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Given that recurrent CDI occurs commonly, a recurrence of symptoms following successful treatment and diarrhea cessation should be assessed by repeat testing. Testing for recurrent CDI should ideally include toxin detection, as persistence of toxigenic C. difficile can occur commonly after infection. Patients can have reduced health scores for months after CDI, and may experience altered bowel habits for prolonged periods. In one study in which all CDI patients with recurrent diarrhea were tested for toxin in stool, 35% were negative [ 195 ]. Empiric treatment, that is without confirmatory testing of suspected recurrence, is discouraged, as this may be unnecessary and indeed possibly harmful to microbiome restoration.

Last, there is no clinical value in repeat CDI testing to establish cure; >60% of patients may remain C. difficile positive even after successful treatment [ 196 , 197 ].

A variety of fecal biomarkers to distinguish inflammatory causes of diarrhea from noninflammatory conditions, such as irritable bowel syndrome, have evolved over the last few decades. Lactoferrin is an iron binding glycoprotein found in neutrophils and its concentration in stool is proportional to the number of neutrophils present [ 198 ]. Calprotectin is a calcium binding protein found in the cytosol of neutrophils [ 198 ]. Secretion of cytokines in the intestines such as interleukin 8 and interleukin 1β has also been evaluated [ 199–201 ]. While they have utility in diagnosing IBD, their usefulness in the diagnosis of CDI has not been established. Most of the published studies include small or moderate numbers of patients. There are few prospective studies. Interpretation of the literature is further complicated by the use of different methods of testing (latex agglutination vs EIA in the case of fecal lactoferrin), deviation from the manufacturers’ cutoffs for interpretation, and other confounding factors. Some of these biomarkers may be helpful in identifying patients at risk for severe disease. Given these limitations, no recommendations for their routine use can be made.

The rate of C. difficile colonization among asymptomatic infants can exceed 40% [ 136 , 143 , 154 ]. Colonization rates among hospitalized neonates are greater than observed for healthy infants [ 136 ]. Although the rate of colonization declines over the first year of life, intermittent detection of C. difficile toxin can persist throughout infancy [ 202 ]. Clostridium difficile toxin can still be detected in approximately 15% of 12-month-old infants [ 153 ]. Thus, there is a substantial risk of a biologic false positive when C. difficile diagnostic testing is performed in neonates and infants. Another challenge to defining when an infant with diarrhea should be tested for C. difficile is the absence of a validated definition of clinically significant diarrhea in this age group, where passage of frequent loose stools is common. Children <12 months of age should only be tested for C. difficile if they have evidence of pseudomembranous colitis or toxic megacolon, or if they have clinically significant diarrhea and other causes of diarrhea have been excluded.

The people on the ship, only some of their children, but most of their grandchildren, are the only people who are going to arrive at this new world. A lot of the people who started on this ship have died. It's their children, their children's children, who are going to get to where they're going. And there are a lot of conflicts going on. Should they turn around and go back to Earth, which they've lost touch with? So they have no idea of what Earth even looks like now. Should they continue? Also there's been a murder on the ship, which never happened before. So that's kind of what starts it. [35]

Tricia Helfer said about Viondra that her "manipulative" character considers herself the "mother of the people on the ship, the mother of humanity in one way if Earth did blow itself up". [35] "Brian [Van Holt] and I play a married couple and as the wife, I'm definitely the woman behind the man more than we would see in our society here on Earth today", Helfer added. [38] She explained about the ship's crew that:

Their morals and the values that they're dealing with are still from the '60s. The society on the ship is very hierarchical and uses genetic linking-arranged marriages, basically to sustain human life (three generations will be born during the trip to Proxima). [My] character Viondra started out on the lower decks but rose through the ranks, as did her husband. They're a power couple. Viondra will do anything to stay in power. [7]

Creator Philip Levens said that:

Ascension will explore how technology has evolved on the ship and the way morality is still rooted in an early '60s, pre-Civil Rights Act view [of] humanity. Issues of class– the ship is divided into decks, with people in positions of power living on the upper ones– will also come into play. There's much more of a sense of obeying your parents because, you know, for the ship to really work, everybody has to cooperate. The murder is kind of the starting of the unravelling, so to speak. And kids start to question choices made by their grandparents. There's a thing on board the ship called "the crisis". It's this existential dilemma that everyone has to go through when they realize that, you know, their life has been circumscribed for them. You know, everybody they ever know or ever will know is already around them. So there's lots of issues like that kind of play [as] a coming of age thing with the kids and their parents. [35]

"Because the series is set on a ship that is self-contained and self-sustained, the people have evolved and developed differently than they would have if they'd remained on Earth. Not only is the technology different, but they think differently, too". [7]

Brian Van Holt described his character as "a man caught in the middle, aware that his legacy as the ship's 'middle route' captain won't probably go down in the record books. The one who launches the ship and the one who lands it will be remembered. No one in the now will be remembered. So he struggles with that". [39] He concluded by saying that "he's a very ambitious character who sought out a leadership role, which was presented to him after an act of heroism on the ship". [7]

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