Understanding of the factors driving global antimicrobial resistance is limited. We analysed antimicrobial resistance and antibiotic consumption worldwide versus many potential contributing factors.
...Using three sources of data (ResistanceMap, the WHO 2014 report on antimicrobial resistance, and contemporary publications), we created two global indices of antimicrobial resistance for 103 countries using data from 2008 to 2014: Escherichia coli resistance—the global average prevalence of E coli bacteria that were resistant to third-generation cephalosporins and fluoroquinolones, and aggregate resistance—the combined average prevalence of E coli and Klebsiella spp resistant to third-generation cephalosporins, fluoroquinolones, and carbapenems, and meticillin-resistant Staphylococcus aureus. Antibiotic consumption data were obtained from the IQVIA MIDAS database. The World Bank DataBank was used to obtain data for governance, education, gross domestic product (GDP) per capita, health-care spending, and community infrastructure (eg, sanitation). A corruption index was derived using data from Transparency International. We examined associations between antimicrobial resistance and potential contributing factors using simple correlation for a univariate analysis and a logistic regression model for a multivariable analysis.
In the univariate analysis, GDP per capita, education, infrastructure, public health-care spending, and antibiotic consumption were all inversely correlated with the two antimicrobial resistance indices, whereas higher temperatures, poorer governance, and the ratio of private to public health expenditure were positively correlated. In the multivariable regression analysis (confined to the 73 countries for which antibiotic consumption data were available) considering the effect of changes in indices on E coli resistance (R2 0·54) and aggregate resistance (R2 0·75), better infrastructure (p=0·014 and p=0·0052) and better governance (p=0·025 and p<0·0001) were associated with lower antimicrobial resistance indices. Antibiotic consumption was not significantly associated with either antimicrobial resistance index in the multivariable analysis (p=0·64 and p=0·070).
Reduction of antibiotic consumption will not be sufficient to control antimicrobial resistance because contagion—the spread of resistant strains and resistance genes—seems to be the dominant contributing factor. Improving sanitation, increasing access to clean water, and ensuring good governance, as well as increasing public health-care expenditure and better regulating the private health sector are all necessary to reduce global antimicrobial resistance.
None.
Purpose
To develop a vision for the future of disaster nursing, identify barriers and facilitators to achieving the vision, and develop recommendations for nursing practice, education, policy, and ...research.
Design and Methods
A series of semistructured conference calls were conducted with 14 national subject matter experts to generate relevant concepts regarding national nursing workforce preparedness. An invitational daylong workshop hosted by the Veterans Emergency Management Evaluation Center, U.S. Department of Veterans Affairs, was held in December 2014 to expand and refine these concepts. Workshop participants included 70 nurses, emergency managers, and a broad range of public health professionals. Conference call notes and audiotapes of the workshop were transcribed and thematic analysis conducted to outline a vision for the future of nursing in disaster preparedness and response, and to articulate an agenda for nursing practice, education, policy, and research to achieve that vision.
Findings
The group developed a vision for the future of disaster nursing, and identified current barriers and opportunities to advance professional disaster nursing. A broad array of recommendations for nursing practice, education, policy, and research, as well as implementation challenges, are summarized in this article.
Conclusions
This project represents an important step toward enhancing nurses’ roles as leaders, educators, responders, policymakers, and researchers in disaster preparedness and response. Nurses and the health and human service organizations that employ them are encouraged to engage in an expansive national dialogue regarding how to best incorporate the vision and recommendations into their individual lives and the organizations for which they work.
Clinical Relevance
Nurses comprise the largest healthcare workforce, and opportunities exist to strengthen disaster readiness, enhance national surge capacity, and build community resiliency to disasters.
Fungal metabolites represent an underutilized resource in the development of novel anticancer drugs. This review will focus on the promising fungal nephrotoxin orellanine, found in mushrooms ...including Cortinarius orellanus (Fools webcap). Emphasis will be placed on its historical significance, structural features, and associated toxicomechanics. Chromatographic methods for analysis of the compound and its metabolites, its synthesis, and chemotherapeutic potential are also discussed. Although orellanine’s exceptional selectivity for proximal tubular cells is well documented, the mechanics of its toxicity in kidney tissue remains disputed. Here, the most commonly proposed hypotheses are detailed in the context of the molecule’s structure, the symptoms seen following ingestion, and its characteristic prolonged latency period. Chromatographic analysis of orellanine and its related substances remains challenging, while biological evaluation of the compound is complicated by uncertainty regarding the role of active metabolites. This has limited efforts to structurally refine the molecule; despite numerous established methods for its synthesis, there is minimal published material on how orellanine’s structure might be optimized for therapeutic use. Despite these obstacles, orellanine has generated promising data in preclinical studies of metastatic clear cell renal cell carcinoma, leading to the early 2022 announcement of phase I/II trials in humans.
Following extensive surgical debridement in the treatment of infection, a "dead space" can result following surgical closure that can fill with hematoma, an environment conducive to bacterial growth. ...The eradication of dead space is essential in order to prevent recurrent infection. This study describes a novel small animal model to investigate dead-space management in muscle tissue. Two absorbable test materials were implanted in each animal; beads of calcium sulfate alone, and beads loaded with vancomycin and tobramycin. In-life blood samples and radiographs were taken from each animal following implantation. Animals were sacrificed at 1, 7, 21, 42, and 63 days post-operatively (n = 4), and implant sites were analysed by micro-computed tomography, histology and immunohistochemistry. Complete resorption was confirmed radiographically at 3 weeks post-implantation. Histologically, the host tissue response to both materials was identical, and subsequent healing at the implant sites was observed with no dead space remaining. Vancomycin was not detected in blood serum. However, peak tobramycin levels were detected in all animals at 6 hours post-implantation with no detectable levels in any animals at 72 hours post implantation. Serological inflammatory cytokine expression for IL-6, TNF-α and IL-1β indicated no unusual inflammatory response to the implanted materials or surgical procedure. The model was found to be convenient and effective for the assessment of implant materials for management of dead space in muscle tissue. The two materials tested were effective in resolving the surgically created dead space, and did not elicit any unexpected adverse host response.
Urban effects on native avifauna: a review Chace, Jameson F.; Walsh, John J.
Landscape and urban planning,
2006, 2006-1-00, 20060101, Letnik:
74, Številka:
1
Journal Article
Recenzirano
The effect of urbanization can be immense, yet our understanding is rudimentary. Here, we compile the most recent information on urban impacts on avian populations and communities. Compared to other ...vertebrates, birds are easily monitored by skilled observers and provide a mechanism to explore urban effects and responses to different urban designs. Taxonomically, bird communities in distinctly different habitats are most different in the least disturbed sites and the most similar in the most urbanized sites. Urbanization tends to select for omnivorous, granivorous, and cavity nesting species. Increased urbanization typically leads to an increase in avian biomass but a reduction in richness. Unlike most passerines, raptors may have home ranges that extend beyond the urban boundary and therefore do not need to meet all their ecological requirements within urban areas. Urban habitats are often of superior quality to raptors because there they are often free from persecution and have an adequate food supply. The processes that underlie the patterns of population and community level responses need more attention, but several areas of have been identified as being important. Birds respond to vegetation composition and structure, and urban areas that retain native vegetative characteristics retain more native species than those that do not. Avian fecundity in urban areas is a reflection of species-specific adaptability to urban resources, and to levels of nest predation and nest parasitism. Additionally, non-consumptive human activities that increase with urbanization are recognized as having negative impacts on avian populations and communities. Avian survivorship in urban areas is influenced by risk of collision with man-made objects, changes in the predator assemblage, food supply, and disease. Missing are thorough investigations in the regions of highest human population growth, e.g. Southeast Asia. Additionally, there is a paucity of information from regions of high avian diversity, e.g. tropical forests. Clearly, local knowledge and study is required before implementation of management policies to reduce urban impacts on bird communities. Hopefully, such policies will include long-term monitoring. Demographic parameters of fecundity and survivorship need to be examined in conjunction with measures of community diversity and density across the urban gradient to better understand the quality of different urban habitats, and the variation of quality among spatial patterns of urbanization within the native habitat matrix.
The meninges are membranous tissues that are pivotal in maintaining homeostasis of the central nervous system. Despite the importance of the cranial meninges in nervous system physiology and in head ...injury mechanics, our knowledge of the tissues' mechanical behavior and structural composition is limited. This systematic review analyzes the existing literature on the mechanical properties of the meningeal tissues. Publications were identified from a search of Scopus, Academic Search Complete, and Web of Science and screened for eligibility according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The review details the wide range of testing techniques employed to date and the significant variability in the observed experimental findings. Our findings identify many gaps in the current literature that can serve as a guide for future work for meningeal mechanics investigators. The review identifies no peer-reviewed mechanical data on the falx and tentorium tissues, both of which have been identified as key structures in influencing brain injury mechanics. A dearth of mechanical data for the pia-arachnoid complex also was identified (no experimental mechanics studies on the human pia-arachnoid complex were identified), which is desirable for biofidelic modeling of human head injuries. Finally, this review provides recommendations on how experiments can be conducted to allow for standardization of test methodologies, enabling simplified comparisons and conclusions on meningeal mechanics.
The dural venous sinuses play an integral role in draining venous blood from the cranial cavity. As a result of the sinuses anatomical location, they are of significant importance when evaluating the ...mechanopathology of traumatic brain injury (TBI). Despite the importance of the dural venous sinuses in normal neurophysiology, no mechanical analyses have been conducted on the tissues. In this study, we conduct mechanical and structural analysis on porcine dural venous sinus tissue to help elucidate the tissues' function in healthy and diseased conditions. With longitudinal elastic moduli values ranging from 33 to 58 MPa, we demonstrate that the sinuses exhibit higher mechanical stiffness than that of native dural tissue, which may be of interest to the field of TBI modelling. Furthermore, by employing histological staining and a colour deconvolution protocol, we show that the sinuses have a collagen-dominant extracellular matrix, with collagen area fractions ranging from 84 to 94%, which likely explains the tissue's large mechanical stiffness. In summary, we provide the first investigation of the dural venous sinus mechanical behaviour with accompanying structural analysis, which may aid in understanding TBI mechanopathology.
An acidic extracellular space is a hallmark of the tumor microenvironment. Acidosis has been postulated to promote the aggressive and invasive characteristics of tumors and also inhibit the ...therapeutic response, particularly in the context of novel immunotherapies. Therefore, methods to quantitatively measure the extracellular pH (pH
) are needed. Here we describe a magnetic resonance spectroscopic imaging (MRSI) technique termed Biosensor Imaging of Redundant Deviation in Shifts (BIRDS), which uses the pH-dependent chemical shifts of nonexchangeable protons of lanthanide-based contrast agents to generate quantitative spatial pH
maps. We assess this method in the context of evaluating the acidic pH
and therapeutic response in glioblastoma in rodents, where normalization of the pH
upon therapy can serve as a quantitative readout of successful drug delivery to the tumor.
Purpose
To demonstrate feasibility of developing a noninvasive extracellular pH (pHe) mapping method on a clinical MRI scanner for molecular imaging of liver cancer.
Methods
In vivo pHe mapping has ...been demonstrated on preclinical scanners (e.g., 9.4T, 11.7T) with Biosensor Imaging of Redundant Deviation in Shifts (BIRDS), where the pHe readout by 3D chemical shift imaging (CSI) depends on hyperfine shifts emanating from paramagnetic macrocyclic chelates like TmDOTP5− which upon extravasation from blood resides in the extracellular space. We implemented BIRDS‐based pHe mapping on a clinical 3T Siemens scanner, where typically diamagnetic 1H signals are detected using millisecond‐long radiofrequency (RF) pulses, and 1H shifts span over ±10 ppm with long transverse (T2, 102 ms) and longitudinal (T1, 103 ms) relaxation times. We modified this 3D‐CSI method for ultra‐fast acquisition with microsecond‐long RF pulses, because even at 3T the paramagnetic 1H shifts of TmDOTP5− have millisecond‐long T2 and T1 and ultra‐wide chemical shifts (±200 ppm) as previously observed in ultra‐high magnetic fields.
Results
We validated BIRDS‐based pH in vitro with a pH electrode. We measured pHe in a rabbit model for liver cancer using VX2 tumors, which are highly vascularized and hyperglycolytic. Compared to intratumoral pHe (6.8 ± 0.1; P < 10−9) and tumor's edge pHe (6.9 ± 0.1; P < 10−7), liver parenchyma pHe was significantly higher (7.2 ± 0.1). Tumor localization was confirmed with histopathological markers of necrosis (hematoxylin and eosin), glucose uptake (glucose transporter 1), and tissue acidosis (lysosome‐associated membrane protein 2).
Conclusion
This work demonstrates feasibility and potential clinical translatability of high‐resolution pHe mapping to monitor tumor aggressiveness and therapeutic outcome, all to improve personalized cancer treatment planning.
Microindentation of fresh biological tissues is necessary for the creation of 3D biomimetic models that accurately represent the native extracellular matrix microenvironment. However, tissue must ...first be precisely sectioned into slices. Challenges exist in the preparation of fresh tissue slices, as they can tear easily and must be processed rapidly in order to mitigate tissue degradation. In this study, we propose an optimised mounting condition for microindentation and demonstrate that embedding tissue in a mixture of 2.5% agarose and 1.5% gelatin is the most favourable method of tissue slice mounting for microindentation. This protocol allows for rapid processing of fresh biological tissue and is applicable to a variety of tissue types.
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