As people are living longer the demand for long-term care facilities (LTCFs) continues to rise. For many reasons, antimicrobials are used intensively in LTCFs, with up to a half of this use ...considered inappropriate or unnecessary. Over-use of antimicrobials can have direct adverse consequences for LTCF residents and promotes the development and spread of resistant bacteria. It is therefore critical that LTCFs are able to engage in antimicrobial stewardship programmes, which have the potential to minimize the antibiotic selective pressure, while improving the quality of care received by LTCF residents. To date, no antimicrobial stewardship guidelines specific to LTCF settings have been published. Here we outline the scale of antimicrobial use in LTCFs and the underlying drivers for antibiotic over-use. We further describe the particular challenges of antimicrobial stewardship in LTCFs, and review the interventional studies that have aimed to improve antibiotic use in these settings. Practical recommendations are then drawn from this research to help guide the development and implementation of antimicrobial stewardship programmes.
Context. Theoretical arguments suggest that dust grains should grow in the dense cold parts of molecular clouds. Evidence of larger grains has so far been gathered in near/mid infrared extinction and ...millimeter observations. Interpreting the data is, however, aggravated by the complex interplay of density and dust properties (as well as temperature for thermal emission). Aims. Direct evidence of larger particles can be derived from scattered mid-infrared (MIR) radiation from a molecular cloud observed in a spectral range where little or no emission from polycyclic aromatic hydrocarbons (PAHs) is expected. Methods. We present new Spitzer data of L183 in bands that are sensitive and insensitive to PAHs. The visual extinction AV map derived in a former paper was fitted by a series of 3D Gaussian distributions. For different dust models, we calculate the scattered MIR radiation images of structures that agree with the AV map and compare them to the Spitzer data. Results. The Spitzer data of L183 show emission in the 3.6 and 4.5 μm bands, while the 5.8 μm band shows slight absorption. The emission layer of stochastically heated particles should coincide with the layer of strongest scattering of optical interstellar radiation, which is seen as an outer surface on I band images different from the emission region seen in the Spitzer images. Moreover, PAH emission is expected to strongly increase from 4.5 to 5.8 μm, which is not seen. Hence, we interpret this emission to be MIR scattered light from grains located further inside the core, and call it ”coreshine”. Scattered light modeling when assuming interstellar medium dust grains without growth does not reproduce flux measurable by Spitzer. In contrast, models with grains growing with density yield images with a flux and pattern comparable to the Spitzer images in the bands 3.6, 4.5, and 8.0 μm. Conclusions. There is direct evidence of dust grain growth in the inner part of L183 from the scattered light MIR images seen by Spitzer.
Several articles have been published about the reorganisation of surgical activity during the COVID-19 pandemic but few, if any, have focused on the impact that this has had on emergency and trauma ...surgery. Our aim was to review the most current data on COVID-19 to provide essential suggestions on how to manage the acute abdomen during the pandemic.
A systematic review was conducted of the most relevant English language articles on COVID-19 and surgery published between 15 December 2019 and 30 March 2020.
Access to the operating theatre is almost exclusively restricted to emergencies and oncological procedures. The use of laparoscopy in COVID-19 positive patients should be cautiously considered. The main risk lies in the presence of the virus in the pneumoperitoneum: the aerosol released in the operating theatre could contaminate both staff and the environment.
During the COVID-19 pandemic, all efforts should be deployed in order to evaluate the feasibility of postponing surgery until the patient is no longer considered potentially infectious or at risk of perioperative complications. If surgery is deemed necessary, the emergency surgeon must minimise the risk of exposure to the virus by involving a minimal number of healthcare staff and shortening the occupation of the operating theatre. In case of a lack of security measures to enable safe laparoscopy, open surgery should be considered.
The complexity of Orion: an ALMA view Pagani, L.; Bergin, E.; Goldsmith, P. F. ...
Astronomy and astrophysics (Berlin),
04/2019, Letnik:
624
Journal Article
Recenzirano
Odprti dostop
The chemistry of complex organic molecules in interstellar dark clouds is still highly uncertain in part because of the lack of constraining observations. Orion is the closest massive star-forming ...region, and observations making use of ALMA allow us to separate the emission regions of various complex organic molecules (COMs) in both velocity and space. Orion also benefits from an exceptional situation, in that it is the site of a powerful explosive event that occurred ∼550 years ago. We show that the closely surrounding Kleinmann-Low region has clearly been influenced by this explosion; some molecular species have been pushed away from the densest parts while others have remained in close proximity. This dynamical segregation reveals the time dependence of the chemistry and, therefore allows us to better constrain the formation sequence of COMs and other species, including deuterated molecules.
Aims. We observed the L1506 filament, which is located in the Taurus molecular complex, with the Herschel PACS and SPIRE instruments. Our aim is to prove the variation in grain properties along the ...entire length of the filament. In particular, we want to determine above which gas density this variation arises and what changes in the grain optical properties/size distribution are required. Methods. We use the 3D radiative transfer code CRT, coupled to the dust emission and extinction code DustEM, to model the emission and extinction of the dense filament. We test a range of optical properties and size distributions for the grains: dust of the diffuse interstellar medium (interstellar PAHs and amorphous carbons and silicates) and both compact and fluffy aggregates. Results. We find that the grain opacity has to increase across the filament to fit simultaneously the near-IR extinction and Herschel emission profiles of L1506. We interpret this change to be a consequence of the coagulation of dust grains to form fluffy aggregates. Grains similar to those in the diffuse medium have to be present in the outer layers of the cloud, whereas aggregates must prevail above gas densities of a few 103 H/cm3. This corresponds to line-of-sights with visual extinction in the V band of the order of 2 to 3. The dust opacity at 250 μm is raised by a factor of 1.8 to 2.2, while the grain average size is increased by a factor of 5. These exact numbers depend naturally on the dust model chosen to fit the data. Our findings agree with the constraints given by the study of the gas molecular lines. Using a simple approach, we show that the aggregates may have time to form inside the filament within the cloud lifetime. Our model also characterises the density structure of the filament, showing that the filament width is not constant along L1506 but instead varies by a factor of the order of 4. Conclusions. We confirm the need for an increase in the far-IR dust opacity to explain the emission and extinction in L1506C, which we interpret as being due to dust growth. We also show that this opacity variation is valid along the entire length of the L1506 dense filament.
•Robust HPLC-MS/MS quantification of plasma levels of 12 daily-used antibiotics.•Directly covering the entire clinically relevant ranges of concentrations.•Simple extraction, short turn-around time, ...stable isotope-labeled internal standards.•In vivo studies on isomers of imipenem and cefepime.•Suitable for adjusting antibiotics dosage for optimal efficacy and minimal toxicity.
Unpredictable pharmacokinetics of antibiotics in patients with life-threatening bacterial infections is associated with drug under- or overdosing. Therapeutic drug monitoring (TDM) may guide dosing adjustment aimed at maximizing antibacterial efficacy and minimizing toxicity. Rapid and accurate analytical methods are key for real-time TDM. Our objective was to develop a robust high-performance liquid chromatography-tandem mass spectrometry method (HPLC-MS/MS) for multiplex quantification of plasma concentrations of 12 antibiotics: imipenem/cilastatin, meropenem, ertapenem, cefepime, ceftazidime, ceftriaxone, piperacillin/tazobactam, amoxicillin, flucloxacillin, rifampicin, daptomycin.
A single extraction procedure consisting in methanol plasma protein precipitation and H2O dilution was used for all analytes. After chromatographic separation on an Acquity UPLC HSS-T3 2.1 × 50 mm, 1.8 µm (Waters®) column, quantification was performed by electro-spray ionisation-triple quadrupole mass spectrometry with selected reaction monitoring detection. Antibiotics were divided in two pools of calibration according to the frequency of analyses requests in the hospital routine antibiotic TDM program. Stable isotopically-labelled analogues were used as internal standards. A single analytical run lasted less than 9 min.
The method was validated based on FDA recommendations, including assessment of extraction yield (96–113.8%), matrix effects, and analytical recovery (86.3–99.6%). The method was sensitive (lower limits of quantification 0.02–0.5 µg/mL), accurate (intra/inter-assay bias −11.3 to +12.7%) and precise (intra/inter-assay CVs 2.1–11.5%) over the clinically relevant plasma concentration ranges (upper limits of quantification 20–160 µg/mL). The application of the TDM assay was illustrated with clinical cases that highlight the impact on patients’ management of an analytical assay providing information with short turn-around time on antibiotic plasma concentration.
This simple, robust high-throughput multiplex HPLC-MS/MS assay for simultaneous quantification of plasma concentrations of 12 daily used antibiotics is optimally suited for clinically efficient real-time TDM.
Context. CO and N2 are two abundant species in molecular clouds. CO molecules are heavily depleted from the gas phase towards the centre of pre-stellar cores, whereas N2 maintains a high gas phase ...abundance. For example, in the molecular cloud L183, CO is depleted by a factor of ≈400 in its centre with respect to the outer regions of the cloud, whereas N2 is only depleted by a factor of ≈20. The reason for this difference is not yet clear, since CO and N2 have identical masses, similar sticking properties, and a relatively close energy of adsorption. Aims. We present a study of the CO-N2 system in sub-monolayer regimes, with the aim to measure, analyse and elucidate how the adsorption energy of the two species varies with coverage, with much attention to the case where CO is more abundant than N2. Methods. Experiments were carried out using the ultra-high vacuum (UHV) set-up called VENUS. Sub-monolayers of either pure 13CO or pure 15N2 and 13CO:15N2 mixtures were deposited on compact amorphous solid water ice, and crystalline water ice. Temperature-programmed desorption experiments, monitored by mass spectrometry, are used to analyse the distributions of binding energies of 13CO and 15N2 when adsorbed together in different proportions. Results. The distribution of binding energies of pure species varies from 990 K to 1630 K for 13CO, and from 890 K to 1430 K for 15N2. When a CO:N2 mixture is deposited, the 15N2 binding energy distribution is strongly affected by the presence of 13CO, whereas the adsorption energy of CO is unaltered. Conclusions. Whatever types of water ice substrate we used, the N2 effective binding energy was significantly lowered by the presence of CO molecules. We discuss the possible impact of this finding in the context of pre-stellar cores.
Using structural equation modeling with a population-based cohort of French-speaking children from Quebec (Canada), prospective associations were made between two previously established factors ...underlying student performance — classroom engagement and the teacher–student relations. Our results show developmental continuity in classroom engagement and teacher–student relations from grades 1 through 4, beyond the influence of confounding child factors (sex, kindergarten cognitive skills, and second grade achievement) and family factors (such as maternal education). Although they were both relatively stable over time, closer relations with teachers showed comparatively less stability than classroom engagement. That is, classroom engagement showed the most developmental continuity from one grade to the next. Because intervention programs targeting very young children are among the most cost-effective (Heckman, 2006), our findings suggest the benefits of investing in evidence-based programs, in concert with practitioners, to promote positive teacher relations with students and encourage their active classroom participation and involvement.
► Classroom engagement and teacher–child relationship are moderately stable. ► Classroom engagement and teacher–child relations covary along the school year. ► Teacher–child relationship in first grade forecasts fourth grade engagement. ► Engagement in first grade did not forecast Teacher–child relations in fourth grade.
The fully human anti-lipopolysaccharide (LPS) immunoglobulin M (IgM) monoclonal antibody panobacumab was developed as an adjunctive immunotherapy for the treatment of O11 serotype
Pseudomonas ...aeruginosa
infections. We evaluated the potential clinical efficacy of panobacumab in the treatment of nosocomial pneumonia. We performed a post-hoc analysis of a multicenter phase IIa trial (NCT00851435) designed to prospectively evaluate the safety and pharmacokinetics of panobacumab. Patients treated with panobacumab (
n
= 17), including 13 patients receiving the full treatment (three doses of 1.2 mg/kg), were compared to 14 patients who did not receive the antibody. Overall, the 17 patients receiving panobacumab were more ill. They were an average of 72 years old interquartile range (IQR): 64–79 versus an average of 50 years old (IQR: 30–73) (
p
= 0.024) and had Acute Physiology and Chronic Health Evaluation II (APACHE II) scores of 17 (IQR: 16–22) versus 15 (IQR: 10–19) (
p
= 0.043). Adjunctive immunotherapy resulted in an improved clinical outcome in the group receiving the full three-course panobacumab treatment, with a resolution rate of 85 % (11/13) versus 64 % (9/14) (
p
= 0.048). The Kaplan–Meier survival curve showed a statistically significantly shorter time to clinical resolution in this group of patients (8.0 IQR: 7.0–11.5 versus 18.5 IQR: 8–30 days in those who did not receive the antibody;
p
= 0.004). Panobacumab adjunctive immunotherapy may improve clinical outcome in a shorter time if patients receive the full treatment (three doses). These preliminary results suggest that passive immunotherapy targeting LPS may be a complementary strategy for the treatment of nosocomial O11
P. aeruginosa
pneumonia.
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