Risk factors for community-associated Clostridioides difficile infection in young children.

The majority of paediatric Clostridioides difficile infections (CDI) are community-associated (CA), but few data exist regarding associated risk factors. We conducted a case-control study to evaluate CA-CDI risk factors in young children. Participants were enrolled from eight US sites during October 2014-February 2016. Case-patients were defined as children aged 1-5 years with a positive C. difficile specimen collected as an outpatient or ⩽3 days of hospital admission, who had no healthcare facility admission in the prior 12 weeks and no history of CDI. Each case-patient was matched to one control. Caregivers were interviewed regarding relevant exposures. Multivariable conditional logistic regression was performed. Of 68 pairs, 44.1% were female. More case-patients than controls had a comorbidity (33.3% vs. 12.1%; P = 0.01); recent higher-risk outpatient exposures (34.9% vs. 17.7%; P = 0.03); recent antibiotic use (54.4% vs. 19.4%; P < 0.0001); or recent exposure to a household member with diarrhoea (41.3% vs. 21.5%; P = 0.04). In multivariable analysis, antibiotic exposure in the preceding 12 weeks was significantly associated with CA-CDI (adjusted matched odds ratio, 6.25; 95% CI 2.18-17.96). Improved antibiotic prescribing might reduce CA-CDI in this population. Further evaluation of the potential role of outpatient healthcare and household exposures in C. difficile transmission is needed.

Spacecraft sample collection and subsurface excavation of asteroid (101955) Bennu.

Carbonaceous asteroids, such as (101955) Bennu, preserve material from the early Solar System, including volatile compounds and organic molecules. We report spacecraft imaging and spectral data collected during and after retrieval of a sample from Bennu's surface. The sampling event mobilized rocks and dust into a debris plume, excavating a 9-meter-long elliptical crater. This exposed material is darker, spectrally redder, and more abundant in fine particulates than the original surface. The bulk density of the displaced subsurface material was 500 to 700 kilograms per cubic meter, which is about half that of the whole asteroid. Particulates that landed on instrument optics spectrally resemble aqueously altered carbonaceous meteorites. The spacecraft stored 250 ± 101 grams of material, which will be delivered to Earth in 2023.

Initial Orbit Determination and Event Reconstruction From Estimation of Particle Trajectories About (101955) Bennu.

The OSIRIS-REx mission has observed multiple instances of particles being ejected from the surface of near-Earth asteroid (101955) Bennu. The ability to quickly identify the particle trajectories and origins is necessary following a particle ejection event. Using proven initial orbit determination techniques, we can rapidly estimate particle trajectories and ejection locations. We present current results pertaining to the identification of particle tracks, an evaluation of the estimated orbits and the excess velocity necessary to induce the particle ejection from the surface, and the uncertainty quantification of the ejection location. We estimate energies per particle ranging from 0.03 to 11.03 mJ for the largest analyzed events and velocities ranging from 5 to 90 cm/s, though we exclude the highest-velocity particles in this technique. We estimate ejection times for eight events and constrain six of the analyzed ejection events to have occurred between about 16:30 and 19:00 local solar time, with the largest events occurring between 16:30 and 18:05.

The membrane transport factor TAP/p115 cycles between the Golgi and earlier secretory compartments and contains distinct domains required for its localization and function.

The mammalian protein TAP/p115 and its yeast homologue Uso1p have an essential role in membrane traffic (Nakajima et al., 1991; Waters et al., 1992; Sztul et al., 1993; Rabouille et al.; 1995). To inquire into the site and mechanism of TAP/p115 action, we aimed to localize it and to identify domains required for its function. We show that in interphase cells, TAP/p115 localizes predominantly to the Golgi and to peripheral structures that represent vesicular tubular clusters (VTCs) involved in ER to Golgi transport. Using BFA/ nocodazole treatments we confirm that TAP/p115 is present on ER to Golgi transport intermediates. TAP/ p115 redistributes to peripheral structures containing ERGIC-53 during a 15 degreesC treatment, suggesting that it is a cycling protein. Within the Golgi, TAP/p115 is associated with pleiomorphic structures on the cis side of the cis-Golgi cisterna and the cis-most cisterna, but is not detected in more distal compartments of the Golgi. TAP/p115 binds the cis-Golgi protein GM130, and the COOH-terminal acidic domain of TAP/p115 is required for this interaction. TAP/p115 interaction with GM130 occurs only in the Golgi and is not required for TAP/p115 association with peripheral VTCs. To examine whether interaction with GM130 is required to recruit TAP/p115 to the Golgi, TAP/p115 mutants lacking the acidic domain were expressed and localized in transfected cells. Mutants lacking the GM130-binding domain showed normal Golgi localization, indicating that TAP/p115 is recruited to the Golgi independently of its ability to bind GM130. Such mutants were also able to associate with peripheral VTCs. Interestingly, TAP/p115 mutants containing the GM130-binding domain but lacking portions of the NH2-terminal region were restricted from the Golgi and localized to the ER. The COOH-terminal domain required for GM130 binding and the NH2-terminal region required for Golgi localization appear functionally relevant since expression of TAP/p115 mutants lacking either of these domains leads to loss of normal Golgi morphology.

Episodes of particle ejection from the surface of the active asteroid (101955) Bennu.

Active asteroids are those that show evidence of ongoing mass loss. We report repeated instances of particle ejection from the surface of (101955) Bennu, demonstrating that it is an active asteroid. The ejection events were imaged by the OSIRIS-REx (Origins, Spectral Interpretation, Resource Identification, and Security-Regolith Explorer) spacecraft. For the three largest observed events, we estimated the ejected particle velocities and sizes, event times, source regions, and energies. We also determined the trajectories and photometric properties of several gravitationally bound particles that orbited temporarily in the Bennu environment. We consider multiple hypotheses for the mechanisms that lead to particle ejection for the largest events, including rotational disruption, electrostatic lofting, ice sublimation, phyllosilicate dehydration, meteoroid impacts, thermal stress fracturing, and secondary impacts.

Stimulation of proliferation in mixed cultures of mouse tumor cells and nonimmune peritoneal cells. II. Stimulation of tumor cells by macrophages and of lymphocytes by a tumor cell product.

Stimulation of [methyl-3H]thymidine incorporation in mixed cultures of mouse peritoneal cells (PC) and tumor cells required a large adherent PC. Flow cytometric analysis, as well as autoradiography, showed that the stimulation involved increased proliferation of tumor cells. The stimulation required contact between tumor and PC; it was partly inhibited by Trasylol (aprotinin) and potentiated by dexamethasone. In addition, there was minor stimulation of PC by a soluble product of tumor cells; this stimulation was not affected by Trasylol or dexamethasone. It is suggested that macrophages can stimulate tumor cell proliferation and that such stimulation may be an important factor in host-tumor relationships.

Stimulation of proliferation in mixed cultures of mouse tumor cells and nonimmune peritoneal cells. I. Occurrence of stimulation and cyclical variation in tumor cell activity.

Mixtures of mouse tumor cells and resident peritoneal cells (PC) from nonimmune mice frequently incorporated [methyl-3H]thymidine [( 3H]dThd) in culture to a far greater extent than did either cell population alone. With PC-to-tumor cell ratios of 10:1, stimulation indices of up to 21 were recorded. Syngeneic, semisyngeneic, and allogeneic mixtures were active. PC elicited by thioglycollate or proteose-peptone could participate in the reaction. PC from mice injected with Corynebacterium parvum also could do so, provided they were precultured for 48 hours. Normal mouse spleen cells and fibroblasts and human Chang cells were inactive. There was considerable variation between experiments in the extent of stimulation observed, even with the same tumor. When tumors were cloned in vitro, freshly isolated clones differed widely in the extent of stimulation. Individual clones studied over a period of time varied markedly and cyclically in the degree of stimulation they exhibited in mixed cultures. This variation appeared to be unrelated to the density of the cultures from which the clones were obtained, to the base-line incorporation of [3H]dThd by tumor cells alone, or to the frequency of passage in vitro. It is suggested that the cyclical variation may be related to the generation of variant cells, which could be important in tumor progression and metastasis.

Macrophages and resistance to tumors. IV. Influence of age on susceptibility of mice to anti-inflammatory and antimacrophage effects of tumor cell products.

Supernatants from cultures of mouse tumors inhibited delayed-type hypersensitivity (DTH) reactions to sheep red blood cells (SRBC) in immunized (C57BL/6J X A/J)F1 and CBA/J mice. In mice older than 17 weeks, two activities were detectable. Material having an apparent molecular weight of less than 10,000 (by membrane filtration) inhibited only the early phase of the reactions: material having a higher molecular weight inhibited only the later phase. In younger mice, DTH reactions were not inhibited. Susceptibility of resistance could not be conferred on young or old mice by reciprocal transfer of spleen cells or sera. Only older SW or A/J mice treated with tumor supernatants displayed reduced inflammation following intradermal injection of concanavalin A (Con A) and depressed cellular responses to Con A injected ip. Supernatant fractions containing material of lower molecular weight inhibited migration and phagocytosis of opsoniazid SRBC in vitro by peritoneal macrophages from both young and old (C57BL/6J X A/J)F1 and CBA/J mice.

Activity of mouse macrophages purified by adherence to, and removal from, a plastic surface.

Mouse peritoneal exudate macrophages were allowed to adhere to plastic Petri dishes and, after washing, were removed by means of EDTA. Cells with the morphology of macrophages were recovered in a fair degree of purity (90-98%) but in low yield (31-34%). The macrophages recovered were fully active in the following ways: re-adherence to glass; pinocytosis of colloidal gold; phagocytosis of opsonized sheep erythrocytes; binding cytophilic antibody; production of lymphocyte activating factor; cytotoxic and cytostatic effects on tumour cells.

Humor in the pediatric emergency department: a 20-year retrospective.

Humorous events often take place in pediatric emergency departments without being recorded. A written account of amusing situations occurring in an emergency department has been compiled over 20 years by personnel at a large urban children's hospital. Data from this reference were analyzed for humorous content and presented in the following categories: most interesting chief complaints, suspicious sounding chief complaints, favorite telephone inquiries, and illustrative cases. This study demonstrates that an emergency department may be a fertile source of medical humor. Recognition of these statements and events helps to relieve the stress of medical training and emergency department work.

Spectrum and frequency of pediatric illness presenting to a general community hospital emergency department.

Knowledge of the range of pediatric illness presenting to a general emergency department (ED) is needed to optimize the quality of care delivered there. It was hypothesized that the pediatric population treated at a general ED exhibited a broad range of medical complaints, while differing significantly from children seen in a pediatric ED. General ED records from 1 week each season were reviewed, and patient age, chief complaint, diagnosis, time of arrival, season, and disposition were recorded. Data on 874 patients were analyzed and compared with pediatric ED data. General ED patient age affected chief complaint, diagnosis, and admission rate (9.5% less than or equal to 1 year admitted vs 2.6% greater than 1 year, P less than .001). General ED patients were older (7.9 vs 6.0 years, P less than .001) and admitted less frequently (3.8% vs 11%, P less than .001). Admission rates varied by arrival time only at the general ED, where minor trauma was more common (41% vs 22%, P less than .001). It is concluded that a wide range of pediatric illness is treated in a general ED, supporting the decision to have pediatric emergency physicians on staff, and that significant differences exist in the spectrum and frequency of pediatric illness seen in a general ED and pediatric ED.

Failure of immunogenic tumors to elicit cytolytic T cells in syngeneic hosts.

Immunogenic, methylcholanthrene-induced sarcomas failed to elicit the production of rapidly cytolytic T lymphocytes in syngeneic mice, although they did elicit the production of more slowly cytotoxic cells. They were, however, susceptible to attack by cytolytic T cells from allo-immune mice and, if infected with ectromelia virus, to attack by similar cells from virus-immune, H-2 compatible mice. It is suggested that the failure to elicit cytolytic T cell production may be due to the lack of an appropriate association between tumour-specific antigens and elements of the major histocompatibility complex.

Effects of hyperglycemia on oxygenation, radiosensitivity and bioenergetic status of subcutaneous RIF-1 tumors.

Since tissue oxygen tension is a balance between delivery and consumption of oxygen, considerable effort has been directed at increasing the former and/or decreasing the latter. Techniques to decrease the rate of cellular oxygen consumption (increasing the distance oxygen can diffuse into tissues) include increasing glycolysis by administering supra-physiologic levels of glucose. We have examined the effect of hyperglycemia produced by intravenous glucose infusion on the tissue oxygenation and radiation response of subcutaneously implanted murine radiation induced fibrosarcomas (RIF-1). A 0.3 M glucose solution was delivered via tail vein injection according to a protocol that maintained glucose at a plasma concentration of 17+/-1 mM. The effect of this treatment on radiation response (clonogenic and growth delay studies), tumor oxygenation (needle electrode pO2 and 2-[2-nitro-1H-imidazol-1-yl]-N-(2,2,3,3,3-pentafluoropropyl) acetamide (EF5) binding), and tumor bioenergetics and pH (31P NMR spectroscopy) was examined. Systemic measurements included hematocrit and blood glucose and lactate concentrations. The results of these studies suggest that these subcutaneously implanted RIF-1 tumors are both radiobiologically and metabolically hypoxic and that intravenous glucose infusion is not an effective method of modifying this metabolic state.

The addition of ceftriaxone to oral therapy does not improve outcome in febrile children with urinary tract infections.

OBJECTIVE: To determine whether the addition of a single dose of ceftriaxone sodium to a 10-day course of trimethoprim and sulfamethoxazole hastens urine sterilization or resolution of clinical symptoms in febrile children with urinary tract infections. DESIGN: Prospective, single-blind, randomized study. SETTING: Tertiary care children's hospital emergency department. PATIENTS: Febrile children aged 6 months to 12 years with a presumptive urinary tract infection based on history, physical examination, and urinalysis findings. INTERVENTIONS: A history was taken, a physical examination and urinalysis and culture were performed, and a white blood cell count and erythrocyte sedimentation rate were obtained. Children were randomized to receive an intramuscular dose of ceftriaxone then 10 days of trimethoprim-sulfamethoxazole (IM + PO group) or oral trimethoprim-sulfamethoxazole alone (PO group). After receiving study medication, patients were discharged from the hospital to return in 48 hours for a follow-up evaluation and urine culture. Treatment failure was defined as the persistence of a positive culture at 48 hours or the need for hospital admission for intravenous rehydration or antibiotic therapy. RESULTS: Sixty-nine children were enrolled, 34 in the IM + PO group and 35 in the PO group. The 2 groups were similar at the initial visit with respect to age, sex, clinical degrees of illness, white blood cell count, and erythrocyte sedimentation rate (P>.05). At the 48-hour follow-up visit, there were no differences between the 2 treatment groups in resolution of vomiting, fever, general appearance, abdominal tenderness, and hydration state (P>.05). There were 9 treatment failures, 4 in the IM + PO group and 5 in the PO group (P =.93). CONCLUSION: The addition of a single dose of intramuscular ceftriaxone to a 10-day course of oral trimethoprim-sulfamethoxazole for urinary tract infection with fever resulted in no difference at 48 hours in the urine sterilization rate, degree of clinical improvement, or subsequent hospital admission rate.

Seizure disorders in autism.

Several reports have suggested that autistic individuals are at greater risk for developing seizure disorders, particularly in adolescence. In this study the frequency of seizures in a series of 192 autistic individuals was examined; 21% of cases had exhibited a seizure disorder. Seizure disorders were more common among individuals with lower IQ. Age specific incidence revealed a 3- to 22-fold increase in risk for seizure relative to the normal population. In contrast to previous studies, risk for developing seizures was highest during early childhood although it was also elevated during early adolescence.

Autoantibodies in cancer patients.

The prevalence of antinuclear antibodies was increased in patients with adenocarcinoma of the corpus uteri, chronic lesions of the cervix uteri, malignant melanoma, non-malignant pigmented skin lesions and basal cell carcinoma. The prevalence of smooth muscle antibodies was increased in patients with squamous carcinoma of the cervix and malignant melanoma. The prevalence of antibodies to gastric parietal cells and thyroid epithelial cells was not increased in any group of patients.

Mechanism of resistance of mice to syngeneic methylcholanthrene induced fibrosarcomas.

Mice become resistant to challenge with certain fibrosarcomas when bearing a tumor graft (concomitant immunity) or after injection of a low, non-tumorigenic dose of cells (sinecomitant immunity). Resistance to footpad challenge was depressed or abolished by treatment with carrageenan, niridazole or reserpine, or by sublethal irradiation, all of which also depressed delayed-type hypersensitivity (DTH) reactions. Immune lymphocytes initiating tumor-suppressive reactions in the feet of non-immune mice were Thy-1+, Ly-1+, Ly-2- and Ly-3-. Injection of tumor cells into the peritoneal cavities of immune mice specifically elicited an influx of macrophages. There was evidence of macrophage stimulation in tumor-immune mice. In vitro, anti-tumor effector cells lacking individual tumor specificity could be detected among the resident peritoneal cells of tumor-immune mice and among peritoneal exudate cells of non-immune mice. The expression of acquired resistance to some tumors may involve reactions akin to DTH in which a specific reaction triggers an accumulation of nonspecific effectors.

Use of propofol sedation in a pediatric emergency department: a prospective study.

The purpose of this study was to determine the efficacy and safety of propofol sedation for pediatric procedures in the emergency department. For patients needing painful procedures, propofol was administered intravenously. Vital signs, complications, and time to recovery were recorded. Patient amnesia and parent, patient, and operator satisfaction with sedation were assessed. The mean age was 7.4 years; 65% were male. Most underwent fracture reduction. Mean total dose was 3.3 mg/kg. Thirty percent experienced desaturation. One required assisted ventilation. Most had decreases in blood pressure. Mean recovery time was 18 minutes. Satisfaction with sedation was rated "excellent." Propofol was an effective sedation with minimal complications in the emergency department setting.

Do parents choose appropriate automotive restraint devices for their children?

This study aims to describe parental choices of childhood automotive restraints and compare them with guidelines based on weight and height. Parents were surveyed and their children's heights and weight were measured. Results indicated that many parents believed their child fit a lap or shoulder belt when their children were too short to fit these devices. For children weighing < 40 pounds, 45% of parents believed the lap belt fit. Thirteen percent of 4-7-year-olds used booster seats, appropriate for 72% by sitting height criteria; and 33% of children < or = 7 years used the lap/shoullder belt, appropriate for 8% by sitting height criteria. Implications are that parental perceptions of fit may lead to inappropriate restraint choices for children. Practitioners should discuss child restraint use with parents in the context of their child's weight and height.

Research note: a lack of response to pantothenic acid supplementation to a corn and soybean meal broiler diet.

Two 21-day battery studies were conducted to determine whether a corn and soybean meal diet without pantothenic acid supplementation was adequate for growth and feed efficiency of broilers. In each experiment, 64 1-day-old broiler chicks (32 male and 32 female) were assigned to each of six dietary treatments. The basal diet was supplemented with 0, .3, .6, 2.4, 4.8, and 14.4 mg of supplemental pantothenic acid/kg of diet. Each diet in both experiments was fed to eight pens containing four females and four male day-old Arbor Acres broiler chicks. The basal diet contained 22.3% protein and 4.74 mg/kg pantothenic acid by analysis. No improvement in growth or feed efficiency was obtained from any level of pantothenic acid supplementation.