Background: Subdural and subgaleal drains are equally effective after burrhole craniostomy for chronic subdural haematoma, however the optimal location of drains after minicraniotomy is not clear. As such we present the first study to assess this. Methods: Consecutive patients undergoing minicraniotomy for cSDH between 2019 and 2023 at a single institution were included. Subgaleal drains were placed exclusively by a single surgeon with the rest of the department utilising standard subdural drains. Cases were stratified by drain location. Primary outcomes included changes in functional status (Modified Rankin Score, mRS) at 3 months from preoperative baseline. Results: A total of 137 patients were included, of which 24.6% received subgaleal drains. Discharge home was higher in the subgaleal group compared to subdural group (79.4% vs 57.3%, p=0.02). Subgaleal drain location (p<0.0001) and better preoperative GCS (p=0.01) were predictors of improved 3 month mRS. Worse premorbid mRS (p=0.002), subdural drain (p=0.004), and decreased consciousness at presentation (p<0.002) were predictors of not being discharged home. Surgical recurrence was lower in the subgaleal group than the subdural group (2.9% vs 13.6%, p=0.12), but not statistically significant. Conclusions: Subgaleal drains are associated with shorter hospitalisation, greater chance of discharge home, and better functional outcomes than subdural drains.

The number of studies of controlled drug-release systems is growing constantly. Bionanocomposite materials which can be prepared from the combination of biopolymers with inorganic solids such as clay minerals offer interesting alternatives for use as drug-delivery systems. In the present study, new bionanocomposite drug-release systems were prepared from the intercalation of the antibiotic drug ciprofloxacin into montmorillonite using an ion-exchange reaction. In order to prepare more stable systems for oral ciprofloxacin release, this ciprofloxacin-clay intercalation compound was incorporated into i-carrageenan-gelatin biopolymer blend to produce bionanocomposite materials. Bionanocomposites of two distinct i-carrageenan and gelatin mass ratios were conformed as beads through an ionic gelification reaction with Ca2+ ions, and dried by freeze-drying where liquid nitrogen or conventional freezing was adopted in the freezing step. The resulting ciprofloxacin-clay hybrid was characterized by X-ray diffraction (XRD) analysis, Fourier-transform infrared (FTIR) spectroscopy, solid state 13C Nuclear Magnetic Resonance (NMR), thermal analysis, and scanning electron microscopy (SEM). The montmorillonite-ciprofloxacin hybrid incorporated into the bionanocomposite beads was evaluated by in vitro release studies which showed a significant difference in the release profiles in the aqueous medium used to simulate the gastrointestinal tract, depending on the blend composition and the freezing method employed in the preparation of the beads. The results point to bionanocomposite systems based on ciprofloxacin-clay hybrids and biopolymers that may be used as devices in the biomedical area.

This study aims to evaluate the effects of N-acetylcysteine (NAC) on bovine oocyte maturation, mitochondrial activity and transzonal projections (TZP), as well as on the levels of reactive oxygen species (ROS) and messenger RNA (mRNA) for catalase (CAT) superoxide dismutase (SOD), periredoxin-6 (Prdx6), glutathione peroxidase (GPx), growth and differentiation factor-9 (GDF9), histone H1Foo, cyclin B1 (CCNB1) and c-Mos. Bovine cumulus–oocyte complexes (COC) of medium-sized antral follicles (3.0–6.0 mm) were prematured in TCM-199 for 8 h at 38.5°C in 5% CO2. After prematuration in the presence of forskolin and C-type natriuretic peptide, COCs were matured in TCM-199 alone or with 0.1, 0.5 or 2.5 mM NAC. Then, oocytes were classified according to the stage of chromatin. Furthermore, mitochondrial activity and intracellular levels of ROS and TZP were also evaluated. The levels of mRNAs for CAT, SOD, Prdx6, GPx, GDF9, H1Foo, CCNB1 and c-Mos were evaluated using real-time polymerase chain reaction (RT-PCR). The results showed that NAC significantly increased the percentages of oocytes with resumption of meiosis when compared with those oocytes matured in control medium. Oocytes had homogeneous mitochondrial distribution, and those cultured with 0.1 and 0.5 mM NAC had lower levels of ROS when compared with the control. In addition, 0.5 mM NAC reduced TZP and the levels of mRNA for CCNB1. In contrast, NAC did not influence the expression of CAT, GPx, Prdx6, SOD, GDF9, H1Foo, and c-Mos. In conclusion, 0.5 mM NAC reduced the levels of ROS, TZP and mRNA for CCNB1, and improved in vitro resumption of meiosis in oocytes from medium-sized bovine antral follicles.

The burden of mental illness in young people with chronic liver disease is not known. In this population cohort study in England, we identified 358 individuals (aged ≤25 years) diagnosed with autoimmune hepatitis or liver disease related to cystic fibrosis and 1541 propensity-score-matched controls. By the first year of follow-up, the cumulative burden of psychiatric events in participants with liver disease was high compared with controls: anxiety disorder (6.87 per 100 individuals [95% CI 4.00–9.73] v. 2.22 [95% CI 1.37–3.07]), depression (5.10 [95% CI 2.83–7.37] v. 0.86 [95% CI 0.53–1.19]), substance misuse (10.61 [95% CI 9.50–11.73] v. 1.23 [95% CI 0.71–1.75]) and self-harm (3.09 [95% CI 1.12–5.05] v. 0.20 [95% CI 0.07–0.33]). Participants with liver disease had a 2-fold increase (OR = 1.94, 95% CI 1.45–2.58), a 2.5-fold increase (OR = 2.59, 95% CI 1.91–3.50) and 4.4-fold increase (OR = 4.44; 95% CI 3.46–5.71) in the risk of anxiety, depression and substance misuse, respectively. These findings highlight the need for effective intervention in psychiatric disorders in young people with rare liver disease.

The once-contiguous Ellesmere Ice Shelf, first reported in writing by European explorers in 1876, and now almost completely disintegrated, has rolling, wave-like surface topography, the origin of which we investigate using a viscous buckling instability analysis. We show that rolls can develop during a winter season (~ 100 d) if sea-ice pressure (depth-integrated horizontal stress applied to the seaward front of the Ellesmere Ice Shelf) is sufficiently large (1 MPa m) and ice thickness sufficiently low (1–10 m). Roll wavelength initially depends only on sea-ice pressure, but evolves over time depending on amplitude growth rate. This implies that a thinner ice shelf, with its faster amplitude growth rate, will have a shorter wavelength compared to a thicker ice shelf when sea-ice pressure is equal. A drawback of the viscous buckling mechanism is that roll amplitude decays once sea-ice pressure is removed. However, non-Newtonian ice rheology, where effective viscosity, and thus roll change rate, depends on total applied stress may constrain roll decay rate to be much slower than growth rate and allow roll persistence from year to year. Whether the viscous-buckling mechanism we explore here ultimately can be confirmed as the origin of the Ellesmere Ice Shelf rolls remains for future research.

In this era of spatially resolved observations of planet-forming disks with Atacama Large Millimeter Array (ALMA) and large ground-based telescopes such as the Very Large Telescope (VLT), Keck, and Subaru, we still lack statistically relevant information on the quantity and composition of the material that is building the planets, such as the total disk gas mass, the ice content of dust, and the state of water in planetesimals. SPace Infrared telescope for Cosmology and Astrophysics (SPICA) is an infrared space mission concept developed jointly by Japan Aerospace Exploration Agency (JAXA) and European Space Agency (ESA) to address these questions. The key unique capabilities of SPICA that enable this research are (1) the wide spectral coverage $10{-}220\,\mu\mathrm{m}$, (2) the high line detection sensitivity of $(1{-}2) \times 10^{-19}\,\mathrm{W\,m}^{-2}$ with $R \sim 2\,000{-}5\,000$ in the far-IR (SAFARI), and $10^{-20}\,\mathrm{W\,m}^{-2}$ with $R \sim 29\,000$ in the mid-IR (SPICA Mid-infrared Instrument (SMI), spectrally resolving line profiles), (3) the high far-IR continuum sensitivity of 0.45 mJy (SAFARI), and (4) the observing efficiency for point source surveys. This paper details how mid- to far-IR infrared spectra will be unique in measuring the gas masses and water/ice content of disks and how these quantities evolve during the planet-forming period. These observations will clarify the crucial transition when disks exhaust their primordial gas and further planet formation requires secondary gas produced from planetesimals. The high spectral resolution mid-IR is also unique for determining the location of the snowline dividing the rocky and icy mass reservoirs within the disk and how the divide evolves during the build-up of planetary systems. Infrared spectroscopy (mid- to far-IR) of key solid-state bands is crucial for assessing whether extensive radial mixing, which is part of our Solar System history, is a general process occurring in most planetary systems and whether extrasolar planetesimals are similar to our Solar System comets/asteroids. We demonstrate that the SPICA mission concept would allow us to achieve the above ambitious science goals through large surveys of several hundred disks within $\sim\!2.5$ months of observing time.

This article develops and tests a new theoretical framework, gendered political socialization, which offers important insights into how children perceive gender in politics and the consequences of these perceptions on sex differences in political interest and ambition. Based on data from 1,604 children who live in four different regions across the United States, we find that children not only perceive politics to be a male-dominated space, but with age, girls increasingly see political leadership as a “man’s world.” Simultaneously, as children grow older, they internalize gendered expectations, which direct their interests toward professions that embody the gendered traits that fit with their own sex. One result of this mismatch between women and politics is that girls express lower levels of interest and ambition in politics than do boys.

Background: Based on data obtained from hospitals in the city of Belo Horizonte (population ~3,000,000), we evaluated relevant factors such as death, age, duration of surgery, potential for contamination and surgical site infection, plastic surgery, and craniotomy. The possibility of predicting surgical site infection (SSI) was then analyzed using pattern recognition algorithms based on MLP (multilayer perceptron). Methods: Data were collected by the hospital infection control committees (CCIHs) in hospitals in Belo Horizonte between 2016 and 2018. The noisy records were filtered, and the occurrences were analyzed. Finally, the predictive power of SSI of 5 types MLP was evaluated experimentally: momentum, backpropagation standard, weight decay, resilient propagation, and quick propagation. The model used 3, 5, 7, and 10 neurons in the occult layer and with resamples varied the number of records for testing (65% and 75%) and for validation (35% and 25%). Comparisons were made by measuring the AUC (area under the curve (range, 0–1). Results: From 1,096 records of craniotomy, 289 were usable for analysis. Moreover, 16% died; averaged age was 56 years (range, 40–65); mean time of surgery was 186 minutes (range, 95–250 minutes); the number of hospitalizations ranged from 1 (90.6%) to 8 (0.3%). Contamination among these cases was rated as follows: 2.7% contaminated, 23.5% potentially contaminated, 72.3% clean. The SSI rate reached 4%. The prediction process in AUCs ranged from 0.7 to 0.994. In plastic surgery, from 3,693 records, 1,099 were intact, with only 1 case of SSI and no deaths. The average age for plastic surgery was 41 years (range, 16–91); the average time of surgery was 218.5 minutes (range, 19–580 minutes); the number of hospitalizations ranged from 1 (77.4%) to 6 times (0.001%). Contamination among these cases was rated as follows: 27.90% potential contamination, 1.67% contaminated, and 0.84% infected. The prediction process ranged in AUCs from 0.2 to 0.4. Conclusions: We identified a high noise index in both surgeries due to subjectivity at the time of data collection. The profiles of each surgery in the statistical analyses were different, which was reflected in the analyzed structures. The MLP for craniotomy surgery demonstrated relevant predictive power and can guide intelligent monitoring software (available in www.sacihweb.com). However, for plastic surgeries, MLPs need more SSI samples to optimize outcomes. To optimize data collection and to enable other hospitals to use the SSI prediction tool, a mobile application was developed.

Disclosures: None

Funding: None

Background: Delayed or in vitro inactive empiric antibiotic therapy may be detrimental to survival in patients with bloodstream infections (BSIs). Understanding the landscape of delayed or discordant empiric antibiotic therapy (DDEAT) across different patient, pathogen, and hospital types, as well as by their baseline resistance milieu, may enable providers, antimicrobial stewardship programs, and policy makers to optimize empiric prescribing. Methods: Inpatients with clinically suspected serious infection (based on sampling of blood cultures and receiving systemic antibiotic therapy on the same or next day) found to have BSI were identified in the Cerner Healthfacts EHR database. Patients were considered to have received DDEAT when, on culture sampling day, they received either no antibiotic(s) or none that displayed in vitro activity against the pathogenic bloodstream isolate. Antibiotic-resistant phenotypes were defined by in vitro resistance to taxon-specific prototype antibiotics (eg, methicillin/oxacillin resistance in S. aureus) and were used to estimate baseline resistance prevalence encountered by the hospital. The probability of DDEAT was examined by bacterial taxon, by time of BSI onset, and by presence versus absence of antibiotic-resistance phenotypes, sepsis or septic shock, hospital type, and baseline resistance. Results: Of 26,036 assessable patients with a BSI at 131 US hospitals between 2005 and 2014, 14,658 (56%) had sepsis, 3,623 (14%) had septic shock, 5,084 (20%) had antibiotic-resistant phenotypes, and 8,593 (33%) received DDEAT. Also, 4,428 (52%) recipients of DDEAT received no antibiotics on culture sampling day, whereas the remaining 4,165 (48%) received in vitro discordant therapy. DDEAT occurred most often in S. maltophilia (87%) and E. faecium (80%) BSIs; however, 75% of DDEAT cases and 76% of deaths among recipients of DDEAT collectively occurred among patients with S. aureus and Enterobacteriales BSIs. For every 8 bacteremic patients presenting with septic shock, 1 patient did not receive any antibiotics on culture day (Fig. 1A). Patients with BSIs of hospital (vs community) onset were twice as likely to receive no antibiotics on culture day, whereas those with bloodstream pathogens displaying antibiotic-resistant (vs susceptible) phenotypes were 3 times as likely to receive in vitro discordant therapy (Fig. 1B). The median proportion of DDEAT ranged between 25% (14, 37%) in eight <300-bed teaching hospitals in the lowest baseline resistance quartile and 40% (31, 50%) at five ≥300-bed teaching hospitals in the third baseline resistance quartile (Fig. 2). Conclusions: Delayed or in vitro discordant empiric antibiotic therapy is common among patients with BSI in US hospitals regardless of hospital size, teaching status, or local resistance patterns. Prompt empiric antibiotic therapy in septic shock and hospital-onset BSI needs more support. Reliable detection of S. aureus and Enterobacteriales bloodstream pathogens and their resistance patterns earlier with rapid point-of-care diagnostics may mitigate the population-level impact of DDEAT in BSI.

Funding: This study was funded in part by the National Institutes of Health Clinical Center, National Institutes of Allergy and Infectious Diseases, National Cancer Institute (NCI contract no. HHSN261200800001E) and the Agency for Healthcare Research and Quality.

Disclosures: None

When women gained the national right to vote 100 years ago, remarkable possibilities for their voice and presence in politics opened. However, despite gains in women’s representation, numerous gaps continue to exist in which adult women engage less in politics than men. In identifying and explaining adult gender gaps, little attention has been given to whether gaps emerge among children. This is a pressing issue because children’s perceptions are likely to influence their participation as adults. This article explores whether and how girls and boys differently view politics and their role in it. We report survey data from more than 1,600 children ages 6 to 12 to explore basic gender gaps in political interest and ambition. We argue that these results may reveal the roots of a larger problem: 100 years after women gained suffrage, girls still express less interest and enthusiasm than boys for political life and political office.

White matter development during adolescents is crucial for a mature integration of neural networks in the brain. Autism spectrum condition (ASC), characterized by social and communication difficulties and rigid behaviour may interact with white matter development observed during adolescence. Changes in white matter development may link autistic symptoms to its genetic underpinnings and explain a 10-fold increase in susceptibility to ASC among siblings of individuals with ASC.

We used diffusion tensor imaging to study an association between age and white matter integrity measures, fractional anisotropy (FA) and mean diffusivity (MD), in adolescents with ASC, their siblings and age-matched healthy controls. Diffusion-weighted data were acquired with 64-direction protocol with 3mm slices and TR of 6600ms and tract-based spatial statistics analysis was performed.

The control subjects showed robust signs of increase in white matter integrity correlated with age. In contrast, individuals with ASC showed significantly lower negative correlation between MD and age in a broad area centred in the right superior longitudinal fasciculus (rSLF). When the three eigenvalues constituting a tensor ellipsoid were considered separately, siblings of individuals with ASC showed a diminished negative correlation between the second eigenvalue and age also centred in the rSLF.

Adolescents with ASC and their siblings experience alterations in white matter development in comparison to age-matched healthy controls, which are similar in direction yet different in scale for the two affected groups. The alterations are observed in the area associated with flexibility of behaviour and may explain both symptoms of ASC and increased susceptibility to ASC.

While early gendered messages mold children's expectations about the world, we know relatively little about the depictions of women in politics and exposure to gender stereotypes in elementary social studies curricula. In this article, we examine the coverage of political leaders in the children's magazine TIME for Kids, a source commonly found in elementary school classrooms. Coding all political content from this source over six years, we evaluate the presence of women political leaders and rate whether the leaders are described as possessing gender-stereotypic traits. Our results show that although TIME for Kids covers women leaders in greater proportion than their overall representation in politics, the content of the coverage contains gendered messages that portray politics as a stereotypically masculine field. We show that gendered traits are applied differently to men and to women in politics: feminine and communal traits are more likely to be applied to women leaders, while men and women are equally described as having masculine and agentic traits. Portrayals of women political leaders in stereotype-congruent ways is problematic because early messages influence children's views of gender roles.

Guangxi, a province in southwestern China, has the second highest reported number of HIV/AIDS cases in China. This study aimed to develop an accurate and effective model to describe the tendency of HIV and to predict its incidence in Guangxi. HIV incidence data of Guangxi from 2005 to 2016 were obtained from the database of the Chinese Center for Disease Control and Prevention. Long short-term memory (LSTM) neural network models, autoregressive integrated moving average (ARIMA) models, generalised regression neural network (GRNN) models and exponential smoothing (ES) were used to fit the incidence data. Data from 2015 and 2016 were used to validate the most suitable models. The model performances were evaluated by evaluating metrics, including mean square error (MSE), root mean square error, mean absolute error and mean absolute percentage error. The LSTM model had the lowest MSE when the N value (time step) was 12. The most appropriate ARIMA models for incidence in 2015 and 2016 were ARIMA (1, 1, 2) (0, 1, 2)12 and ARIMA (2, 1, 0) (1, 1, 2)12, respectively. The accuracy of GRNN and ES models in forecasting HIV incidence in Guangxi was relatively poor. Four performance metrics of the LSTM model were all lower than the ARIMA, GRNN and ES models. The LSTM model was more effective than other time-series models and is important for the monitoring and control of local HIV epidemics.

Inappropriate use of antibiotics is contributing to a serious antimicrobial resistance problem in Asian hospitals. Despite resource constraints in the region, all Asian hospitals should implement antimicrobial stewardship (AMS) programs to optimize antibiotic treatment, improve patient outcomes, and minimize antimicrobial resistance. This document describes a consensus statement from a panel of regional experts to help multidisciplinary AMS teams design programs that suit the needs and resources of their hospitals. In general, AMS teams must decide on appropriate interventions (eg, prospective audit and/or formulary restriction) for their hospital, focusing on the most misused antibiotics and problematic multidrug-resistant organisms. This focus is likely to include carbapenem use with the goal to reduce carbapenem-resistant gram-negative bacteria. Rather than initially trying to introduce a comprehensive, hospital-wide AMS program, it would be practical to begin by pilot testing a simple program based on 1 achievable core intervention for the hospital. AMS team members must work together to determine the most suitable AMS interventions to implement in their hospitals and how best to put them into practice. Continuous monitoring and feedback of outcomes to the AMS teams, hospital administration, and prescribers will enhance sustainability of the AMS programs.

Due to the lack of basic information on water required by maize (Zea mays L.) in Brazil, the large amount of water applied usually exceeds crop requirements, wasting water and energy. In this study, we measured crop evapotranspiration (ETc) as evaporative heat flux from a centre pivot-irrigated maize plantation in Southern Brazil during winter and summer seasons, using the Bowen ratio method to evaluate how the degree of canopy-atmosphere coupling affects crop water needs and irrigation management. Irrigation requirements were determined by comparing ETc with reference evapotranspiration (ETo), derived from the Penman–Monteith equation and expressed as the ETc/ETo (Kc) ratio. In this study, the average Kc values obtained were 1.31 and 0.90 for the winter and summer, respectively. Using aerodynamic and canopy resistance measurements, the decoupling factor (Ω) was computed. Ω values tending to zero (0.09 and 0.20 for winter and summer, respectively) showed that strong coupling of maize plants to the atmosphere and sensitivity to high air temperatures, vapour pressure deficits and wind speed caused variations in Kc in relation to ETo ranges. During the experimental period, the Kc value ranged from 0.92 when the ETo exceeded 4 mm d−1 to 1.64 when the ETo was less than 2 mm d−1.