Affordable Implementation of a Point-of-Care-Ultrasound Program in a Large Tertiary NICU to Assess Umbilical Venous Catheter Tips and Aid Central Placement.

Objective To implement a Point-of-Care-Ultrasound (POCUS) program into a large NICU to enhance care by improving (1) umbilical venous catheter (UVC) tip identification and (2) central placement. Study Design A POCUS program was established with core providers who received training from external and internal experts. A prospective study (n=94) compared the accuracy of UVC identification between neonatology-performed ultrasound (NeoUS) and X-ray relative to a referent of radiology-interpreted ultrasound. Finally, an US-guided UVC insertion protocol was introduced to rescue non-central traditionally-placed catheters (n=37). Results Program implementation trained 6 providers for a total cost of ~$10,500 USD. NeoUS was more accurate than X-ray at identifying UVC location (81.9% vs 60.6%) with improved sensitivity and specificity (80.0 and 84.6% vs 52.5% and 66.7%, respectively). POCUS-guidance was able to rescue 89.2% of catheters that were originally non-central. Conclusion POCUS implementation in a large NICU is feasible, affordable, and can improve quality of care.

A colon cancer "prequel".

The development of colorectal cancer has been predicted to inolve the enteric microbiome. In this issue of Cell Host & Microbe, Kordahi et al. (2021) address this predisposition by identifying not just pathobiont micro-organisms but also distinct microbial signatures within those bacteria that predict the presence of pre-cancerous polyps.

Pneumococcal Neuraminidase A (NanA) Promotes Biofilm Formation and Synergizes with Influenza A Virus in Nasal Colonization and Middle Ear Infection.

Even in the vaccine era, Streptococcus pneumoniae (the pneumococcus) remains a leading cause of otitis media, a significant public health burden, in large part because of the high prevalence of nasal colonization with the pneumococcus in children. The primary pneumococcal neuraminidase, NanA, which is a sialidase that catalyzes the cleavage of terminal sialic acids from host glycoconjugates, is involved in both of these processes. Coinfection with influenza A virus, which also expresses a neuraminidase, exacerbates nasal colonization and disease by S. pneumoniae, in part via the synergistic contributions of the viral neuraminidase. The specific role of its pneumococcal counterpart, NanA, in this interaction, however, is less well understood. We demonstrate in a mouse model that NanA-deficient pneumococci are impaired in their ability to cause both nasal colonization and middle ear infection. Coinfection with neuraminidase-expressing influenza virus and S. pneumoniae potentiates both colonization and infection but not to wild-type levels, suggesting an intrinsic role of NanA. Using in vitro models, we show that while NanA contributes to both epithelial adherence and biofilm viability, its effect on the latter is actually independent of its sialidase activity. These data indicate that NanA contributes both enzymatically and nonenzymatically to pneumococcal pathogenesis and, as such, suggest that it is not a redundant bystander during coinfection with influenza A virus. Rather, its expression is required for the full synergism between these two pathogens.

Multinuclear Magnetic Resonance Investigation of Crystalline Alkali Molybdates.

A variety of crystalline alkali molybdate phases are characterized by (23)Na, (133)Cs, and (95)Mo magic-angle-spinning nuclear magnetic resonance (MAS NMR) to provide spectroscopic handles for studies of devitrification products in borosilicate nuclear waste glasses. The NMR parameters obtained from line-shape simulations are plotted as a function of various structural parameters to discern trends that may prove useful in the determination of unknown phases. These are applied to Cs3Na(MoO4)2, the most common precipitate found in cesium- and molybdenum-bearing model nuclear waste glasses, the crystal structure of which has not yet been determined, to provide structural constraints that may guide the refinement of powder X-ray diffraction data.

Nonencapsulated Streptococcus pneumoniae causes otitis media during single-species infection and during polymicrobial infection with nontypeable Haemophilus influenzae.

Streptococcus pneumoniae strains lacking capsular polysaccharide have been increasingly reported in carriage and disease contexts. Since most cases of otitis media involve more than one bacterial species, we aimed to determine the capacity of a nonencapsulated S. pneumoniae clinical isolate to induce disease in the context of a single-species infection and as a polymicrobial infection with nontypeable Haemophilus influenzae. Using the chinchilla model of otitis media, we found that nonencapsulated S. pneumoniae colonizes the nasopharynx following intranasal inoculation, but does not readily ascend into the middle ear. However, when we inoculated nonencapsulated S. pneumoniae directly into the middle ear, the bacteria persisted for two weeks post-inoculation and induced symptoms consistent with chronic otitis media. During coinfection with nontypeable H. influenzae, both species persisted for one week and induced polymicrobial otitis media. We also observed that nontypeable H. influenzae conferred passive protection from killing by amoxicillin upon S. pneumoniae from within polymicrobial biofilms in vitro. Therefore, based on these results, we conclude that nonencapsulated pneumococci are a potential causative agent of chronic/recurrent otitis media, and can also cause mutualistic infection with other opportunists, which could complicate treatment outcomes.

Structural Insights into Bound Water in Crystalline Amino Acids: Experimental and Theoretical (17)O NMR.

We demonstrate here that the (17)O NMR properties of bound water in a series of amino acids and dipeptides can be determined with a combination of nonspinning and magic-angle spinning experiments using a range of magnetic field strengths from 9.4 to 21.1 T. Furthermore, we propose a (17)O chemical shift fingerprint region for bound water molecules in biological solids that is well outside the previously determined ranges for carbonyl, carboxylic, and hydroxyl oxygens, thereby offering the ability to resolve multiple (17)O environments using rapid one-dimensional NMR techniques. Finally, we compare our experimental data against quantum chemical calculations using GIPAW and hybrid-DFT, finding intriguing discrepancies between the electric field gradients calculated from structures determined by X-ray and neutron diffraction.

Replication of type 5 adenovirus promotes middle ear infection by Streptococcus pneumoniae in the chinchilla model of otitis media.

Adenoviral infection is a major risk factor for otitis media. We hypothesized that adenovirus promotes bacterial ascension into the middle ear through the disruption of normal function in the Eustachian tubes due to inflammation-induced changes. An intranasal infection model of the chinchilla was used to test the ability of type 5 adenovirus to promote middle ear infection by Streptococcus pneumoniae. The hyperinflammatory adenovirus mutant dl327 and the nonreplicating adenovirus mutant H5wt300ΔpTP were used to test the role of inflammation and viral replication, respectively, in promotion of pneumococcal middle ear infection. Precedent infection with adenovirus resulted in a significantly greater incidence of middle ear disease by S. pneumoniae as compared to nonadenovirus infected animals. Infection with the adenovirus mutant dl327 induced a comparable degree of bacterial ascension into the middle ear as did infection with the wild-type virus. By contrast, infection with the nonreplicating adenovirus mutant H5wt300ΔpTP resulted in less extensive middle ear infection compared to the wild-type adenovirus. We conclude that viral replication is necessary for adenoviral-induced pneumococcal middle ear disease.

Coinfection with Streptococcus pneumoniae negatively modulates the size and composition of the ongoing influenza-specific CD8⁺ T cell response.

Infection with influenza A virus can lead to increased susceptibility to subsequent bacterial infection, often with Streptococcus pneumoniae. Given the substantial modification of the lung environment that occurs following pathogen infection, there is significant potential for modulation of immune responses. In this study, we show that infection of mice with influenza virus, followed by the noninvasive EF3030 strain of Streptococcus pneumoniae, leads to a significant decrease in the virus-specific CD8(+) T cell response in the lung. Adoptive-transfer studies suggest that this reduction contributes to disease in coinfected animals. The reduced number of lung effector cells in coinfected animals was associated with increased death, as well as a reduction in cytokine production in surviving cells. Further, cells that retained the ability to produce IFN-γ exhibited a decreased potential for coproduction of TNF-α. Reduced cytokine production was directly correlated with a decrease in the level of mRNA. Negative regulation of cells in the mediastinal lymph node was minimal compared with that present in the lung, supporting a model of selective regulation in the tissue harboring high pathogen burden. These results show that entry of a coinfecting pathogen can have profound immunoregulatory effects on an ongoing immune response. Together, these findings reveal a novel dynamic interplay between concurrently infecting pathogens and the adaptive immune system.

Influenza A virus alters pneumococcal nasal colonization and middle ear infection independently of phase variation.

Streptococcus pneumoniae (pneumococcus) is both a widespread nasal colonizer and a leading cause of otitis media, one of the most common diseases of childhood. Pneumococcal phase variation influences both colonization and disease and thus has been linked to the bacteria's transition from colonizer to otopathogen. Further contributing to this transition, coinfection with influenza A virus has been strongly associated epidemiologically with the dissemination of pneumococci from the nasopharynx to the middle ear. Using a mouse infection model, we demonstrated that coinfection with influenza virus and pneumococci enhanced both colonization and inflammatory responses within the nasopharynx and middle ear chamber. Coinfection studies were also performed using pneumococcal populations enriched for opaque or transparent phase variants. As shown previously, opaque variants were less able to colonize the nasopharynx. In vitro, this phase also demonstrated diminished biofilm viability and epithelial adherence. However, coinfection with influenza virus ameliorated this colonization defect in vivo. Further, viral coinfection ultimately induced a similar magnitude of middle ear infection by both phase variants. These data indicate that despite inherent differences in colonization, the influenza A virus exacerbation of experimental middle ear infection is independent of the pneumococcal phase. These findings provide new insights into the synergistic link between pneumococcus and influenza virus in the context of otitis media.

Residence of Streptococcus pneumoniae and Moraxella catarrhalis within polymicrobial biofilm promotes antibiotic resistance and bacterial persistence in vivo.

Otitis media (OM) is an extremely common pediatric ailment caused by opportunists that reside within the nasopharynx. Inflammation within the upper airway can promote ascension of these opportunists into the middle ear chamber. OM can be chronic/recurrent in nature, and a wealth of data indicates that in these cases, the bacteria persist within biofilms. Epidemiological data demonstrate that most cases of OM are polymicrobial, which may have significant impact on antibiotic resistance. In this study, we used in vitro biofilm assays and rodent infection models to examine the impact of polymicrobial infection with Moraxella catarrhalis and Streptococcus pneumoniae (pneumococcus) on biofilm resistance to antibiotic treatment and persistence in vivo. Consistent with prior work, M. catarrhalis conferred beta-lactamase-dependent passive protection from beta-lactam killing to pneumococci within polymicrobial biofilms. Moreover, pneumococci increased resistance of M. catarrhalis to macrolide killing in polymicrobial biofilms. However, pneumococci increased colonization in vivo by M. catarrhalis in a quorum signal-dependent manner. We also found that co-infection with M. catarrhalis affects middle ear ascension of pneumococci in both mice and chinchillas. Therefore, we conclude that residence of M. catarrhalis and pneumococci within the same biofilm community significantly impacts resistance to antibiotic treatment and bacterial persistence in vivo.

Solid state complex chemistry: formation, structure, and properties of homoleptic tetracyanamidogermanates RbRE[Ge(CN2)4] (RE = La, Pr, Nd, Gd).

Tetracyanamidometallates with the general formula RbRE[T(CN2)4] (RE = La, Pr, Nd, Gd; T = Si, Ge) were prepared by solid state metathesis reactions starting from stoichiometric mixtures of RECl3, A2[TF6], and Li2(CN2). Reactions were studied by differential thermal analysis that showed ignition temperatures between 360 and 390 °C for the formation of RbGd[T(CN2)4] with T = Si and Ge. The powder diffraction patterns of RbRE[Ge(CN2)4] were indexed isotypically to the already known RbRE[Si(CN2)4] compound. IR spectra of RbLa[Ge(CN2)4] were measured and compared with those of RbLa[Si(CN2)4]. (73)Ge, (87)Rb, and (139)La solid state NMR measurements and density functional theory calculations were used to verify the novel homoleptic [Ge(CN2)4](4-) ion. Luminescence properties of Eu(3+), Ce(3+), and Tb(3+) doped samples are reported.

What is the value and impact of the safety World Conference? Evaluators' reflections of safety 2012.

Using survey and documentary information collected as part of an evaluation of the 2012 conference, this paper reflects upon the value of the 2012 World Conference to attendees of the event. The results are discussed in the context of questions about what the purpose of conference is to the world injury prevention community and how they are organised. The evaluators challenge the community and future organisers to clarify what the purpose of these events are to better inform future evaluation activities.

Aggregation of [Au(CN)4]- anions: examination by crystallography and 15N CP-MAS NMR and the structural factors influencing intermolecular Au···N interactions.

To investigate the factors influencing the formation of intermolecular Au···NC interactions between [Au(CN)(4)](-) units, a series of [cation](n+)[Au(CN)(4)](n) double salts was synthesized, structurally characterized and probed by IR and (15)N{(1)H} CP-MAS NMR spectroscopy. Thus, [(n)Bu(4)N][Au(CN)(4)], [AsPh(4)][Au(CN)(4)], [N(PPh(3))(2)][Au(CN)(4)], [Co(1,10-phenanthroline)(3)][Au(CN)(4)](2), and [Mn(2,2';6',2''-terpyridine)(2)][Au(CN)(4)](2) show [Au(CN)(4)](-) anions that are well-separated from one another; no Au-Au or Au···NC interactions are present. trans-[Co(1,2-diaminoethane)(2)Cl(2)][Au(CN)(4)] forms a supramolecular structure, where trans-[Co(en)(2)Cl(2)](+) and [Au(CN)(4)](-) ions are found in separate layers connected by Au-CN···H-N hydrogen-bonding; weak Au···NC coordinate bonds complete octahedral Au(III) centers, and support a 2-D (4,4) network motif of [Au(CN)(4)](-)-units. A similar structure-type is formed by [Co(NH(3))(6)][Au(CN)(4)](3)·(H(2)O)(4). In [Ni(1,2-diaminoethane)(3)][Au(CN)(4)](2), intermolecular Au···NC interactions facilitate formation of 1-D chains of [Au(CN)(4)](-) anions in the supramolecular structure, which are separated from one another by [Ni(en)(3)](2+) cations. In [1,4-diazabicyclo[2.2.2]octane-H][Au(CN)(4)], the monoprotonated amine cation forms a hydrogen-bond to the [Au(CN)(4)](-) unit on one side, while coordinating to the axial sites of the gold(III) center through the unprotonated amine on the other, thereby generating a 2-D (4,4) net of cations and anions; an additional, uncoordinated [Au(CN)(4)](-)-unit lies in the central space of each grid. This body of structural data indicates that cations with hydrogen-bonding groups can induce intermolecular Au···NC interactions, while the cationic charge, shape, size, and aromaticity have little effect. While the ν(CN) values are poor indicators of the presence or absence of N-cyano bridging between [Au(CN)(4)](-)-units (partly because of the very low intensity of the observed bands), (15)N{(1)H} CP-MAS NMR reveals well-defined, ordered cyanide groups in the six diamagnetic compounds with chemical shifts between 250 and 275 ppm; the resonances between 260 and 275 ppm can be assigned to C-bound terminal ligands, while those subject to CN···H-N bonding resonate lower, around 250-257 ppm. The (15)N chemical shift also correlates with the intermolecular Au···N distances: the shortest Au-N distances also shift the (15)N peak to lower frequency. This provides a real, spectroscopically measurable electronic effect associated with the crystallographic observation of intermolecular Au···NC interactions, thereby lending support for their viability.

The New Zealand child work-related fatal injury study: 1985-1998.

AIMS: To estimate the numbers and rates of work-related fatal injury for children under the age of 15 years. METHODS: Potential cases of work-related injury deaths of persons aged <15 years of age were identified from the national electronic mortality data-files for the period 1985-1998 inclusive. The circumstances of the death in each fatality incident were reviewed directly from coronial files to determine work-relatedness. RESULTS: A total of 87 workplace work-related fatalities were identified. The vast majority of children identified were fatally injured while a bystander to another person's work. Workplace bystander involvement was found to vary by age, with the majority of workers identified aged 10-14 years old. With a third of all fatalities, the agricultural industry was the most common industry for workplace work-related fatalities in children. In the period 1985-94, children <15 years of age were found to account for 46% of New Zealand's total workplace bystander deaths. CONCLUSIONS: Children contribute significantly to the overall burden of work-related fatal injury in New Zealand, especially as bystanders to other people's work. The high contribution to bystander deaths by children aged <15 years suggests that hazard control in certain work settings is lacking.