fitted separate multivariable logistic regression models for high (≥75th percentile (P75)) vs low (

A cross-sectional analysis of medical conditions and environmental factors associated with fractional exhaled nitric oxide (FeNO) in women and children from the ISA birth cohort, Costa Rica.

BACKGROUND: Fractional exhaled nitric oxide (FeNO) is a marker of airway inflammation. Elevated FeNO has been associated with environmental exposures, however, studies from tropical countries are limited. Using data from the Infants' Environmental Health Study (ISA) birth cohort, we evaluated medical conditions and environmental exposures' association with elevated FeNO. METHODS: We performed a cross-sectional analysis of 277 women and 293 8-year old children who participated in the 8-year post-partum visit in 2019. We measured FeNO and collected information on medical conditions and environmental exposures including smoke from waste burning, work in banana plantations, and home pesticide use. We defined elevated FeNO as >25 ppb for women and >20 ppb for children. To evaluate factors associated with elevated FeNO, we used logistic regression models adjusted for obesity in women and unadjusted in children. RESULTS: Overall elevated FeNO was common (20% of women, 13% of children). Rhinitis diagnosis was significantly associated with elevated FeNO in both women (odds ratio (OR): 3.67 95% Confidence Interval (CI): 1.81,7.35) and children (OR: 8.18 95%CI: 3.15, 21.22); wheeze was associated with elevated FeNO in women (OR: 4.50 95% CI: 2.25, 8.99). Environmental exposures were associated with elevated FeNO, but not significantly. Waste burning was associated with elevated FeNO in both women (OR: 1.58 95%CI 0.68, 4.15) and children (OR: 2.49 95%CI:0.82, 10.79). Para-occupational pesticide exposures were associated with elevated FeNO in women and children. For women, having a partner working in agriculture was associated with elevated FeNO (OR: 1.61 95%CI:0.77, 3.58) and for children, maternal work in agriculture was associated with elevated FeNO. (OR 2.08 95%CI 0.86, 4.67) CONCLUSION: Rhinitis and wheeze were associated with elevated FeNO in this rural, agricultural population. Smoke from waste burning as well as para-occupational pesticide exposure may contribute to elevated FeNO in rural communities.

Extended axial irradiances: Barker rings.

For extending focal depth we employ a set of transparent concentric rings, which are coded with the Barker sequences of length L. At the neighborhood of the paraxial focal plane, these transparent masks generate an axial uniform distribution, which is modulated with sinusoidal variations. For imaging applications, one can extend focal depth if the Barker length is congruent to unity modulo 4. And, for optical trapping, a bottle neck irradiance distribution is generated if the Barker length is congruent to three modulo 4.

Two-conjugate zoom system: the zero-throw advantage.

We present the Gaussian design of a two-conjugate zoom system, which does not require any mechanical compensation. The device works in two stages. First, with fixed optical power, a lens images the pupil aperture, forming a pair of conjugate planes. Then, we invert the conjugate planes for setting the two-conjugate condition. At the second stage, two varifocal lenses generate a tunable magnified virtual image, at the fixed object plane. The varifocal lenses have fixed interlens separation, and they work with zero-throw. We specify the optical powers of the composing elements and the equivalent optical power as functions of the variable magnification.

Schlieren masks: square root monomials, sigmoidal functions, and off-axis Gaussians.

By using an effective transfer function, one can describe conveniently the nonlinear mapping between an input thin transparent structure and its image irradiance distribution. This effective transfer function is useful for making sound comparisons between several spatial filters employed for phase rendering. Here, we unveil three nonconventional Schlieren techniques, which employ absorption masks whose amplitude distributions are described by square root monomials, by sigmoidal functions, or by off-axis Gaussian functions. We apply the effective transfer function for analyzing the similarities between the proposed masks and other Schlieren techniques.

Hopkins procedure for tunable magnification: surgical spectacles.

We analyze the use of two varifocal lenses, with fixed interlens separation, for achieving tunable magnification at a specific throw. Our discussion extends the Hopkins procedure circumscribed to the determination of fixed optical powers in a multilens system. We illustrate our results by presenting the Gaussian optics design of surgical spectacles, which have tunable magnification while generating virtual images with zero throw. We also report novel formulas describing this type of two-lens zoom system, which works without any mechanical compensation.

Reducing field depth: annular Hadamard masks.

For optically narrowing field depth, we explore the use of annular masks that are coded with the elements of Hadamard matrices. We show that with no further reduction of light throughput, these annular masks can enhance the influence of focus error on the modulation transfer functions (MTF). We report numerical evaluations of the irradiance point spread functions (PSFs), their associated MTFs, and of some digitally generated images. For complementing our assessments, we evaluate the Fisher information of these Walsh-Hadamard, annular masks. We suggest an optical technique for breaking 3-D scenes into several 2-D sliced frames by translating out-of-focus images into background noise.

Impact of ANCA-Associated Vasculitis on Outcomes of Hospitalizations for Goodpasture's Syndrome in the United States: Nationwide Inpatient Sample 2003-2014.

Background and objectives: Goodpasture's syndrome (GS) is a rare, life-threatening autoimmune disease. Although the coexistence of anti-neutrophil cytoplasmic antibody (ANCA) with Goodpasture's syndrome has been recognized, the impacts of ANCA vasculitis on mortality and resource utilization among patients with GS are unclear. Materials and Methods: We used the National Inpatient Sample to identify hospitalized patients with a principal diagnosis of GS from 2003 to 2014 in the database. The predictor of interest was the presence of ANCA-associated vasculitis. We tested the differences concerning in-hospital treatment and outcomes between GS patients with and without ANCA-associated vasculitis using logistic regression analysis with adjustment for other clinical characteristics. Results: A total of 964 patients were primarily admitted to hospital for GS. Of these, 84 (8.7%) had a concurrent diagnosis of ANCA-associated vasculitis. Hemoptysis was more prevalent in GS patients with ANCA-associated vasculitis. During hospitalization, GS patients with ANCA-associated required non-significantly more mechanical ventilation and non-invasive ventilation support, but non-significantly less renal replacement therapy and plasmapheresis than those with GS alone. There was no significant difference in in-hospital outcomes, including organ failure and mortality, between GS patients with and without ANCA-associated vasculitis. Conclusions: Our study demonstrated no significant differences between resource utilization and in-hospital mortality among hospitalized patients with coexistence of ANCA vasculitis and GS, compared to those with GS alone.

Baclofen-induced neurotoxicity in patients with compromised renal function: Review.

Baclofen is a centrally-acting γ-amino butyric acid agonist used mainly in the symptomatic management of spasticity originating from the spinal cord. It is absorbed completely from the gastrointestinal tract, metabolized by the liver to a minor degree, and excreted unchanged by the kidneys. Baclofen is moderately lipophilic and can cross the blood-brain barrier easily. At the usual dosage, it acts mainly at the spinal level without central nervous system (CNS) side effects. During renal failure, however, the elimination of the drug will decrease with a prolonged half-life, resulting in a larger area-under-the-curve exposure and disproportionate CNS toxicity. Clinically, these patients with renal failure may present with a variety of toxic symptoms manifesting at therapeutic/sub-therapeutic doses of baclofen. In cases of unexplained mental status changes in a patient receiving baclofen therapy, a careful assessment of renal function and a high suspicion of baclofen-induced encephalopathy will be key to the diagnosis.
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Pseudo-random masks for angular alignment.

We present an alignment technique that exploits angular correlations by employing a pair of masks, which encode in an angular format pseudo-random sequences. The angular correlator generates peaked irradiance distributions on-axis, provided that the elements of the pair are aligned. Otherwise, the on-axis irradiance distribution decreases to a minimum value. Since the proposed angular correlator is independent of the lateral magnification, it is useful for testing the performance of varifocal lenses. A merit function describes the tolerance to focus errors associated with the location of a small size detector. We use linearly polarized films for showing that the technique also works well with broad band light.

Prediction of steel plate-based damper for improving the behavior of concentrically braced frames based on RSM and ML approaches for sustainable structures.

The stiffness (K) and slenderness factor (λ) of a steel plate-based damper has been studied on the basis of elastic-inelastic-plastic buckling (EIP) modes and flexural/shear/flexural-shear failure mechanisms (FSF-S), which has been designed for the improvement of the behavior of concentrically braced frames. Steel plate-based dampers offer significant benefits in terms of mode shapes and failure mechanisms, contributing to improved dynamic performance, enhanced structural resilience, and increased safety of civil engineering structures. Their effectiveness in mitigating dynamic loads makes them a valuable tool for engineers designing structures to withstand extreme environmental conditions and seismic events. This study was undertaken by using the learning abilities of the response surface methodology (RSM), artificial neural network (ANN) and the evolutionary polynomial regression (EPR). Steel plate dampers are special structural designs used to withstand the effect of special loading conditions especially seismic effects. Its design based on the prediction of its stiffness (K) and slenderness factor (λ) cannot be overlooked in the present-day artificial intelligence technology. In this research work, thirty-three entries based on the steel plate damper geometrical properties were recorded and deployed for the intelligent forecast of the fundamental properties (λ and K). Design ratios of the steel plate damper properties were considered and models behavior was recorded. From the outcome of the model, it can be observed that even though the EPR and ANN in that order outclassed the other techniques, the RSM produced model minimization and maximization features of the desirability levels, color factor scales and 3D surface observation, which shows the real model behaviors. Overall, the EPR with R2 of 0.999 and 1.000 for the λ and K, respectively showed to be the decisive model but the RSM has features that can be beneficial to the structural design of the studied steel plate damper for a more robust and sustainable construction. With these performances recorded in this exercise, the techniques have shown their potential to be applied in the prediction of steel damper stiffness with optimized characteristic features to withstand structural stresses.

Alkaline saline lakes: A chemical evolution experiment evaluating the stability of formaldehyde in an aqueous saline environment.

Formaldehyde condensation in the presence of a mineral catalyst and under alkaline conditions is considered to be a "messy" chemical system due to its dependence on the complex chemical equilibrium between the reaction intermediates, which has a significant impact on the final products. This chemical system is extremely important in prebiotic chemistry and has been proposed as a potential pathway for carbohydrate formation in the early Earth. Saline and soda lakes are alkaline systems that could concentrate and accumulate a wide variety of ions (such as phosphate) and clay minerals, which can catalyze prebiotic chemical reactions. These geological environments have recently been suggested as ideal environments in which prebiotic chemical reactions could have occurred. This study uses Lake Alchichica in Mexico as a physicochemical analog of an early Archean saline lake to examine the stability of formaldehyde in these aqueous saline environments. Formaldehyde decomposes into sugar-like and CHO molecules in alkaline, high-salinity environments depending on the minerals phases present. As phosphate ion (HPO4 2-) is available in the aqueous medium, the results of our experiments also imply that phosphorylation processes may have occurred in these natural settings.

Assessment of Culture Systems to Produce Bacterial Cellulose with a Kombucha Consortium.

Bacterial cellulose (BC) is an emerging material for high-end applications due to its biocompatibility and physicochemical characteristics. However, the scale-up production of this material is still expensive, with the culture medium constituting one-third of the total cost. Herein, four different media (yeast nitrogen base, YNB; Murashige and Skoog, MSO; black tea; and NPK fertilizer solution) were compared while using sucrose as an additional carbon source. The yields of BC were best for YNB and fertilizer with 0.37 and 0.34 gBC/gC respectively. These two were then compared using glucose as a carbon source, with improvements in the production of 29% for the fertilizer, while only an 8% increase for YNB was seen; however, as the carbon concentration increased with a fixed N concentration, the yield was lower but the rate of production of BC increased. The obtained BC films were sanitized and showed low molecular weight and all the expected cellulose characteristic FT-IR bands while SEM showed nanofibers around 0.1 µm. Compared to traditional methods for lab-scale production, the use of the fertilizer and the consortium represent benefits compared to traditional lab-scale BC culture methods such as a competitive cost (two times lower) while posing resilience and tolerance to stress conditions given that it is produced by microbial communities and not with a single strain. Additionally, the low molecular weight of the films could be of interest for certain coating formulations.

Pesticide exposure, birth size, and gestational age in the ISA birth cohort, Costa Rica.

Purpose: To examine associations of prenatal biomarkers of pesticide exposure with birth size measures and length of gestation among newborns from the Infants' Environmental Health (ISA) birth cohort, Costa Rica. Methods: We included 386 singleton liveborn newborns with data on birth size measures, length of gestation, and maternal urinary biomarkers of chlorpyrifos, synthetic pyrethroids, mancozeb, pyrimethanil, and 2, 4-D during pregnancy. We associated biomarkers of exposure with birth outcomes using multivariate linear regression and generalized additive models. Results: Concentrations were highest for ethylene thiourea (ETU, metabolite of mancozeb), median = 3.40; p10-90 = 1.90-6.79 µg/L, followed by 3,5,6-trichloro-2-pyridinol (TCP, metabolite of chlorpyrifos) p50 = 1.76 p10-90 = 0.97-4.36 µg/L, and lowest for 2,4-D (p50 = 0.33 p10-90 = 0.18-1.07 µg/L). Among term newborns (≥37 weeks), higher prenatal TCP was associated with lower birth weight and smaller head circumference (e.g., ß per 10-fold-increase) during the second half of pregnancy = -129.6 (95% confidence interval [CI] = -255.8, -3.5) grams, and -0.61 (95% CI = -1.05, -0.17) centimeters, respectively. Also, among term newborns, prenatal 2,4-D was associated with lower birth weight (ß per 10-fold-increase = -125.1; 95% CI = -228.8, -21.5), smaller head circumference (ß = -0.41; 95% CI = -0.78, -0.03), and, during the second half of pregnancy, with shorter body length (ß = -0.58; 95% CI = -1.09, -0.07). Furthermore, ETU was nonlinearly associated with head circumference during the second half of pregnancy. Biomarkers of pyrethroids and pyrimethanil were not associated with birth size, and none of the biomarkers explained the length of gestation. Conclusions: Prenatal exposure to chlorpyrifos and 2,4-D, and, possibly, mancozeb/ETU, may impair fetal growth.

In vitro activity of ceftazidime-avibactam against gram-negative bacteria in patients with bacteremia and skin and soft-tissue infections in Colombia 2019-2021.

OBJECTIVES: Ceftazidime-avibactam (CAZ-AVI) is an option for infections caused by MDR gram-negative bacilli. In this study, we aimed to analyze the in vitro antimicrobial activity of CAZ-AVI and other antimicrobial agents against gram-negative bacilli that were collected in Colombia between 2019 and 2021 from patients with bacteremia and skin and soft-tissue infections (SSTIs). METHODS: A total of 600 Enterobacterales and 259 P. aeruginosa strains were analyzed. The phenotypic resistance of isolates, particularly non-susceptibility to meropenem, multidrug-resistant (MDR) isolates, and difficult-to-treat (DTR) P. aeruginosa, was evaluated according to CLSI breakpoints. RESULTS: Enterobacterales had the most susceptibility to CAZ-AVI (96.5 %) and tigecycline (95 %). Tigecycline and CAZ-AVI were the antimicrobial agents with the most in vitro activity against carbapenem-resistant Enterobacterales (CRE). CAZ-AVI was the antimicrobial treatment with the most activity against P. aeruginosa. CONCLUSIONS: Tigecycline and CAZ-AVI were the antimicrobial agents with the most activity against CRE and MDR Enterobacterales. For P. aeruginosa, CAZ-AVI was the antimicrobial treatment with the most in vitro activity.

Conjunctival ultraviolet autofluorescence as a biomarker of outdoor exposure in myopia: a systematic review and meta-analysis.

Outdoor exposure is considered the primary modifiable risk factor in preventing the development of myopia. This effect is thought to be attributed to the light-induced synthesis and release of dopamine in the retina. However, until recent years, there was no objective quantifiable method available to measure the association between time spent outdoors and myopia. It is only recently that the conjunctival ultraviolet autofluorescence (CUVAF) area, serving as a biomarker for sun exposure, has begun to be utilized in numerous studies. To provide a comprehensive summary of the relevant evidence pertaining to the association between the CUVAF area and myopia across different geographic regions and age groups, a systematic review and meta-analysis were conducted. The search encompassed multiple databases, including MEDLINE, SCIENCE DIRECT, GOOGLE SCHOLAR, WEB OF SCIENCE, and SCOPUS, and utilized specific search terms such as "conjunctival ultraviolet autofluorescence", "CUVAF", "UVAF", "objective marker of ocular sun exposure", "myopia", "degenerative myopia", and "high myopia". The bibliographic research included papers published between the years 2006 and 2022. A total of 4051 records were initially identified, and after duplicates were removed, 49 articles underwent full-text review. Nine articles were included in the systematic review. These studies covered myopia and outdoor exposure across different regions (Australia, Europe and India) with a total population of 3615 individuals. They found that myopes generally had smaller CUVAF areas compared to non-myopes. The meta-analysis confirmed this, revealing statistically smaller CUVAF areas in myopic patients, with a mean difference of - 3.30 mm2 (95% CI - 5.53; - 1.06). Additionally, some studies showed a positive correlation between more outdoor exposure and larger CUVAF areas. In terms of outdoor exposure time, myopic patients reported less time outdoors than non-myopic individuals, with a mean difference of - 3.38 h/week (95% CI - 4.66; - 2.09). Overall, these findings highlight the connection between outdoor exposure, CUVAF area and myopia, with regional variations playing a significant role. The results of this meta-analysis validate CUVAF as a quantitative method to objectively measure outdoor exposure in relation with myopia development.

Multiple-frame photography for extended depth of field.

For extending the depth of field, we analyze the result of superimposing several snapshots, which are taken while changing the amount of focus error, at full pupil aperture. We unveil the use of a varifocal lens for controlling the amount of focus error, without modifying either the lateral magnification or light throughput. After recording a set of snapshots, we use suitable acquisition factors for shaping an optical transfer function, which has reduced sensitivity to focus errors.

In vitro activity of ceftazidime-avibactam against Gram-negative strains in Chile 2015-2021.

OBJECTIVES: Ceftazidime-avibactam (CAZ-AVI) combines ceftazidime and a reversible ß-lactamase inhibitor that has shown activity against multidrug-resistant (MDR) Enterobacterales and P. aeruginosa. Using data from the Antimicrobial Testing Leadership and Surveillance program (ATLAS), this study examined the in vitro antimicrobial activity of CAZ-AVI and other antibiotics against Gram-negative bacteria collected from Chilean hospitals between 2015 and 2021. METHODS: Clinical isolates of Enterobacterales and P. aeruginosa were collected from three medical centres in Chile. Blood, abdominal fluid, urine, soft tissues, and respiratory tract samples were obtained from infected patients. Minimum inhibitory concentrations using the broth microdilution method were determined for susceptibility testing, and the Clinical and Laboratory Standards Institute (CLSI) breakpoints were used for interpreting the results. Extended-spectrum ß-lactamases (ESBL) and carbapenemase genes were also detected through polymerase chain reaction. RESULTS: A total of 2600 Enterobacterales and 836 P. aeruginosa were analysed. CAZ-AVI was the antibiotic with the highest in vitro activity against Enterobacterales (99.72%). The incidence of carbapenem-resistant Enterobacterales (CRE) was 1.5% (n = 39), and the antibiotics with the best in vitro activity were tigecycline (92.31%), CAZ-AVI (88.57%), and amikacin (79.49%). CAZ-AVI was the antibiotic with the best activity against ESBL-producing Enterobacterales (99.34%) and MDR Enterobacterales (99.31%). For KPC-producing Enterobacterales, susceptibility to amikacin was 100%, whereas susceptibility to CAZ-AVI was 91.67%. Regarding MDR and difficult-to-treat resistance P. aeruginosa, 44.83% and 38.99% were susceptible to CAZ-AVI, respectively. CONCLUSION: CAZ-AVI shows excellent in vitro activity against Enterobacterales in general, CRE, ESBL-producing Enterobacterales, and KPC-producing Enterobacterales. CAZ-AVI is also an option against MDR P. aeruginosa.

Aligning recycling behaviors and the recycling system - Towards a full cycle of materials and behavioral methods.

In a transdisciplinary project with the Municipality of Trelew (Argentina), we assessed barriers to households disposing of separated waste, developed supportive behavioral interventions, tested the interventions in a randomized controlled trial, and supported the Municipality in upscaling the most successful and cost-effective intervention to a total of 20,000 households. The interventions were designed to address the three main barriers to waste separation detected through a baseline study: a lack of knowledge on how separation works; the additional hassle it represents; and the self-regulation challenge it poses. The interventions consisted of envelopes containing simplifying information, empathetic messages, a magnetic calendar acting as a reminder, or a combination thereof. The interventions roughly halved the prevalence of bags containing unusable mixed waste two weeks after the intervention. This impact was still present after six months. We did not find evidence for an additional effect of empathetic messages or the reminder. Based on these results, the simplified information intervention was rolled out. The results provide evidence of the high potential of using the full range of behavioral methods to increase sustainable behaviors, particularly in the context of limited options to adapt the waste management system as such.