Intravenous versus Oral Step-Down for the Treatment of Staphylococcus aureus Bacteremia in a Pediatric Population

Limited data are available regarding optimal antimicrobial therapy for Staphylococcus aureus bacteremia (SAB) in pediatric patients. The purpose of this study was to assess clinical characteristics and outcomes associated with intravenous (IV) versus oral step-down treatment of pediatric SAB. This study evaluated patients aged 3 months to 18 years that received at least 72 h of inpatient treatment for SAB. The primary endpoint was 30-day readmission. Secondary endpoints included hospital length of stay and inpatient mortality. One hundred and one patients were included in this study. The median age was 7.9 years. Patients who underwent oral step-down were less likely to be immunocompromised and more likely to have community-acquired SAB from osteomyelitis or skin and soft tissue infection (SSTI). More patients in the IV therapy group had a 30-day readmission (10 (25.6%) vs. 3 (5.3%), p = 0.006). Mortality was low (5 (5%)) and not statistically different between groups. Length of stay was greater in patients receiving IV therapy only (11 vs. 7 days, p = 0.001). In this study, over half of the patients received oral step-down therapy and 30-day readmission was low for this group. Oral therapy appears to be safe and effective for patients with SAB from osteomyelitis or SSTIs.

Limb, joint and pelvic kinematic control in the quail coping with step perturbations

Small cursorial birds display remarkable walking skills and can negotiate complex and unstructured terrains with ease. The neuromechanical control strategies necessary to adapt to these challenging terrains are still not well understood. Here, we analyzed the 2D- and 3D pelvic and leg kinematic strategies employed by the common quail to negotiate visible step-up and step-down perturbations of 1 cm, 2.5 cm, and 5 cm. We used biplanar fluoroscopy to accurately describe joint positions in three dimensions and performed semi-automatic landmark localization using deep learning. Quails negotiated vertical perturbations without major problems and rapidly regained steady-state locomotion. When coping with step-up perturbations, the quail mostly adapted the trailing limb to permit the leading leg to step on the elevated substrate in a similar way as it did during level locomotion. When the quail negotiated step-down perturbations, both legs showed significant adaptations. For small and moderate perturbations (not inducing aerial running) the quail kept the function of the distal joints (i.e., their kinematic pattern) largely unchanged during uneven locomotion, and most changes occurred in proximal joints. The hip regulated leg length, while the distal joints maintained the spring-damped limb patterns. However, to negotiate the largest visible step perturbations, more dramatic kinematic alterations were observed. For these large perturbations, all joints contributed to leg lengthening/ shortening in the trailing leg and both the trailing and leading legs stepped more vertically and less abducted. This indicates a shift from a dynamic walking program to strategies that are focused on maximizing safety.

First Successful Proppant Frac in a Water Injection Field Strategy, West Qurna-1, South Iraq

Zubair formation in West Qurna field, is one of the largest prolific reservoirs comprising of oil bearing sandstone layers interbedded with shale sequences. An average productivity index of 6 STB/D/psi is observed without any types of stimulation treatment. As the reservoir pressure declines from production, a peripheral water injection strategy was planned in both flanks of the reservoir to enhance the existing wells production deliverability. The peripheral injection program was initiated by drilling several injectors in the west flank. Well A1 was the first injector drilled and its reservoir pressure indicated good communication with the up-dip production wells. An injection test was conducted, revealing an estimated injectivity index of 0.06 STB//D/psi. Candidate well was then re-perforated and stimulated with HF/HCl mud acid, however no significant improvement in injectivity was observed due to the complex reservoir mineralogy and heterogeneity associated to the different targeted layers. An extended high-pressure injection test was performed achieving an injectivity index of 0.29 STB/D/psi at 4500 psi. As this performance was sub-optimal, a proppant fracture was proposed to achieve an optimal injection rate. A reservoir-centric fracture model was built, using the petrophysical and geo-mechanical properties from the Zubair formation, with the objective of optimizing the perforation cluster, fracture placement and injectivity performance. A wellhead isolation tool was utilized as wellhead rating was not able to withstand the fracture model surface pressure; downhole gauges were also installed to provide an accurate analysis of the pressure trends. The job commenced with a brine injection test to determine the base-line injectivity profile. The tubing volume was then displaced with a linear gel to perform a step-rate / step-down test. The analysis of the step-rate test revealed the fracture extension pressure, which was set as the maximum allowable injection pressure when the well is put on continuous injection. The step-down test showed significant near wellbore tortuosity with negligible perforation friction. A fracture fluid calibration test was then performed to validate the integrated model leak-off profile, fracture gradient and young’s modulus; via a coupled pressure fall-off and temperature log analysis. Based on the fluid efficiency, the pad volume was adjusted to achieve a tip screen-out. The job was successfully pumped and tip screen-out was achieved after pumping over ~90% of the planned proppant volume. A 7 days post-frac extended injection test was then conducted, achieving an injection rate of 12.5 KBWD at 1300 psi with an injectivity index of 4.2 STB/D/psi. These results proved that the implementation of a reservoir-centric Proppant Fracture treatment, can drastically improve the water injection strategy and field deliverability performance even in good quality rock formations. This first integrated fracture model and water injection field strategy, represents a building platform for further field development optimization plans in Southern Iraq.

Mind the Gap! Reconciling Environmental Water Requirements with Scarcity in the Murray–Darling Basin, Australia

The Murray–Darling Basin Plan is a $AU 13 billion program to return water from irrigation use to the environment. Central to the success of the Plan, commenced in 2012, is the implementation of an Environmentally Sustainable Level of Take (ESLT) and a Sustainable Diversion Limit (SDL) on the volume of water that can be taken for consumptive use. Under the enabling legislation, the Water Act (2007), the ESLT and SDL must be set by the “best available science.” In 2009, the volume of water to maintain wetlands and rivers of the Basin was estimated at 3000–7600 GL per year. Since then, there has been a steady step-down in this volume to 2075 GL year due to repeated policy adjustments, including “supply measures projects,” building of infrastructure to obtain the same environmental outcomes with less water. Since implementation of the Plan, return of water to the environment is falling far short of targets. The gap between the volume required to maintain wetlands and rivers and what is available is increasing with climate change and other risks, but the Plan makes no direct allowance for climate change. We present policy options that address the need to adapt to less water and re-frame the decision context from contestation between water for irrigation versus the environment. Options include best use of water for adaptation and structural adjustment packages for irrigation communities integrated with environmental triage of those wetlands likely to transition to dryland ecosystems under climate change.

Kazakh president hemmed in by his predecessor

Significance Since resigning as president in 2019, Nazarbayev wields considerable power thanks to the concentration of political levers in his hands. On November 23, he announced his intention to step down as chairman of the ruling Nur Otan party in favour of President Kassym Zhomart Tokayev. Impacts The Kazakh leadership will offer Russia sympathy but no more in its confrontation with the West. Daily COVID-19 cases and deaths have fallen significantly since an August peak but the Omicron variant presents new threats. The current power-sharing model weakens the authorities' ability to deal with the root causes of economic stagnation.

Design of a High Efficiency High Step-Up/Step-Down Bidirectional Isolated DC–DC Converter

This paper presents a novel bidirectional DC–DC converter, equipped with a three-winding coupled inductor, that can be applied to high-voltage, bidirectional DC–DC energy conversion and meet battery charging and discharging requirements. The architecture consists of a semi-Z-source converter and a forward–flyback converter featuring a three-winding coupled inductor with an iron core. This proposed topology retains the current continuity characteristics of the low-voltage side, all switches possess the zero-voltage switching feature, and the switches on the low-voltage side in the step-down mode have a synchronous rectification function. A 500-W bidirectional converter is implemented to examine the practicality and feasibility of the proposed topology. The relatively streamlined design of the converter can greatly reduce production costs. In the step-up and step-down modes, the maximum energy conversion efficiencies are 95.74% and 96.13%, respectively.