Many different definitions for multidrug-resistant (MDR), extensively drug-resistant (XDR) and pandrug-resistant (PDR) bacteria are being used in the medical literature to characterize the different ...patterns of resistance found in healthcare-associated, antimicrobial-resistant bacteria. A group of international experts came together through a joint initiative by the European Centre for Disease Prevention and Control (ECDC) and the Centers for Disease Control and Prevention (CDC), to create a standardized international terminology with which to describe acquired resistance profiles in Staphylococcus aureus, Enterococcus spp., Enterobacteriaceae (other than Salmonella and Shigella), Pseudomonas aeruginosa and Acinetobacter spp., all bacteria often responsible for healthcare-associated infections and prone to multidrug resistance. Epidemiologically significant antimicrobial categories were constructed for each bacterium. Lists of antimicrobial categories proposed for antimicrobial susceptibility testing were created using documents and breakpoints from the Clinical Laboratory Standards Institute (CLSI), the European Committee on Antimicrobial Susceptibility Testing (EUCAST) and the United States Food and Drug Administration (FDA). MDR was defined as acquired non-susceptibility to at least one agent in three or more antimicrobial categories, XDR was defined as non-susceptibility to at least one agent in all but two or fewer antimicrobial categories (i.e. bacterial isolates remain susceptible to only one or two categories) and PDR was defined as non-susceptibility to all agents in all antimicrobial categories. To ensure correct application of these definitions, bacterial isolates should be tested against all or nearly all of the antimicrobial agents within the antimicrobial categories and selective reporting and suppression of results should be avoided.
The Klebsiella pneumoniae carbapenem (KPC) β-lactamase occurs in Enterobacteriaceae and can confer resistance to all β-lactam agents including carbapenems. The enzyme may confer low-level carbapenem ...resistance, and the failure of susceptibility methods to identify this resistance has been reported. Automated and nonautomated methods for carbapenem susceptibility were evaluated for identification of KPC-mediated resistance. Ertapenem was a more sensitive indicator of KPC resistance than meropenem and imipenem independently of the method used. Carbapenemase production could be confirmed with the modified Hodge test.
Oxygen availability is decreasing in many lakes and reservoirs worldwide, raising the urgency for understanding how anoxia (low oxygen) affects coupled biogeochemical cycling, which has major ...implications for water quality, food webs, and ecosystem functioning. Although the increasing magnitude and prevalence of anoxia has been documented in freshwaters globally, the challenges of disentangling oxygen and temperature responses have hindered assessment of the effects of anoxia on carbon, nitrogen, and phosphorus concentrations, stoichiometry (chemical ratios), and retention in freshwaters. The consequences of anoxia are likely severe and may be irreversible, necessitating ecosystem‐scale experimental investigation of decreasing freshwater oxygen availability. To address this gap, we devised and conducted REDOX (the Reservoir Ecosystem Dynamic Oxygenation eXperiment), an unprecedented, 7‐year experiment in which we manipulated and modeled bottom‐water (hypolimnetic) oxygen availability at the whole‐ecosystem scale in a eutrophic reservoir. Seven years of data reveal that anoxia significantly increased hypolimnetic carbon, nitrogen, and phosphorus concentrations and altered elemental stoichiometry by factors of 2–5× relative to oxic periods. Importantly, prolonged summer anoxia increased nitrogen export from the reservoir by six‐fold and changed the reservoir from a net sink to a net source of phosphorus and organic carbon downstream. While low oxygen in freshwaters is thought of as a response to land use and climate change, results from REDOX demonstrate that low oxygen can also be a driver of major changes to freshwater biogeochemical cycling, which may serve as an intensifying feedback that increases anoxia in downstream waterbodies. Consequently, as climate and land use change continue to increase the prevalence of anoxia in lakes and reservoirs globally, it is likely that anoxia will have major effects on freshwater carbon, nitrogen, and phosphorus budgets as well as water quality and ecosystem functioning.
Our seven‐year, whole‐ecosystem oxygen manipulation demonstrates that anoxia significantly increases freshwater concentrations and downstream export of carbon (C), nitrogen (N), and phosphorus (P). The "% of inflow" represents the percent of inflowing C, N, and P into a waterbody that is exported: values <100% indicate that the focal reservoir was a net sink of C, N, or P; and values >100% indicate that the reservoir was a net source of C, N, or P downstream. Anoxia switched the reservoir from a net sink of C and P to a net source of C and P downstream, and increased N export substantially.
ICCEDI is an international seminar that is held every two years organized by the Law and Citizenship Department, Faculty of Social Science Universitas Negeri Malang. The activities aim to discuss the ...theoretical and practical citizenship education that becomes needed for democracy in Indonesia and other countries with a view to build academic networks by gathering academics from various research institutes and universities. Citizenship education is an urgent need for the nation in order to build a civilized democracy for several reasons. Citizenship education is important for those who are politically illiterate and do not know how to work the democracy of its institutions. Another problem is the increasing political apathy, indicated by the limited involvement of citizens in the political process. These conditions show how citizenship education becomes the means needed by a democratic country like Indonesia. The book addresses a number of important issues, such as law issues, philosophy of moral values, political government, socio-cultural and Pancasila, and civic education. Finally, it offers a conceptual framework for future democracy. This book will be of interest to students, scholars, and practitioners, governance, and other related stakeholders.
Prince Dipanagara led the Javanese armies in the Java War (1825–30), 30), the last stand of Java’s Old Order against Dutch colonial rule. Some participants immortalised the conflict in verse ...chronicles known generically as Babad Dipanagara. This book comprises a transliteration of one such Javanese text together with a long introduction, translations into English and Indonesian Malay, and detailed notes.
To investigate all the available evidence assessing the effect of nutrition intervention on patients with chyle leakage and its effectiveness at reducing the need for surgical intervention.
A ...systematic review was undertaken of all English language studies using MEDLINE, Cinahl and Web of Science from January 1980 to September 2013. Case series were included because of limited available evidence. Exclusion criteria included animal studies, pediatrics and studies without nutritional intervention. Assessment of study quality was included. Because of the heterogeneity of the data, no meta-analysis was performed.
Thirty-one articles were identified for analysis, all of which were retrospective case series studies. The data within these studies were greatly limited. A total of 550 subjects were identified from these studies, 72% of whom had a chyle leak successfully resolved without surgical intervention. However, there was no significant difference between the type of dietary intervention and the rate of resolution (χ(2)=11.14, P=0.08).
Although there is evidence to suggest that nutrition may have a role in the management of patients with chyle leakage, it is not possible to determine which dietary methods are most effective. More research is required before any guidelines for best practice can be established.
This monograph develops the theory of noise mechanisms and measurements, and describes general noise characteristics and computational methods. The vast ambient noise literature is concisely ...summarized using theory combined with key representative results. The air sea boundary interaction zone is described in terms of nondimensional variables requisite for future experiments. Noise field coherency, rare directional measurements, and unique basin scale computations and methods are presented. The use of satellite measurements in these basin scale models is demonstrated. A series of appendices provides in-depth mathematical treatments which will be of interest to graduate students and active researchers.
Metalimnetic oxygen minimum zones (MOMs) commonly develop during the summer stratified period in freshwater reservoirs because of both natural processes and water quality management. While several ...previous studies have examined the causes of MOMs, much less is known about their effects, especially on reservoir biogeochemistry. MOMs create distinct redox gradients in the water column which may alter the magnitude and vertical distribution of dissolved methane (CH4) and carbon dioxide (CO2). The vertical distribution and diffusive efflux of CH4 and CO2 was monitored for two consecutive open-water seasons in a eutrophic reservoir that develops MOMs as a result of the operation of water quality engineering systems. During both summers, elevated concentrations of CH4 accumulated within the anoxic MOM, reaching a maximum of 120 μM, and elevated concentrations of CO2 accumulated in the oxic hypolimnion, reaching a maximum of 780 μM. Interestingly, the largest observed diffusive CH4 effluxes occurred before fall turnover in both years, while peak diffusive CO2 effluxes occurred both before and during turnover. Our data indicate that MOMs can substantially change the vertical distribution of CH4 and CO2 in the water column in reservoirs, resulting in the accumulation of CH4 in the metalimnion (vs. at the sediments) and CO2 in the hypolimnion.
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•Metalimnetic oxygen minimum zones (MOMs) commonly develop in freshwater reservoirs.•Dissolved greenhouse gases and emissions were monitored in a reservoir with MOMs.•MOMs altered the seasonal profiles of CH4 and CO2 in the water column.•Methane (CH4) accumulated in the MOMs that developed both monitoring periods.•Evaluation of MOMs on GHGs is critical as reservoir construction increases.
BACKGROUND AND PURPOSE:Dengue is a common arboviral disease, which uncommonly involves the brain. There has been a recent surge in dengue cases and dengue-related deaths in tropical countries. The ...aim of this study was to describe brain imaging findings in patients with dengue infection having neurologic symptoms.MATERIALS AND METHODS:Thirty-five patients with positive serology for dengue with CNS symptoms undergoing imaging of the brain were included in the study. Clinical, laboratory, and imaging parameters were assessed and correlated to poor outcome.RESULTS:A Glasgow Coma Scale score of ≤12 at presentation, clinical classification of severe-type dengue, and the presence of acute renal failure were associated with poor outcome. Imaging parameters associated with poor outcome were involvement of the thalami and cerebellar peduncles and the presence of diffusion restriction and hemorrhagic foci in the brain parenchyma.CONCLUSIONS:Although not specific, dengue infection has imaging findings that can be used to narrow down the differential list and help in prognostication.
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