Class of 2014 Abstract / Specific Aims: The incidence of Clostridium difficile (C. Diff) infections in pediatric patients has continually risen, which could be caused by the emergence of a hyper virulent strain, specifically NAP1/B1/027. The objectives of the study were to evaluate the incidence of strain type, compare treatment(s) prescribed, treatment duration, rate of infection recurrence based on strain and severity, rates of re-infection or recurrence, and treatment failures for patients less than 6 months and up to 18 years of age. Methods: A retrospective study of patients admitted to an academic medical center with detection of C. diff toxin was performed. Data analyses included descriptive and inferential statistics to examine demographics, strain type, infection severity, and treatment failure. Main Results: Fourty-five patients with C. Diff toxin detection were included in study analyses and the median age was 6.2 [0.31- 17.9 years]. Oral or intravenous metronidazole was prescribed as initial therapy in 89% of the patients. Strain type was available in 77% of patients, with NAP1/B1/027 detected in 31% of stool samples tested. Within 21 days after initial toxin detection, there was a 13% rate of clinical failure or death, although none directly associated with C. Diff. Within days 22 - 65 after initial toxin detection, there was a 16% rate of recurrence or reinfection. Initial therapy selection, therapy duration, and rate of recurrence or reinfection were not significantly associated with NAP1/B1/027 strain type. Conclusion: Despite variability in severity of infection, the majority of pediatric patients with C. Diff were treated with metronidazole and were infected with a non-B1/NAP1/027 strain.

Currently, a viable solution to provide multicast provision over a multiprotocol label switch with traffic engineering (MPLS-TE) domain is unavailable because of the missing link able to couple multicast traffic distribution with an MPLS-TE enabled network. This is due to the limited or less research investigation that was done in this area. Most of the investigation methods tackle the problem individually such as deploying internet protocol (IP) multicast in a plain network or MPLS domain but without considering a combination of both technologies that is aware of differentiated services requirements. This thesis presents an alternative solution for the multicast differentiated services provision problem over a MPLS-TE enabled network. The approach is exposed and analyzed through a practical solution that was developed within a network simulation environment. The research presented in this thesis orchestrates the already available technologies offered by the multicast protocols suite and differentiated services (DiffServ) aware MPLS-TE that allows applying separately the constraint-based routing and admission control to different classes of services. The novelty and solution of this thesis relies on using MPLS constraint-based routing concepts (e.g.traffic trunks) in order to solve TE issues revealed during multicast traffic distribution.

Background: Blastomycosis is caused by a dimorphic fungus that can be difficult to diagnose in certain situations. The disease is sometimes serious and can be deadly. Diagnosis by fungal serology and urinary antigens is not easy to establish and unreliable. Culture is also time-consuming and is not easy to perform. Thus, documentation of such an organism on cytology offers a quick and cost-effective alternative. This report describes for the first time identification of the 'negative image' of Blastomyces budding yeast. Case: A 79-year-old man presented with a left lung nodule associated with mediastinal and hilar lymphadenopathy. Fine needle aspiration was performed, and a 'negative image' of a yeast with wide base budding was noted on Diff-Quik (DQ)-stained smears. Blastomyces species were confirmed with periodic acid-Schiff fungal stain. Additionally, the fungal capsule contained focally polarizable material on Congo red stain and lacked mucin with mucicarmine stain. Conclusion: Blastomyces yeast forms can be easily identified with DQ staining by their 'negative image'. This feature can be utilized as a quick and cost-effective cytological characteristic to further triage these specimens for confirmation. The information can be of great value to clinicians in making appropriate clinical decisions.

Ett sätt att utveckla webbapplikationer är att göra det i två delar. Dels ett API, dels en klient. Denna rapport fokuserar på JSON-API:er och på att hitta en lösning för att identifiera kritiska ändringar i JSON-meddelanden innan de påverkar sin avseddak lient på ett oönskat sätt.En fallstudie är genomförd hos ett företag som utvecklar sina webbapplikationer i två delar. Resultatet är en utvecklad webbapplikation (ett verktyg) som löser problemet genom att spela in API-förfrågningar som repeteras mot flera olika versioner av API:et. Versionstaggade svar samlas in och jämförs mot varandra med olika avseenden. Webbapplikationen (verktyget) lyckas på ett tillfredställande sätt identifiera kritiska ändringar i JSON-meddelanden. Detta verifieras med hjälp av ett test-API, och bekräftar därmed examensarbetets hypotes.För att kunna testa ett API, vars bakomliggande applikation är stateful, förväntas den applikationen vara återställd till ett standardiserat tillstånd inför varje användning av verktyget. Detta är en begränsning. Det finns en utvecklingspotential i att få verktyget att fungera även mot autentiserade API:er.

The challenge of combating Clostridium difficile infections (CDI) is a major problem within many health care organizations as CDI adds to the cost of care and is an uncomfortable and sometimes fatal complication of hospitalization for the patient. The practice-focused question for this doctoral project was targeted at patients in hospital settings on a medical surgical floor and asked if clostridium difficile preventive bundles reduce the incidence of CDI compared with nonstandardized preventative methods. Using the plan-do-study-act framework, the purpose of this DNP project was to use a clostridium difficile bundle approach to study the effects of clostridium difficile incidence (CDI) decrease on a medical-surgical unit with high CDI incidences. Standardized environmental cleaning practices resulted in improvement of the patient environment. High-touch cleaning improved from 43.7% to 83.3%. Time between CDI events lengthened from 19.9 days to 30.2, environmental cleaning with the use of Dazo auditing improved from 33.4% to 81.6%, isolation practices improved from 62.7% to 90%, and with the implementation of the nurse-driven CD testing protocol, unnecessary testing improved. Results showed that the CDI incidence on an acute care medical surgical unit was reduced through the use of a clostridium difficile preventive bundle in this DNP project. Reducing the incidence of CDI is a significant contribution to social change as this unwanted complication of hospitalization causes discomfort and pain and adds unnecessary cost to health care.

Leukocyter, vita blodkroppar, utgör en del av kroppens immunförsvar. De utmognar från hematopoetiska stamceller i benmärgen. Leukocyterna kan delas in i neutrofila granulocyter, lymfocyter, monocyter, eosinofila granulocyter och basofila granulocyter. För att bestämma antalet leukocyter i blodet analyseras leukocytpartikelkoncentration (B-LPK) med cellräknare. Om B-LPK är förhöjt eller sänkt utförs en differentialräkning av leukocyter (B-Diff) för att se i vilket cellsystem förändring föreligger. Den manuella analysen utförs på perifera blodutstryk färgade med cytokemisk färg, May-Grünwald Giemsa. Utstryket granskas i ett automatiskt mikroskopiskt system som räknar, fotograferar och förklassificerar leukocyter efter deras utseende. DiffMaster Octavia och CellaVision DM1200 är två varianter av ett sådant instrument från samma tillverkare (CellaVision AB, Lund, Sverige). Syftet med studien var att utföra en metodjämförelse mellan dessa instrument genom analys av 60 patientprov bestående av venöst blod taget i EDTA-rör. Proven samlades in slumpmässigt från patienter (32 män och 28 kvinnor) mellan 19-95 år. Resultaten visade enligt tvåsidigt parat t-test ingen signifikant skillnad avseende differentialräkning av neutrofila granulocyter, lymfocyter och monocyter. Korrelationen var 0,95, 0,91 respektive 0,68. Det fanns dock en signifikant skillnad mellan instrumenten avseende differentialräkning av eosinofila- och basofila granulocyter, korrelationen var 0,91 respektive 0,20. När endast 200 celler räknas kan ett resultat på 2 % skilja upp till 1-5 %. Därför blir skillnader på leukocyttyper som utgör enstaka procent i blodet normalt mycket stora. Metodjämförelsen visade att båda instrumenten ger samma resultat och anses därför likvärdiga vid analys av manuell B-Diff. / Leukocytes, white blood cells, are cells of the immune system. They are produced and derived from hematopoietic stem cells in the bone marrow. Leukocytes can be divided into neutrophils, lymphocytes, monocytes, eosinophils and basophils. To determine the numbers of leukocytes in blood the leukocyte particle concentration (B-LPK) can be analyzed by cell counters. When B-LPK is elevated or lowered a differential count of leukocytes (B-Diff) is performed to see in which cell systems the change exists. The manual analysis involves peripheral blood smears stained with a cytochemical color, May-Grünwald Giemsa. The smear examined in an automatic microscopically system that counts, photographs and pre-classify leukocytes by its appearance. DiffMaster Octavia and CellaVision DM1200 are two variants of such instruments from the same manufacturer (CellaVision AB, Lund, Sweden). The aim of the study was to do a comparison between these instruments by analyzing 60 samples consisting venous blood in EDTA-tubes. The samples were collected randomly from patients (32 men and 28 women) between 19-95 years old. The results from two-sided paired t-test showed no significant difference between the differential count of neutrophils, lymphocytes and monocytes. The correlation was 0,95, 0,91 and 0,68. However, there was a significant difference between the instruments differential count of eosinophils and basophils, the correlation was 0,91 and 0,20. When counting only 200 cells a profit of 2 % distinguish up to 1-5 %. Abnormalities in leukocytes which represents only a few percent in blood can therefore be very large. Method comparison showed that both instruments give the same results and are considered equivalent in analysis of manual B-Diff.

<p>Detta examensarbete undersöker om och hur man med hjälp av filskillnader kan effektivisera uppdateringar av datorspel. Flertalet olika tester med deltaenkodning har utförts, detta på olika versioner av filer från kommersiella och aktuella spel. Bland annat har försöken med deltaenkodning jämförts med de officiella speluppdateringarna, och med vanlig komprimering av de aktuella filerna. Resultaten visar att användning av deltaenkodning på de filer som ändrats mellan spelens versioner kan vara mycket effektivare och ta mindre plats än de officiella speluppdateringarna.</p>

La nature extraordinaire du r??gime national-socialiste a longtemps paralys?? les tentatives d???en expliquer les causes, les m??canismes et les assises id??ologiques. Pourtant, depuis les ann??es 1960 et de mani??re toujours croissante par la suite, il s???av??re que ce qu???il y a de plus significatif sur le Troisi??me Reich semble ??tre r??v??l?? gr??ce ?? son inscription dans une trame sociohistorique qui le d??passe. En ce sens, la tendance misogyne du r??gime nazi ne peut ??tre comprise que par un exercice g??n??alogique. Caract??ristique fondamentale souvent n??glig??e, l???antif??minisme nazi s???inscrit dans une tendance paternaliste occidentale qui, bien qu???elle n???explique pas ?? elle seule les politiques et mesures nazies concernant les femmes, permet de saisir la nature id??ologique de leurs motivations. Plongeant au c??ur d???un XIXe si??cle post-Lumi??res aux contradictions nombreuses, aux revendications sociales certaines et aux maintes red??finitions ??pist??mologiques provoqu??es, entre autres, par le mouvement ?? anti-Lumi??res ??, notre m??moire propose d???observer les ??chos du discours allemand sur la diff??renciation des sexes et les femmes sous le Troisi??me Reich. Les id??es nazies sur les femmes ne naissent ainsi pas ex nihilo ; elles s???inscrivent dans une r??cup??ration id??ologique et une continuit?? philosophique. Tant les philosophes Arthur Schopenhauer, Friedrich Nietzsche et Otto Weininger que le m??decin Paul M??bius et le sociologue Georg Simmel s???expriment abondamment sur la ?? question f??minine ??. Repr??sentants du discours allemand de la seconde moiti?? du XIXe si??cle et du premier tiers du XXe si??cle, ils s???inscrivent ??videmment dans la tendance europ??enne, voire occidentale, d???une remise en question des acquis des Lumi??res et des revendications f??ministes. Se pronon??ant tant sur le corps f??minin que sur les capacit??s intellectuelles et morales des femmes, ces penseurs discr??ditent le mouvement d?????mancipation f??minine et mettent de l???avant des valeurs in??galitaires et d??terministes qui caract??riseront ??galement l???Allemagne d???Hitler.

Dans cette thèse, nous établissons un théorème de rigidité topologique pour une large classe de sous-groupes du groupe de difféomorphismes analytiques réels préservant l'orien- tation du cercle Diff (S1). En effet, les objets principaux étudiés dans cette thèse sont les sous-groupes localement C 2-non-discrets de type fini de Diff (S1). Dans le premier Chapitre, on donne des rappels sur la relation entre la théorie de la mesure et les systèmes dynamiques et on donne aussi des rappels sur les définitions et les propriétés des espaces hyperboliques, des groupes hyperboliques et des leurs bords. Le deuxième Chapitre contient des définitions précises pour la plupart des notions pertinentes pour cette thèse, revisite les résultats concernant la théorie de Shcherbakov- Nakai sous une forme adaptée à nos besoins et fournit une description des dynamiques topologiques associées au sous-groupe localement C 2-non-discret de Diff (S1). Le troisième Chapitre est consacré à la preuve du Théorème A "le théorème de rigidité topologique". Dans la première section de ce chapitre, on démontre le Théorème A dans divers cas particuliers, dont le cas où le groupe a une orbite finie et le cas où le groupe est résoluble mais non-abélien. Il restera alors démontrer le Théorème A dans le cas dit "générique" et cela sera l'objet du restant de ce chapitre. Dans la deuxième section de ce chapitre, nous construisons une suite de difféomorphismes de G1 convergeant vers l'identité dans C 2-topologie sur l'intervalle I C S1. Dans la dernière section de ce chapitre, nous allons démontrer le Théorème A modulo la Proposition 3.3.3. En effet, le Théorème 3.3.1 sera prouvé et ce théorème constitue un énoncé plus forte que celui du Théorème A. L'énoncé principal du quatrième Chapitre est le Théorème 4.2.1. La démonstration du Théorème 4.2.1 est une combinaison des faits standards sur les groupes hyperboliques avec l'éxistence d'une mesure µ sur G1 donnant lieu à une mesure stationnaire absolu- ment continue. Ce théorème entraînera la démonstration du Théorème B. Finalement, l'Annexe contient une réponse partielle dans la catégorie analytique à une question posée dans [De]. L'annexe se termine ensuite par un résumé du rôle joué par l'hypothèse de régularité (C) dans cette thèse. / In this thesis we establish a topological rigidity theorem for a large class of subgroups of the group Diff (S1) consisting of (orientation-preserving) real analytic diffeomorphisms of the circle S1. Indeed, the primary object studied in this thesis are finitely generated, locally C 2-non-discrete subgroups of Diff (S1). In the first Chapter, we briefly recall several basic facts in the relation between measure theory and dynamical systems and recall the definitions and basic properties of hyperbolic spaces, hyperbolic groups and their boundaries. The second Chapter contains accurate definitions for most of the notions relevant for this thesis, revisits results related to Shcherbakov-Nakai theory in a form adapted to our needs and provides a description of the topological dynamics associated with a locally C 2-non-discrete subgroup of Diff (S1). The third Chapter is devoted to proving Theorem A "topological rigidity theorem". In the first section of this chapter, we prove Theorem A in various special cases, including the case where the group has a finite orbit as well as the case in which the group is solvable but non-abelian. It will then prove Theorem A in the case called "generic" and this will be the subject of the remainder of this chapter. In the second section of this chapter, we construct an explicit sequence of diffeomorphisms in G1 converging to the identity in the C 2-topology on the interval I C S1. In the last section of this chapter, we shall prove Theorem A modulo Proposition 3.3.3. In fact, Theorem 3.3.1 will be proved and this theorem provides a statement fairly stronger than what is strictly needed to derive Theorem A. The main statement in the fourth Chapter is Theorem 4.2.1. The proof of The- orem 4.2.1 is combined standard facts about hyperbolic groups with the existence of a measure µ on G1 giving rise to an absolutely continuous stationary measure. This theorem will lead to the proof of Theorem B. In the end, the Appendix contains a partial answer in the analytic category to a question raised in [De]. The appendix then ends with a summary of the role played by the regularity assumption (C) in this thesis.

Detta examensarbete undersöker om och hur man med hjälp av filskillnader kan effektivisera uppdateringar av datorspel. Flertalet olika tester med deltaenkodning har utförts, detta på olika versioner av filer från kommersiella och aktuella spel. Bland annat har försöken med deltaenkodning jämförts med de officiella speluppdateringarna, och med vanlig komprimering av de aktuella filerna. Resultaten visar att användning av deltaenkodning på de filer som ändrats mellan spelens versioner kan vara mycket effektivare och ta mindre plats än de officiella speluppdateringarna.