Reversible Li-Ion Conversion Reaction for a TixGe Alloy in a Ti/Ge Multilayer.

Group IV intermetallics electrochemically alloy with Li with stoichiometries as high as Li4.4M (M = Si, Ge, Sn, or Pb). This provides the second highest known specific capacity (after pure lithium metal) for lithium-ion batteries, but the dramatic volume change during cycling greatly limits their use as anodes in Li-ion batteries. We describe an approach to overcome this limitation by constructing electrodes using a Ge/Ti multilayer architecture. In operando X-ray reflectivity and ex situ transmission electron microscopy are used to characterize the heterolayer structure at various lithium stoichiometries along a lithiation/delithiation cycle. The as-deposited multilayer spontaneously forms a one-dimensional TixGe/Ti/TixGe core-shell planar structure embedded in a Ge matrix. The interfacial TixGe alloy is observed to be electrochemically active and exhibits reversible phase separation (i.e., a conversion reaction). Including the germanium components, the overall multilayer structure exhibits a 2.3-fold reversible vertical expansion and contraction and is shown to have improved capacity and capacity retention with respect to a Ge film with equivalent active material thickness.

Characterization of the Cathode Electrolyte Interface in Lithium Ion Batteries by Desorption Electrospray Ionization Mass Spectrometry.

The solid electrolyte interface (SEI) formed via electrolyte decomposition on the anode of lithium ion batteries is largely responsible for the stable cycling of conventional lithium ion batteries. Similarly, there is a lesser-known analogous layer on the cathode side of a lithium ion battery, termed the cathode electrolyte interface (CEI), whose composition and role are debated. To confirm the existence and composition of the CEI, desorption electrospray ionization mass spectrometry (DESI-MS) is applied to study common lithium ion battery cathodes. We observe CEI formation on the LiMn2O4 cathode material after cycling between 3.5 and 4.5 V vs Li/Li(+) in electrolyte solution containing 1 M LiPF6 or LiClO4 in 1:1 (v/v) ethylene carbonate (EC) and dimethyl carbonate (DMC). Intact poly(ethylene glycol) dimethyl ether is identified as the electrolyte degradation product on the cathode surface by the high mass-resolution Orbitrap mass spectrometer. When EC is paired with ethyl methyl carbonate (EMC), poly(ethylene glycol) dimethyl ether, poly(ethylene glycol) ethyl methyl ether, and poly(ethylene glycol) are found on the surface simultaneously. The presence of ethoxy and methoxy end groups indicates both methoxide and ethoxide are produced and involved in the process of oligomerization. Au surfaces cycled under different electrochemical windows as model systems for Li-ion battery anodes are also examined. Interestingly, the identical oligomeric species to those found in the CEI are found on Au surfaces after running five cycles between 2.0 and 0.1 V vs Li/Li(+) in half-cells. These results show that DESI-MS provides intact molecular information on battery electrodes, enabling deeper understanding of the SEI or CEI composition.

Identification of Li-Ion Battery SEI Compounds through (7)Li and (13)C Solid-State MAS NMR Spectroscopy and MALDI-TOF Mass Spectrometry.

Solid-state (7)Li and (13)C MAS NMR spectra of cycled graphitic Li-ion anodes demonstrate SEI compound formation upon lithiation that is followed by changes in the SEI upon delithiation. Solid-state (13)C DPMAS NMR shows changes in peaks associated with organic solvent compounds (ethylene carbonate and dimethyl carbonate, EC/DMC) upon electrochemical cycling due to the formation of and subsequent changes in the SEI compounds. Solid-state (13)C NMR spin-lattice (T1) relaxation time measurements of lithiated Li-ion anodes and reference poly(ethylene oxide) (PEO) powders, along with MALDI-TOF mass spectrometry results, indicate that large-molecular-weight polymers are formed in the SEI layers of the discharged anodes. MALDI-TOF MS and NMR spectroscopy results additionally indicate that delithiated anodes exhibit a larger number of SEI products than is found in lithiated anodes.

In Situ EQCM Study Examining Irreversible Changes the Sulfur-Carbon Cathode in Lithium-Sulfur Batteries.

In situ EQCM experiments were used to investigate the stability and roughness changes occurring in a sulfur-carbon cathode utilized for a Li-S battery during the charge-discharge process. Results show that the sulfur-carbon cathode gains mass during the first discharge plateau (∼2.4 V) due to the formation of the long chain polysulfides during the discharge (lithiation) process. However, further discharge to below 2.4 V yields an increase in the crystal resistance (Rc) suggesting the sulfur-carbon cathode becomes rougher. During the charge (delithiation) process, the roughness of the sulfur-carbon cathode decreases. Time dependent measurements show that the electrode surface becomes rougher with the deeper discharge, with the change occurring following a step to 1.5 V. The sulfur-carbon cathode exhibits stable Rc and frequency behavior initially, but then becomes rougher in subsequent following cycles.

Development and validation of a prediction model for diagnosing blood stream infections in febrile, non-neutropenic children with cancer.

BACKGROUND: Pediatric oncology patients are at increased risk for blood stream infections (BSI). Risk in the absence of severe neutropenia (absolute neutrophil count [ANC] ≥500/µl) is not well defined. PROCEDURE: In a retrospective cohort of febrile (temperature ≥38.0° for >1 hr or ≥38.3°) pediatric oncology patients with ANC ≥500/µl, a diagnostic prediction model for BSI was constructed using logistic regression modeling and the following candidate predictors: age, ANC, absolute monocyte count, body temperature, inpatient/outpatient presentation, sex, central venous catheter type, hypotension, chills, cancer diagnosis, stem cell transplant, upper respiratory symptoms, and exposure to cytarabine, anti-thymocyte globulin, or anti-GD2 antibody. The model was internally validated with bootstrapping methods. RESULTS: Among 932 febrile episodes in 463 patients, we identified 91 cases of BSI. Independently significant predictors for BSI were higher body temperature (Odds ratio [OR] 2.36 P < 0.001), tunneled external catheter (OR 13.79 P < 0.001), peripherally inserted central catheter (OR 3.95 P = 0.005), elevated ANC (OR 1.19 P = 0.024), chills (OR 2.09 P = 0.031), and hypotension (OR 3.08 P = 0.004). Acute lymphoblastic leukemia diagnosis (OR 0.34 P = 0.026), increased age (OR 0.70 P = 0.049), and drug exposure (OR 0.08 P < 0.001) were associated with decreased risk for BSI. The risk prediction model had a C-index of 0.898; after bootstrapping adjustment for optimism, corrected C-index 0.885. CONCLUSIONS: We developed a diagnostic prediction model for BSI in febrile pediatric oncology patients without severe neutropenia. External validation is warranted before use in clinical practice. Pediatr Blood Cancer 2015;62:262-268. © 2014 Wiley Periodicals, Inc.

Respiratory virus shedding in a cohort of on-duty healthcare workers undergoing prospective surveillance.

BACKGROUND: Healthcare-associated transmission of respiratory viruses is a concerning patient safety issue. DESIGN: Surveillance for influenza virus among a cohort of healthcare workers (HCWs) was conducted in a tertiary care children's hospital from November 2009 through April 2010 using biweekly nasal swab specimen collection. If a subject reported respiratory symptoms, an additional specimen was collected. Specimens from ill HCWs and a randomly selected sample from asymptomatic subjects were tested for additional respiratory viruses by multiplex polymerase chain reaction (PCR). RESULTS: A total of 1,404 nasal swab specimens were collected from 170 enrolled subjects. Influenza circulated at very low levels during the surveillance period, and 74.2% of subjects received influenza vaccination. Influenza virus was not detected in any specimen. Multiplex respiratory virus PCR analysis of all 119 specimens from symptomatic subjects and 200 specimens from asymptomatic subjects yielded a total of 42 positive specimens, including 7 (16.7%) in asymptomatic subjects. Viral shedding was associated with report of any symptom (odds ratio [OR], 13.06 [95% confidence interval, 5.45-31.28]; [Formula: see text]) and younger age (OR, 0.96 [95% confidence interval, 0.92-0.99]; [Formula: see text]) when controlled for sex and occupation of physician or nurse. After the surveillance period, 46% of subjects reported working while ill with an influenza-like illness during the previous influenza season. CONCLUSIONS: In this cohort, HCWs working while ill was common, as was viral shedding among those with symptoms. Asymptomatic viral shedding was infrequent but did occur. HCWs should refrain from patient care duties while ill, and staffing contingencies should accommodate them.

Pediatric infectious diseases fellowship training in healthcare epidemiology: a national needs assessment.

OBJECTIVE: Pediatric infectious diseases (ID) fellows are required to receive training in hospital epidemiology and infection control and prevention. We sought to assess the current state of healthcare epidemiology training for fellows and to determine which topics are considered important by key stakeholders. PARTICIPANTS: US pediatric ID fellowship program directors and hospital epidemiologists. METHODS: We conducted an anonymous Web-based survey in February 2012. We assessed the presence and content of curricula, perceived importance of specific topics, and barriers to career development. RESULTS: Of 97 eligible participants, 76 (78%) completed the survey, representing 54 programs. Respondents were program directors (60%), hospital epidemiologists (25%), or both (15%). A total of 82% of programs with didactic curricula have infection control sessions, most commonly 1-2 hours in total duration. Of 17 identified topics, only 3 were covered by more than 50% of programs: isolation precautions (54%), central line-associated bloodstream infection (CLABSI; 53%), and hand hygiene (51%). Of the 76 respondents, 35% indicated that fellows participate in a dedicated infection control rotation. Six topics were considered very important by more than 75% of respondents: antimicrobial stewardship (94%), isolation precautions (93%), hand hygiene (90%), CLABSI (90%), surveillance for resistant bacteria (81%), and communicable disease exposure management (81%). CONCLUSIONS: Pediatric ID fellowship programs dedicate little time to didactic or experiential learning in healthcare epidemiology. There are a wide array of topics that the majority of programs do not cover, including several subjects that are considered to be very important by program directors and hospital epidemiologists. Creating a standardized pediatric infection control curriculum would likely benefit fellows in training.

Cytomegalovirus infection.

Although commonly asymptomatic, congenital CMV infection is the leading cause of nonhereditary SNHL. Other sequelae that may be evident only after the neonatal period can include chorioretinitis, neurodevelopmental delay with mental or motor impairment, and microcephaly. (13) • Congenital CMV infection is confirmed by detection of the virus in urine, blood, or saliva within the first 3 weeks of life by culture or polymerase chain reaction. A positive test does not necessarily confirm symptomatic CMV disease or need for treatment. (13) • Postnatal CMV infections transmitted through human milk have been reported and may be clinically relevant in extremely premature infants; however, the risk-benefit ratio of pasteurizing human milk for the prevention of postnatal CMV infection is unclear. • Ganciclovir, valganciclovir, foscarnet, cidofovir, and CMV hyperimmune globulin are effective in treating or preventing CMV infections in the immunocompromised host, but require close monitoring for associated toxicities. Treatment for congenital CMV is associated with significant toxicity and uncertain effectiveness. • Based on strong evidence, anticipatory guidance for congenital CMV infection should include hearing tests and neurodevelopmental assessments until school age. (3) In patients with symptomatic congenital CMV infection, lifelong ophthalmologic screening should be included. (4) • Based primarily on consensus, owing to lack of relevant clinical studies, it is not recommended to withhold human milk produced by CMV-seropositive mothers from healthy term infants. (5)(6) • Based on some research evidence, as well as consensus, treatment for congenital CMV is recommended only in symptomatic infants with central nervous system involvement. (9)

Severe ehrlichia infection in pediatric oncology and stem cell transplant patients.

Ehrlichiosis, a tickborne illness transmitted by tick vectors Amblyomma americanum and Ixodes scapularis, can be acquired in endemic areas. Clinical manifestations range from asymptomatic to fulminant in nature. We report three cases of ehrlichiosis in pediatric oncology patients, one of whom was a stem cell transplant recipient. Early symptoms included fever, malaise, and vague gastrointestinal symptoms. Laboratory abnormalities were initially attributed to chemotherapy toxicity. Illness was severe in all three patients and one patient died even after initiation of doxycycline. These cases emphasize the need for a high index of suspicion for tickborne illness in oncology patients, and the importance of a low threshold for starting empiric treatment before confirming the diagnosis.