Explore the vast range of titles available.

Maternal immunisation schedules are increasingly coming under the spotlight as part of the development of lifetime immunisation programmes for the role that they play in improving maternal, foetal, and neonatal health. Maternally-acquired antibodies are critical in protecting infants during the first months of their lives. Maternal immunisation was previously overlooked owing to concerns regarding vaccinations in this untested and high-risk population but is now acknowledged for its potential impact on the outcomes in many domains of foetal and neonatal health, aside from its maternal benefits. This article highlights the role that maternal immunisation may play in reducing infections in preterm and term infants. It explores the barriers to antenatal vaccinations and the optimisation of the immunisation uptake. This review also probes the part that maternal immunisation may hold in the reduction of perinatal antimicrobial resistance and the prevention of non-infectious diseases. Both healthcare providers and expectant mothers should continue to be educated on the importance and safety of the appropriate immunizations during pregnancy. Maternal vaccination merits its deserved priority in a life-course immunization approach and it is perhaps the only immunization whereby two generations benefit directly from a single input. We outline the current recommendations for antenatal vaccinations and highlight the potential advances in the field contributing to “preventive neonatology”.

ObjectiveThis study examines the forensic medical examination (FME) service provided to children in a regional centre in Dublin, Ireland, over 5 years. It reports on patient characteristics, alleged perpetrators and service provision. The goal is to inform future service provision and prevention strategies.DesignThe retrospective cohort study included all children and adolescents who underwent FME from January 2018 to December 2022. Data was collected from encrypted child protection reports and analysed with descriptive statisticsSettingThe study was undertaken in the Laurels Clinic, one of the three regional Irish centres for FME.ResultsOf 448 patients, 79% were female, with 37.3% aged 5–11 years. Vaginal penetration occurred in 46% of cases, with digital penetration (vaginal or anal) being the most common method. Anal penetration was reported in 26%, and 6.3% had anogenital findings suggestive of child sexual abuse (CSA). CSA was most often perpetrated in the home, with nearly half of patients showing behavioural changes. About 18% had developmental concerns, and 30% lived in blended families. Alleged perpetrators were mainly male (90.1%), with over 20% being teenagers and 12.8% under 13. Over half of cases involved repeated abuse. Disclosure rates were higher with age, with 69% of disclosures made to a parent.ConclusionThis study highlights CSA risk factors, including blended families and developmental concerns. A worrying finding was that many perpetrators were adolescents or children. Prevention programmes must address risks related to smartphone use and exposure to pornography. These findings can guide clinicians, policymakers and institutions in strengthening CSA prevention and response efforts.

Each year in the United States, Clostridioides difficile causes nearly 500,000 gastrointestinal infections that range from mild diarrhea to severe colitis and death. The ability to identify patients at increased risk for severe disease or mortality at the time of diagnosis of C. difficile infection (CDI) would allow clinicians to effectively allocate disease modifying therapies. In this study, we developed models consisting of only a small number of serum biomarkers that are capable of predicting both 30-day all-cause mortality and adverse outcomes of patients at time of CDI diagnosis. We were able to validate these models through experimental mouse infection. This provides evidence that the biomarkers reflect the underlying pathophysiology and that our mouse model of CDI reflects the pathogenesis of human infection. Predictive models can not only assist clinicians in identifying patients at risk for severe CDI but also be utilized for targeted enrollment in clinical trials aimed at reduction of adverse outcomes from severe CDI. Clostridioides difficile infection (CDI) can result in severe disease and death, with no accurate models that allow for early prediction of adverse outcomes. To address this need, we sought to develop serum-based biomarker models to predict CDI outcomes. We prospectively collected sera ≤48 h after diagnosis of CDI in two cohorts. Biomarkers were measured with a custom multiplex bead array assay. Patients were classified using IDSA severity criteria and the development of disease-related complications (DRCs), which were defined as ICU admission, colectomy, and/or death attributed to CDI. Unadjusted and adjusted models were built using logistic and elastic net modeling. The best model for severity included procalcitonin (PCT) and hepatocyte growth factor (HGF) with an area (AUC) under the receiver operating characteristic (ROC) curve of 0.74 (95% confidence interval, 0.67 to 0.81). The best model for 30-day mortality included interleukin-8 (IL-8), PCT, CXCL-5, IP-10, and IL-2Rα with an AUC of 0.89 (0.84 to 0.95). The best model for DRCs included IL-8, procalcitonin, HGF, and IL-2Rα with an AUC of 0.84 (0.73 to 0.94). To validate our models, we employed experimental infection of mice with C. difficile . Antibiotic-treated mice were challenged with C. difficile and a similar panel of serum biomarkers was measured. Applying each model to the mouse cohort of severe and nonsevere CDI revealed AUCs of 0.59 (0.44 to 0.74), 0.96 (0.90 to 1.0), and 0.89 (0.81 to 0.97). In both human and murine CDI, models based on serum biomarkers predicted adverse CDI outcomes. Our results support the use of serum-based biomarker panels to inform Clostridioides difficile infection treatment. IMPORTANCE Each year in the United States, Clostridioides difficile causes nearly 500,000 gastrointestinal infections that range from mild diarrhea to severe colitis and death. The ability to identify patients at increased risk for severe disease or mortality at the time of diagnosis of C. difficile infection (CDI) would allow clinicians to effectively allocate disease modifying therapies. In this study, we developed models consisting of only a small number of serum biomarkers that are capable of predicting both 30-day all-cause mortality and adverse outcomes of patients at time of CDI diagnosis. We were able to validate these models through experimental mouse infection. This provides evidence that the biomarkers reflect the underlying pathophysiology and that our mouse model of CDI reflects the pathogenesis of human infection. Predictive models can not only assist clinicians in identifying patients at risk for severe CDI but also be utilized for targeted enrollment in clinical trials aimed at reduction of adverse outcomes from severe CDI.

The water snowline location in protostellar envelopes provides crucial information about the thermal structure and the mass accretion process as it can inform about the occurrence of recent (≲1000 yr) accretion bursts. In addition, the ability to image water emission makes these sources excellent laboratories to test indirect snowline tracers such as H13CO+. We study the water snowline in five protostellar envelopes in Perseus using a suite of molecular-line observations taken with the Atacama Large Millimeter/submillimeter Array (ALMA) at ∼0.″2−0.″7 (60–210 au) resolution. B1-c provides a textbook example of compact H218O (31,3−22,0) and HDO (31,2−22,1) emission surrounded by a ring of H13CO+ (J = 2−1) and HC18O+ (J = 3−2). Compact HDO surrounded by H13CO+ is also detected toward B1-bS. The optically thick main isotopologue HCO+ is not suited to trace the snowline, and HC18O+ is a better tracer than H13CO+ due to a lower contribution from the outer envelope. However, because a detailed analysis is needed to derive a snowline location from H13CO+ or HC18O+ emission, their true value as a snowline tracer will lie in the application in sources where water cannot be readily detected. For protostellar envelopes, the most straightforward way to locate the water snowline is through observations of H218O or HDO. Including all subarcsecond-resolution water observations from the literature, we derive an average burst interval of ∼10,000 yr, but high-resolution water observations of a larger number of protostars are required to better constrain the burst frequency.

Background Clostridium difficile infection (CDI) can result in severe disease and death. We are currently unable to identify patients at risk for developing adverse outcomes. We previously showed multiple inflammatory mediators were associated with severity and adverse outcomes. Here, we set out to validate these findings in patients and a murine model of CDI. Methods CDI was diagnosed by the clinical microbiology laboratory. Sera were collected ≤48 hours after diagnosis from pilot (October 2010–November 2012) and validation (January–September 2016) cohorts. Inflammatory mediators were measured with a custom multiplex assay. IDSA severity was defined as serum creatinine >1.5-fold above baseline or white blood cell count >15,000 cells/mL. The 30-day outcomes were all-cause mortality and disease-related complications (DRCs): ICU admission, colectomy, or death attributed to CDI. We sought to validate our patient findings in a murine model of CDI: 67 antibiotic-treated mice were infected with 630 g (37 mice), a low virulence strain, or VPI 10463 (30 mice), a highly virulent strain. Host responses were assessed with a murine version of the multiplex panel. Unadjusted and adjusted models were built using logistic and L1 regression, respectively. Results The pilot cohort had 156 CDI cases; 63 (40%) with IDSA severity. The inflammatory response in IDSA severe cases was distinct based on redundancy analysis of all measured analytes (P = 0.01). In unadjusted analysis, IL-2R, IL-6, and procalcitonin associated with severity (P < 0.001, P = 0.003, and P = 0.003, respectively). The same findings were seen in the validation cohort of 272 cases (Figure 1). Unadjusted analyses revealed several predictors of severity and outcomes (Table 1). Adjusted models performed well (Figure 2) with AUCs of 0.74 [0.67–0.81] (IDSA severity), 0.89 [0.83–0.95] (death), and 0.84 [0.74–0.95] (DRCs). Application of each model to the mouse cohort for high vs. low virulence infections revealed AUCs of 0.59 [0.44–0.74], 0.96 [0.90–1.0], and 0.89 [0.81–0.97] (Figure 3). Conclusion In both humans and a murine CDI model, a panel of biomarkers from sera associated with severe CDI and predicted adverse outcomes. Our results support the possibility of a serum-based biomarker panel to inform medical decision-making for patients with CDI. Disclosures All Authors: No reported Disclosures.

The water snowline location in protostellar envelopes provides crucial information about the thermal structure and the mass accretion process as it can inform about the occurrence of recent (\\(\\)1,000 yr) accretion bursts. In addition, the ability to image water emission makes these sources excellent laboratories to test indirect snowline tracers such as H\\(^13\\)CO\\(^+\\). We study the water snowline in five protostellar envelopes in Perseus using a suite of molecular line observations taken with the Atacama Large Millimeter/submillimeter Array (ALMA) at \\(\\)0.2\\(^-\\)0.7\\(^\\) (60--210 au) resolution. B1-c provides a textbook example of compact H\\(_2^18\\)O (\\(3_1,3-2_2,0\\)) and HDO (\\(3_1,2-2_2,1\\)) emission surrounded by a ring of H\\(^13\\)CO\\(^+\\) (\\(J=2-1\\)) and HC\\(^18\\)O\\(^+\\) (\\(J=3-2\\)). Compact HDO surrounded by H\\(^13\\)CO\\(^+\\) is also detected toward B1-bS. The optically thick main isotopologue HCO\\(^+\\) is not suited to trace the snowline and HC\\(^18\\)O\\(^+\\) is a better tracer than H\\(^13\\)CO\\(^+\\) due to a lower contribution from the outer envelope. However, since a detailed analysis is needed to derive a snowline location from H\\(^13\\)CO\\(^+\\) or HC\\(^18\\)O\\(^+\\) emission, their true value as snowline tracer will lie in the application in sources where water cannot be readily detected. For protostellar envelopes, the most straightforward way to locate the water snowline is through observations of H\\(_2^18\\)O or HDO. Including all sub-arcsecond resolution water observations from the literature, we derive an average burst interval of \\(\\)10,000 yr, but high-resolution water observations of a larger number of protostars is required to better constrain the burst frequency.

If public management education is to continue to educate qualified public managers, it must update its programs to reflect the continuing changes in society, government, and knowledge, particularly those changes precipitated by the computer age. At minimum, managers must be able to: 1. use the technology in their own work, 2. utilize the technology of the organizations they manage, and 3. develop policy for effective use and control of the technology for strategic and operational advantages. Public management programs should allow students the option to develop different levels of computing literacy and integrate computing in present course offerings. The National Association of Schools of Public Affairs and Administration (NASPAA) recommends 3 levels of computer literacy courses: 1. computing appreciation, 2. computing use, and 3. computing management. The proposed general structure would require investment in new hardware, facilities, and faculty.

In order to obtain a census of the pre-stellar and star-forming molecular cores, we have begun an unbiased survey in CS and N2H+ of the L1630 and L1641 molecular clouds. The use of these two molecular species enables us to quantify and disentangle the effects of depletion often seen in CS observations of dense cores. The spectral line data will provide essential kinematical information not present in similar studies of the sub-millimeter dust-continuum, enabling us to examine the overall core to core velocity dispersion and study the effects of infall and outflows around known sub-mm and infra-red sources. Here we present our initial observations of part of L1630, taken during the commissioning phase of the FCRAO On-the-Fly Mapping system in January 2002.

The systematic education of public managers has undergone various changes throughout its history. Today, if we are to continue to educate qualified public managers, we must update our programs to reflect the continuing changes in society, government, and knowledge-particularly those changes precipitated by the computer age. At minimum, we must provide managers with three levels of computer literacy: (1) the ability to use the technology in their own work, (2) the ability to use the technology of the organizations they manage, (3) the ability to develop policy for effective use and control of the technology for strategic as well as for operational advantages. This report outlines the rationale for computer literacy, the nature of an academic program and courses to deliver it, and its relation to other knowledge and skill requirements of modern public administration.