Bloodstream infections are a major cause of death with increasing incidence and severity. Blood cultures are still the reference standard for microbiological diagnosis, but are rather slow. Molecular ...methods can be used as add-on complementary assays. They can be useful to speed up microbial identification and to predict antimicrobial susceptibility, applied to direct blood samples or positive blood cultures.
To review recent developments in molecular-based diagnostic platforms used for the identification of bloodstream infections, with a focus on assays performed directly on blood samples and positive blood cultures.
Peer reviewed articles, conference abstracts, and manufacturers' websites.
We give an update on recent developments of molecular methods in diagnosing BSIs. We first describe the currently available molecular methods to be used for positive blood cultures including: a) in situ hybridization-based methods; b) DNA-microarray-based hybridization technology; c) nucleic acid amplification-based methods; and d) combined methods. Subsequently, molecular methods applied directly to whole blood samples are discussed, including the use of nucleic acid amplification-based methods, T2 magnetic resonance-based methods, and metagenomics for diagnosing BSIs.
Advances in molecular-based methods complementary to conventional blood culture diagnostics and antimicrobial stewardship programmes may optimize infection management by allowing rapid identification of pathogens and relevant antimicrobial resistance genes. Rapid diagnosis of the causing microorganism and relevant resistance determinants is important for early administration and modification of appropriate antimicrobial therapy. Ultimately, this may lead to improved quality and cost-effectiveness of health care, as well as reduced antimicrobial resistance selection.
In this study we use a high-quality data set of in situ ozone measurements at a suburban site called Mohali in the state of Punjab to estimate ozone-related crop yield losses for wheat, rice, cotton ...and maize for Punjab and the neighbouring state Haryana for the years 2011-2013. We intercompare crop yield loss estimates according to different exposure metrics, such as AOT40 (accumulated ozone exposure over a threshold of 40) and M7 (mean 7-hour ozone mixing ratio from 09:00 to 15:59), for the two major crop growing seasons of kharif (June-October) and rabi (November-April) and establish a new crop-yield-exposure relationship for southern Asian wheat, maize and rice cultivars. These are a factor of 2 more sensitive to ozone-induced crop yield losses compared to their European and American counterparts. Relative yield losses based on the AOT40 metrics ranged from 27 to 41 % for wheat, 21 to 26 % for rice, 3 to 5 % for maize and 47 to 58 % for cotton. Crop production losses for wheat amounted to 20.8 plus or minus 10.4 million t in the fiscal year of 2012-2013 and 10.3 plus or minus 4.7 million t in the fiscal year of 2013-2014 for Punjab and Haryana taken together. Crop production losses for rice totalled 5.4 plus or minus 1.2 million t in the fiscal year of 2012-2013 and 3.2 plus or minus 0.8 million t in the year 2013-2014 for Punjab and Haryana taken together. The Indian National Food Security Ordinance entitles ~ 820 million of India's poor to purchase about 60 kg of rice or wheat per person annually at subsidized rates. The scheme requires 27.6 Mt of wheat and 33.6 Mt of rice per year. The mitigation of ozone-related crop production losses in Punjab and Haryana alone could provide > 50 % of the wheat and ~ 10 % of the rice required for the scheme. The total economic cost losses in Punjab and Haryana amounted to USD 6.5 plus or minus 2.2 billion in the fiscal year of 2012-2013 and USD 3.7 plus or minus 1.2 billion in the fiscal year of 2013-2014. This economic loss estimate represents a very conservative lower limit based on the minimum support price of the crop, which is lower than the actual production costs. The upper limit for ozone-related crop yield losses in all of India currently amounts to 3.5-20 % of India's GDP. The mitigation of high surface ozone would require relatively little investment in comparison to the economic losses incurred presently. Therefore, ozone mitigation can yield massive benefits in terms of ensuring food security and boosting the economy. The co-benefits of ozone mitigation also include a decrease in the ozone-related mortality and morbidity and a reduction of the ozone-induced warming in the lower troposphere.
Apert Syndrome (Acrocephalo Syndactyly) (A Case Report) Sinha, Dr. R. C.; Sinha, Dr. B. B.; Agrawal, Dr. S. P.
Indian Journal of Plastic Surgery/Indian journal of plastic surgery,
02/2024, Volume:
12, Issue:
2
Journal Article
The first decade of the 21st century was characterized by a hiatus in global surface warming. Using ocean model hindcasts and reanalyses we show that heat uptake between the 1990s and 2000s increased ...by 0.7 ± 0.3W m−2. Approximately 30% of the increase is associated with colder sea surface temperatures in the eastern Pacific. Other basins contribute via reduced heat loss to the atmosphere, in particular, the Southern and subtropical Indian Oceans (30%) and the subpolar North Atlantic (40%). A different mechanism is important at longer timescales (1960s–present) over which the Southern Annular Mode trended upward. In this period, increased ocean heat uptake has largely arisen from reduced heat loss associated with reduced winds over the Agulhas Return Current and southward displacement of Southern Ocean westerlies.
Key PointsHeat uptake increased in the Southern, Atlantic, and Indian OceansThe increase of 0.5–1 W/m2 in ocean heat uptake is enough to explain the hiatusTropical Pacific SST is not the only way to change global ocean heat uptake
Bioaerosols are relevant for public health and may play an important role in the climate system, but their atmospheric abundance, properties, and sources are not well understood. Here we show that ...the concentration of airborne biological particles in a North American forest ecosystem increases significantly during rain and that bioparticles are closely correlated with atmospheric ice nuclei (IN). The greatest increase of bioparticles and IN occurred in the size range of 2–6 μm, which is characteristic for bacterial aggregates and fungal spores. By DNA analysis we found high diversities of airborne bacteria and fungi, including groups containing human and plant pathogens (mildew, smut and rust fungi, molds, Enterobacteriaceae, Pseudomonadaceae). In addition to detecting known bacterial and fungal IN (Pseudomonas sp., Fusarium sporotrichioides), we discovered two species of IN-active fungi that were not previously known as biological ice nucleators (Isaria farinosa and Acremonium implicatum). Our findings suggest that atmospheric bioaerosols, IN, and rainfall are more tightly coupled than previously assumed.
Sickle cell disease (SCD) is an inherited blood disorder that primarily affects African-American and other ethnic minority populations. There are three available disease-modifying therapies for ...sickle cell disease: hydroxyurea (HU), bone marrow transplantation (BMT), and chronic blood transfusion (CBT). Since these treatments vary in their therapeutic intent, efficacy in preventing progression of the disease, short and long-term adverse effects, costs and patient burden, the decision-making process regarding these therapies is complicated for both the patient and healthcare provider. While previous research has focused on the patient perspective of treatment-related decision making, there is a paucity of research investigating the physician perspective of treatment-related decision making. We conducted a qualitative study with physicians who were experts in the field of SCD. Interviews focused on physician perceptions of patient decisional needs as well as physicians' approach to decision making regarding disease-modifying therapies in SCD. Thirty-six physician interviews were analyzed, with a focus on their perspectives regarding available treatment options and on how they approach decision making with patients. We identified two narrative approaches. The Collaborative approach (CA) was characterized by emphasizing the need to discuss all possible treatment options to ensure that the patient and/or family was equipped to make an informed decision. The Proponent approach (PA) was characterized by strongly advocating a pre-determined treatment plan and providing patients/families with information, with the objective of convincing them to accept the treatment. An interplay of patient-related and disease-related factors, decision type and physician-related factors, as well as institutional frameworks, influenced physician perspectives on treatment options and decision making regarding these therapies. These findings point to the potential value of developing systems to foster patient engagement as a way of facilitating shared decision making.
Machine learning (ML) is increasingly being used in many areas of health care. Its use in infection management is catching up as identified in a recent review in this journal. We present here a ...complementary review to this work.
To support clinicians and researchers in navigating through the methodological aspects of ML approaches in the field of infection management.
A Medline search was performed with the keywords artificial intelligence, machine learning, infection∗, and infectious disease∗ for the years 2014–2019. Studies using routinely available electronic hospital record data from an inpatient setting with a focus on bacterial and fungal infections were included.
Fifty-two studies were included and divided into six groups based on their focus. These studies covered detection/prediction of sepsis (n = 19), hospital-acquired infections (n = 11), surgical site infections and other postoperative infections (n = 11), microbiological test results (n = 4), infections in general (n = 2), musculoskeletal infections (n = 2), and other topics (urinary tract infections, deep fungal infections, antimicrobial prescriptions; n = 1 each). In total, 35 different ML techniques were used. Logistic regression was applied in 18 studies followed by random forest, support vector machines, and artificial neural networks in 18, 12, and seven studies, respectively. Overall, the studies were very heterogeneous in their approach and their reporting. Detailed information on data handling and software code was often missing. Validation on new datasets and/or in other institutions was rarely done. Clinical studies on the impact of ML in infection management were lacking.
Promising approaches for ML use in infectious diseases were identified. But building trust in these new technologies will require improved reporting. Explainability and interpretability of the models used were rarely addressed and should be further explored. Independent model validation and clinical studies evaluating the added value of ML approaches are needed.
Despite its efficacy, the uptake of HU in adults with sickle cell disease (SCD) is poor likely due to a combination of system, provider, and patient-related factors. We investigated attitudes of ...adult patients towards HU by conducting qualitative interviews with 95 adult SCD patients (age 18 to 67 years old, 71 were female). While 53% of all participants reported that they were currently taking HU, patients ranging in age 18-30 years (Group 1) were more likely to report current HU use as compared to those (Group 2) ranging in age 31-67 years (65% vs. 41% P = 0.01). Most Group 1 participants who reported currently taking HU indicated that the decision to start HU was made by a parent, though some made the decision themselves as a young adult. Group 1 participants expressed trust in the efficacy of HU as well as trust that their physician adequately shared risks and benefits for the medication. The Group 2 participants, who were not currently on HU, were skeptical that all the risks and benefits of HU were known, were concerned that the efficacy of HU was not proven, and that they were not receiving complete information about its potential side effects. Of Group 2 participants who reported currently being on HU, 25% were concerned about the side effects and efficacy of HU and reported continuing HU because of a lack of effective alternatives. These data suggest that there are significant differences by age in adult SCD patients' attitudes towards, utilization and understanding of the risks and benefits of HU.
Summary 1. Sixty cases drawn from different age groups and sexes having wounds resulting from burn injury or trauma or infection were taken up for the study of the utility of amniotic membrane as ...temporary biological cover. 2. The membranes usually survived upto five days on even deep wounds or severely infected wounds after which it had to be replaced. The deep wounds also had healing from margins. 3. In all cases bacterial counts dropped down following amnion grafting.
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