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We thank Barra and Agarwal for their interest in our examination of implantable cardioverter-defibrillator (ICD) outcomes and therapies in different age groups, focusing on the elderly.1 We agree that rates of device therapies with conventional programming may overestimate the potential benefit of ICD implantation. Barra and Agarwal suggest that device programming approaches that were used in the Primary Prevention Parameters Evaluation (PREPARE),2 Multicenter Automatic Defibrillator Implantation Trial - Reduce Inappropriate Therapy (MADIT-RIT),3 and Avoid Delivering Therapies for Non-sustained Arrhythmias in ICD Patients III (ADVANCE III)4 trials would lead to rates of appropriate shock and therapy that better reflect the occurrence of ventricular tachyarrhythmia episodes that would more likely have been associated with an arrhythmic death. Early after the initiation of the Ontario ICD Database, the PREPARE study was published, the potential benefits of delaying ICD-delivered therapies were recognized, and participating sites adapted …

Ce mémoire explore la dynamique mémorielle au sein de l’écriture. Dans la partie création, le personnage de Sam erre à l’intérieur de ses souvenirs à la recherche de sa sœur Lidie. Il s’agit d’une tentative vaine, toujours à recommencer puisque la mémoire, liée à la conscience, est sans cesse gauchie et subjective, incapable de redonner un passé objectif. La figure de Lidie se trouve ainsi être le point central inatteignable d’une circonvolution, le mouvement circulaire révélant la présence de la mémoire dans le corps du texte. La partie essai aborde la question de la liaison entre la mémoire et l’écriture dans Le Palace de Claude Simon. Reprenant l’idée du triple présent de Saint Augustin, le passé n’est alors possible que dans un présent du passé. Cette dynamique crée un mouvement circulaire ; le personnage parcourt ses souvenirs, mais il ne peut les investir que par la lorgnette d’un présent. Cela se traduit par un texte sans début ni fin, révolutionnaire, où le souvenir, plutôt qu’un retour dans le temps, fait avancer le texte et devient le temps présent de l’écriture. This master explores the dynamism of the memory within writing. In the creation part, the character of Sam wanders in his memories, searching for his sister Lidie. It is a vain attempt, always to begin again since the memory, related to the consciousness, is unceasingly subjective and distorted, unable to give back an objective past. The figure of Lidie find to be the unattainable central point of a convolution, the cercle trajectory revealing the presence of the memory in the body of the text. The essay part discusses the question of the bond between the memory and the writing in Le Palace of Claude Simon. Taking up the idea of the triple present of St. Augustine, the past is then possible only in a present of the past, and this dynamism creates a circular motion while the character goes through his memories that he can only invest by the lens of a present. This reveals a text without any beginning or end, revolutionary, where the memory, rather than a return in time, is moving forward the text and becomes the present time of the writing. Mémoire en recherche-création.

ABSTRACTTraining protocols designed to improve dual-task performance of an obstacle crossing and auditory Stroop task (OBS+Stroop) were tested. In Experiment 1, following baseline collection of OBS+Stroop trials, proximally related walking training was performed, and participants were then retested on the OBS+Stroop test. After training, participants adopted a more cautious obstacle crossing strategy, indicating a potentially safer navigation strategy. Transfer effects from distally related training were then examined (Experiment 2); a computer game training paradigm was examined using the same testing protocol as Experiment 1. Computer training demonstrated improved dual-task performance on some measures, but did not induce a more cautious stepping strategy. Results indicate that dual-task training needs to be similar to targeted tasks to yield reliable, positive training outcomes.

The present investigation deals with the facile synthesis and characterization of chitosan (CTS)-based zinc oxide (ZnO) nanoparticles (NPs) and their antimicrobial activities against pathogenic microorganisms. ZnO–CTS NPs were synthesized through two different methods: nano spray drying and precipitation, using various organic compounds (citric acid, glycerol, starch and whey powder) as stabilizers. Both the synthesis methods were simple and were devoid of any chemical usage. The detailed characterization of the NPs was carried out using UV–Vis spectroscopy, dynamic light scattering particle size analysis, zeta potential measurements and scanning electron microscopy, which confirmed the fabrication of NPs with different shapes and sizes. Antimicrobial assay of synthesized ZnO–CTS NPs was carried out against different pathogenic microbial strains (Candida albicans, Micrococcus luteus and Staphylococcus aureus). The significant (p < 0.05) inhibition of growth was observed for both M. luteus and S. aureus with ZnO–CTS NPs (with a concentration ranging from 0.625 to 0.156 mg/ml) as compared to control treatment. ZnO–CTS NPs also showed significant biofilm inhibition activity (p < 0.05) against M. luteus and S. aureus. The study demonstrated the potential of ZnO–CTS NPs as antimicrobial and antibiofilm agents.

AbstractObjectiveTo evaluate trends in organisms causing early-onset neonatal sepsis (EONS). Congruent with recent reports, we hypothesized there would be an increase in EONS caused by Escherichia coli.Study DesignNational data on infants admitted to neonatal intensive care units from 2009 to 2014 were compared to previously reported data from 2003 to 2008. We report 430 cases of EONS from 2009 to 2014. Bivariate analyses were used to analyze the distribution of causative organisms over time and differences by gestational age. Linear regression was used to estimate trends in causative organisms.ResultsSince 2003, there has been a trend of increasing numbers of cases caused by E coli (P&lt;0.01). The predominant organism was E coli in preterm infants and Group B Streptococcus in term infants.ConclusionsWith the majority of EONS cases now caused by E coli, our findings emphasize the importance of continued surveillance of causative organism patterns and developing approaches to reduce cases caused by E coli.

ABSTRACT Background: Though multidisciplinary pain treatment (MPT) is considered the gold standard for managing chronic pain, it is unclear which patients benefit most from this high-cost treatment approach. Aims: The goals were to identify subgroups of patients sharing similar pain severity trajectories over time and predictors of MPT responsiveness. Methods: Participants were 1894 patients (mean age = 53.18 years [SD = 14.0]; female = 60.3%) enrolled in the Quebec Pain Registry with moderate to severe baseline pain severity. Patients completed validated questionnaires on pain and related constructs before initiating treatment and 6, 12, and 24 months later. Results: Trajectory analyses of pain severity (intensity and interference) showed that a three-class model best fit the data. Two of the trajectories, which included 24.5% of patients, showed significant improvement in pain severity levels over time (improvers). Compared to patients in the nonimproving trajectory (non-improvers), improvers were younger and more likely to suffer from neuropathic pain and had pain of shorter duration, lower worst pain intensity, lower sleep disturbances and depression scores at baseline, a lower tendency to catastrophize, and better physical health–related quality of life (QOL). This predictive model had a specificity of 96.2% and a sensitivity of 23.6%. Conclusions: Only a minority of patients exhibited an improvement in their pain severity with MPT. Several patients’ characteristics were significantly associated with pain trajectory membership. Early identification of nonimprovers, through examination of baseline characteristics and rates of change in pain scores, can provide valuable information about prognosis and open the doors for evaluation of different cost-effective treatment approaches. Abbreviations: CP = chronic pain; MPT = multidisciplinary pain treatment; QPR = Quebec Pain Registry; QOL = quality of life.

This dataset is composed of CT pulmonary angiograms and annotations related to pulmonary embolism. It is available at https://www.rsna.org/education/ai-resources-and-training/ai-image-challenge/rsn...

Converging evidence from biopsychosocial research in humans and animals demonstrates that chronic sensory stimulation (via excessive screen exposure) affects brain development increasing the risk of cognitive, emotional, and behavioural disorders in adolescents and young adults. Emerging evidence suggests that some of these effects are similar to those seen in adults with symptoms of mild cognitive impairment (MCI) in the early stages of dementia, including impaired concentration, orientation, acquisition of recent memories (anterograde amnesia), recall of past memories (retrograde amnesia), social functioning, and self-care. Excessive screen time is known to alter gray matter and white volumes in the brain, increase the risk of mental disorders, and impair acquisition of memories and learning which are known risk factors for dementia. Chronic sensory overstimulation (i.e., excessive screen time) during brain development increases the risk of accelerated neurodegeneration in adulthood (i.e., amnesia, early onset dementia). This relationship is affected by several mediating/moderating factors (e.g., IQ decline, learning impairments and mental illness). We hypothesize that excessive screen exposure during critical periods of development in Generation Z will lead to mild cognitive impairments in early to middle adulthood resulting in substantially increased rates of early onset dementia in later adulthood. We predict that from 2060 to 2100, the rates of Alzheimer’s disease and related dementias (ADRD) will increase significantly, far above the Centres for Disease Control (CDC) projected estimates of a two-fold increase, to upwards of a four-to-six-fold increase. The CDC estimates are based entirely on factors related to the age, sex, race and ethnicity of individuals born before 1950 who did not have access to mobile digital technology during critical periods of brain development. Compared to previous generations, the average 17–19-year-old spends approximately 6 hours a day on mobile digital devices (MDD) (smartphones, tablets, and laptop computers) whereas individuals born before 1950 at the same age spent zero. Our estimates include the documented effects of excessive screen time on individuals born after 1980, Millennials and Generation Z, who will be the majority of individuals ≥65 years old. An estimated 4-to-6-fold increase in rates of ADRD post-2060 will result in widespread societal and economic distress and the complete collapse of already overburdened healthcare systems in developed countries. Preventative measures must be set in place immediately including investments and interventions in public education, social policy, laws, and healthcare.

The base of the Proterozoic Negaunee Iron Formation is exposed in the open pit at Tilden Mine, Marquette, Michigan. Juxtaposed against the Archean-aged Palmer Gneiss, it is bounded by the regional-scale Southern Shear Zone and cut by two sets of dykes: an older chloritic and schistose set and a younger 1.1 Ga Keweenawan set. Tilden Mine is dominated by a 100 m scale plunging northwest-anticline and is cut by a growth fault locally termed the Tower Hill Fault that intersects the Southern Shear Zone. The base of the exposed iron formation is composed of three lithofacies, including lower clastics that grade into the overlying banded iron formation that in turn grades upward into granular iron formation. This succession is capped by chloritic metadiabases locally termed the Summit Hill Sill and Pillar Intrusive. Petrographic and mineral chemical investigations document primary or early diagenetic hematite, siderite and possibly ferri-hydrite, metamorphic and related hydrothermal magnetite, chlorite, late martite overgrowing earlier magnetite and growth of specularite. All three lithofacies are cut by brittle fractures and late quartz veins. Brittle fractures are coated with chlorite, carbonate minerals, fluor-apatite, and sparse Cu-sulphides. These lithofacies document initial clastic sedimentation of strained detrital quartz into a subsiding fault trough. Over time, as subsidence slowed or sea level fluctuated, clastic deposition competed with quiescent chemical sedimentation, leading to deposition of the banded iron formation facies. As a stable shelf platform emerged, the granular iron formation facies was deposited via wave reworking of hardgrounds. Subsequent diagenesis initiated dissolution of carbonate and chert and promoted diagenetic replacement of primary iron minerals and chert. Regional metamorphism during Penokean orogeny at 1875–1835 Ma produced a suite of secondary metamorphic and related hydrothermal minerals. Metamorphism and hydrothermal flux related to the 1750 Ma development of the Republic Metamorphic Node overprinted the iron formation at Tilden to greenschist facies and infilled brittle fractures with a unique mineral assemblage. This unique mineral assemblage exhibits some striking similarities to Mn, Au, and Cu-sulphides documented at Champion Mine, west of Tilden, and proximal to the core of the Republic Node.

There is an ongoing debate on the importance of genetic factors in cancer development, where gene-centered cancer predisposition seems to show that only 5 to 10% of the cancer cases are inheritable. By conducting a systematic analysis of germline genomes of 9712 cancer patients representing 22 common cancer types along with 16,670 noncancer individuals, we identified seven cancer-associated germline genomic patterns (CGGPs), which summarized trinucleotide mutational spectra of germline genomes. A few CGGPs were consistently enriched in the germline genomes of patients whose tumors had smoking signatures or correlated with oncogenesis- and genome instability–related mutations. Furthermore, subgroups defined by the CGGPs were significantly associated with distinct oncogenic pathways, tumor histological subtypes, and prognosis in 13 common cancer types, suggesting that germline genomic patterns enable to inform treatment and clinical outcomes. These results provided evidence that cancer risk and clinical outcomes could be encoded in germline genomes. Germline variants when organized as genomic patterns are associated with cancer risk, oncogenic pathways, and clinical outcomes.