Serratia marcescens Endocarditis Oliver, Tucker; Vazquez, Jose
JIM - high impact case reports,
01/2023, Volume:
11
Journal Article
Peer reviewed
Open access
Severe infections due to Serratia marcescens have been documented with increasing frequency in persons who inject drugs and are frequently associated with nosocomial outbreaks. S marcescens ...endocarditis is rare, and there are very few, if any, reported cases secondary to an infected wound acquired at home. We present such a case in an immunocompetent 50-year-old man with paraplegia for 30 years and chronic decubitus ulcers who likely contracted the rare opportunistic Serratia following sacral wound contact with unclean surfaces in his hotel room bathroom. While it is also possible that the organism was obtained during a hospital admission 2 months before the positive blood cultures, he was found sitting with his ulcer in direct contact with red-pigmented accumulations on the shower floor. Therefore, it is more likely that he acquired the infection outside of the hospital setting. Early and effective management with advanced cardiac techniques and appropriate antibiotic coverage resulted in a positive outcome.
This retrospective review examines the utility of phase-contrast magnetic resonance imaging (PC-MRI) to calculate flow through the aqueduct between the third and fourth ventricles to estimate ...cerebrospinal fluid (CSF) production. Imaging software quantified the CSF flow rate across the aqueduct of four females and two males at a single center, and the mean of these results was compared to the established mean CSF production calculated by invasive techniques. There was no significant difference between the means, contributing to the body of literature suggesting the utility of PC-MRI in estimating CSF production rates.
Charge balancing is used in deep brain stimulation (DBS) to avoid net charge accumulation at the tissue-electrode interface that can result in neural damage. Charge balancing paradigms include ...passive recharge and active recharge. In passive recharge, each cathodic pulse is accompanied by a waiting period before the next stimulation, whereas active recharge uses energy to deliver symmetric anodic and cathodic stimulation pulses sequentially, producing a net zero charge. We sought to determine differences in stimulation induced side effect thresholds between active vs. passive recharge during the intraoperative monopolar review.
Sixty-five consecutive patients undergoing DBS from 2021 to 2022 were retrospectively reviewed. Intraoperative monopolar review was performed with both active recharge and passive recharge for all included patients to determine side effect stimulation thresholds. Sixteen patients with 64 total DBS contacts met inclusion criteria for further analysis. Intraoperative monopolar review results were compared with the monopolar review from the first DBS programming visit.
The mean intraoperative active recharge stimulation threshold was 4.1 mA, while the mean intraoperative passive recharge stimulation threshold was 3.9 mA, though this difference was not statistically significant on
-test (
= 0.442). Mean stimulation threshold at clinic follow-up was 3.2 mA. In Pearson correlation, intraoperative passive recharge thresholds had stronger correlation with follow-up stimulation thresholds (Pearson
= 0.5281,
< 0.001) than intraoperative active recharge (Pearson
= 0.340,
= 0.018), however the difference between these correlations was not statistically significant on Fisher
correlation test (
= 0.294). The mean difference between intraoperative passive recharge stimulation threshold and follow-up stimulation threshold was 0.8 mA, while the mean difference between intraoperative active recharge threshold and follow-up threshold was 1.2 mA. This difference was not statistically significant on a
-test (
= 0.134).
Both intraoperative active recharge and passive recharge stimulation were well-correlated with the monopolar review at the first programming visit. No statistically significant differences were observed suggesting that either passive or active recharge may be utilized intraoperatively.
Most thermal comfort standards and guidelines currently in use do not consider occupants' adaptive capabilities associated with real-world situations when predicting occupant thermal comfort in ...mechanically conditioned buildings, although the adaptive approach is commonly applied to naturally ventilated buildings. These standards are generally based on results derived from experiments conducted in climate-controlled chambers. In some cases, this can lead to overcooling of buildings while still not satisfying most of occupants. One common method to reduce peak electricity demand is via temporarily increasing cooling temperature setpoint during peak hours. However, the potential negative impacts on occupant thermal comfort and wellbeing calls for further study on this. This paper describes a study conducted on a university campus in the United States that investigated occupants' thermal sensation, acceptability, and preferences corresponding to increased cooling temperature setpoint in parts of the building that are temporarily occupied. The results revealed a potential for at least temporarily increasing cooling temperature setpoint (at least 2 °C) across this campus without impairing occupant thermal comfort. For operative temperatures between 22 and 24.5 °C, the average Actual Mean Vote (AMV) for the class sections remained in the ASHRAE comfort range and the self-reported thermal acceptability was above 80%. Occupants’ thermal acceptability dropped to less than 80% when the temperature was increased to more than 24.5 °C, and the AMV values increased to more than 0.5 (on ASHRAE 7-point scale). The percentage of occupants who were involved in some sort of adaptive behavior did not considerably change with room temperature.
•By temporarily increasing indoor operative temperature in campus classrooms from 21 to 25 °C, thermal acceptability remains above 80%.•At 23.5 °C, occupants' mean thermal preference and their actual mean votes equals zero, while thermal acceptability is above 90%.•Occupants' adaptive behavior in this study, with limited adaptive options, is not a function of the operative temperature.•Heat balance model under-predicts the percentage of dissatisfied occupants at environmental conditions warmer than neutral.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPUK, ZAGLJ, ZRSKP
PurposePervasive mobile games (PMG) expand the game context into the real world, spatially, temporally and socially. The most prominent example to date is Pokémon Go (PGo), which in the first 12 ...months of its launch achieved over 800 million downloads and huge revenues for Pokémon, its majority owner Nintendo, and its developer Niantic. Like many mobile apps and innovative services, PGo's revenue structure requires continual usage (through in-app purchases and sponsorships) as it is free to download. Thus, as many players discontinued after initial adoption, substantial drops in Nintendo's share price occurred alongside the damage to brand equity. Such a case highlights the need to extend scholarship beyond traditional ‘adoption’ and begin to truly illustrate and explain the consumer behaviour phenomenon of ‘discontinuance’, particularly in the emerging and lucrative domain of PMGs.Design/methodology/approachLike many emerging marketing channels before it, large-scale discontinuance of PGo occurred and still remains unexplained in the academic literature. Herein, we address this shortcoming through a consumer case study methodology analysing a variety of data sources pertaining to PGo in Australia.FindingsThe development of the P2D_PMG model provides a new conceptual framework to illustrate the distinct forms discontinuance manifests in, for the first time. Scholarly rigour of the P2D_PMGs is achieved through validating and extending Soliman and Rinta-Kahila's (2020) framework for ‘discontinuance’ through its five forms. These forms are revealed as access and on-boarding (rejection), disconfirmation and hedonic adaptation (regressive discontinuance), technological, social, third parties, and personal issues (quitting), re-occurrences of hedonic adaptation (temporary), and alternatives and iterations (replacement).Originality/valueConceptual contributions are made in developing a model to explain what drives PMG discontinuance and when it occurs. This is particularly crucial for products with revenue structures built on continual usage, instead of initial adoption. In deriving data from actual players and aggregate user behaviour over an extended time period, the innovative case study methodology validates new discontinuance research in a manner other methods cannot. Managerial implications highlight the importance of CX, alpha/beta testing, promotion and research, gameplay design and collaboration/community engagement.
Endocarditis Tucker Oliver BS; Jose Vazquez MD, FACP, FIDSA
JIM - high impact case reports,
12/2023, Volume:
11
Journal Article
Peer reviewed
Open access
Severe infections due to Serratia marcescens have been documented with increasing frequency in persons who inject drugs and are frequently associated with nosocomial outbreaks. S marcescens ...endocarditis is rare, and there are very few, if any, reported cases secondary to an infected wound acquired at home. We present such a case in an immunocompetent 50-year-old man with paraplegia for 30 years and chronic decubitus ulcers who likely contracted the rare opportunistic Serratia following sacral wound contact with unclean surfaces in his hotel room bathroom. While it is also possible that the organism was obtained during a hospital admission 2 months before the positive blood cultures, he was found sitting with his ulcer in direct contact with red-pigmented accumulations on the shower floor. Therefore, it is more likely that he acquired the infection outside of the hospital setting. Early and effective management with advanced cardiac techniques and appropriate antibiotic coverage resulted in a positive outcome.
In this single-cohort study of patients with obstructive sleep apnea who could not adhere to treatment with continuous positive airway pressure, stimulation of the upper-airway muscles in synchrony ...with ventilatory efforts improved sleep quality.
Obstructive sleep apnea is a common disorder, characterized by recurrent narrowing and closure of the upper airway accompanied by intermittent oxyhemoglobin desaturation and sympathetic activation.
1
Sequelae include excessive sleepiness and impaired quality of life. Moderate-to-severe obstructive sleep apnea, defined as an apnea–hypopnea index (AHI) score of 15 or more apnea or hypopnea events per hour, is an independent risk factor for insulin resistance, dyslipidemia, vascular disease, and death.
2
–
7
Treatment with continuous positive airway pressure (CPAP) with the use of a mask favorably modifies these adverse health consequences.
8
However, the general effectiveness of CPAP therapy is dependent on patient acceptance . . .
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