Ongoing advances in nanotechnology research have established a variety of methods to synthesize nanoparticles (NPs) from a diverse range of materials, including metals, semiconductors, ceramics, ...metal oxides, polymers,
etc.
Depending upon their origin and synthesis methods, NPs possess unique physicochemical, structural and morphological characteristics, which are important in a wide variety of applications concomitant to electronic, optoelectronic, optical, electrochemical, environment and biomedical fields. This review provides a comprehensive overview on various physical, chemical and bio-assisted methods largely employed to synthesize and fabricate NPs of varying size, surface characteristics, functionalities and physicochemical behavior. The key applications of nanoparticles have also been discussed.
Various methods to synthesize diverse nanoparticles with their different applications.
Abstract Background /Purpose: Multidrug-resistant strains of Citrobacter have emerged, which carry Amp-C β-lactamase (Amp-C), broad-spectrum β-lactamase, extended-spectrum β-lactamase (ESBL), and ...other resistance mechanisms. These strains are associated with a higher rate of in-hospital mortality. The object of this study is to determine the mortality risk factors, susceptibility pattern to antibiotics, and prevalence of resistance genes in patients with Citrobacter freundii bacteremia. Methods From January 2009 to December 2014, blood isolates of C. freundii were collected in MacKay Memorial Hospital, Taipei, Taiwan. PCR technique and sequencing were performed for resistance genes. Pulsed-field gel electrophoresis (PFGE) was done using Xba I restriction enzyme. The clinical characteristics and risk factors for mortality are demonstrated. Results The 36 blood isolates of C. freundii belonged to 32 different PFGE pulsotypes , and 15 isolates (41.7%) were polymicrobial. The most common source of infection was intra-abdominal origin (61.1%), followed by unknown sources (22.2%), the urinary tract (8.3%), intravascular catheter (5.6%), and soft tissue (2.8%). High degree of antibiotic resistance was noted for cefazolin (100%), cefoxitin (97.2%), and cefuroxime (66.7%). The blaTEM-1 resistance gene was present in 16.7% isolates. 72.2% isolates carried blaAmpC and 5.6% isolates carried ESBL genes ( blaSHV-12 or blaCTX-M-15 ). Multivariate analysis indicated that the independent risk factor for 28-day mortality was carrying the blaTEM-1 resistance gene. Conclusion For patients with C. freundii bacteremia, carrying the blaTEM-1 resistance gene was an independent risk factor for 28-day mortality. Carbapenems, fourth-generation cephalosporins, amikacin, and quinolones are still reliable agents for drug-resistant strains.
Introduction
This study examines undergraduate dental students' perceptions of their self‐confidence in communicating with patients and paradental staff.
Materials and Methods
A survey questionnaire ...was designed based on a literature review and input from students and academic staff relating to clinical communication skills with 19 questions across 7 domains. Through email, a convenience sampling of undergraduate students were invited to complete the survey questionnaire. Qualitative and quantitative analysis of the responses was performed with a thematic analysis to the open‐ended questions.
Results
In total, 102 students were surveyed from 4 years of students with a 36.6% response rate. Students reported some areas of low confidence across various communication domains, in particular, building rapport, behavioural change, management of patient expectation and breaking bad news. Students reported insufficient confidence and knowledge in specialist clinical areas, layperson terms and success rates and longevity of treatment items when communicating with patients. Information sheets and visual aids such as models or photos were suggested by students to be helpful in patient communication. Students also reported challenges in communication with nurses when they might challenge or change their clinical decisions in front of their patients.
Conclusion
Our study reveals areas of low confidence among undergraduate dental students in communication towards patients and paradental staff. Barriers and challenges have been identified with an action plan suggested accordingly. There is a need for additional training in the form of learning content and communications experiences, and channels of communications for undergraduate students.
Carbapenem-nonsusceptible Enterobacterales (CNSE) are a growing global threat. Carbapenemases are often produced by plasmids, which allow rapid transmission. This study aimed to investigate (1) the ...bacterial type (2) resistant genes (3) antimicrobial susceptibility and (4) risk factors for acquisition of carbapenemase-producing carbapenem-nonsusceptible Enterobacterales (CP-CNSE) and non-carbapenemase-producing carbapenem-nonsusceptible Enterobacterales (non-CP-CNSE) bacteremia.
There were a total of 113 isolates of Enterobacterales from 2013 to 2018. After excluding nonblood isolates and including only one sample from each patient, 99 isolates were analyzed and the medical charts of these patients were reviewed. Carbapenemase genes, β-lactamase genes and antimicrobial susceptibility of the isolates were determined. Multilocus sequence typing (MLST) was performed on CP-CNSE isolates.
CP-CNSE carried more blaSHV (P = 0.004) and were more resistant to imipenem than non-CP-CNSE (P < 0.001). In the univariate analyses, we found that CP-CNSE bloodstream infection was associated with patient <65 years of age (odds ratio, 3.90; 95% confidence interval CI, 1.16 to 13.10; P = 0.027), mechanical ventilation at the time of bloodstream infection (BSI) (odds ratio, 3.85; 95% CI, 1.16–12.78; P = 0.028) and exposure to piperacillin/tazobactam (odds ratio, 3.96; 95% CI, 1.09–14.38; P = 0.037). However, on multivariate analyses, no independent predictor for CP-CNSE was identified in this study.
CP-CNSE carried more blaSHV and were more resistant to imipenem when compared to non-CP-CNSE. No independent predictor for CP-CNSE was identified after multivariate analysis. This is the first study conducted in Taiwan comparing risk factors between CP-CNSE and non-CP-CNSE from both clinical and molecular aspects.
Carbapenem-resistant Enterobacteriales has become a threat in Taiwan. This is the first local study focusing on the association between carbapenem-resistant Enterobacteriales and antimicrobial ...consumption. From January 2012 to December 2020, data were collected in a tertiary care hospital in Taipei, Taiwan. Antimicrobial consumption was estimated by the defined daily dose/1,000 patient-days. During the same period, the prevalence of carbapenem-resistant Escherichia coli (CREC) and carbapenem-resistant Klebsiella pneumoniae (CRKP) were collected through routine surveillance data. The following retrospective analyses were conducted: 1) analysis of antimicrobial consumption over time, (2) analysis and forecast of CREC and CRKP prevalence over time, and 3) analysis of correlation between antimicrobial consumption and the prevalence of CREC and CRKP. The consumption of piperacillin/tazobactam (β = 0.615), fluoroquinolones (β = 0.856), meropenem (β = 0.819), and doripenem (β = 0.891) increased during the observation period (P < 0.001), and the consumption of aminoglycosides (β = -0.852) and imipenem/cilastatin (β = -0.851) decreased (P < 0.001). The prevalence of CRKP rose over time (β = 0.522, P = 0.001) and correlated positively with the consumption of fluoroquinolones, levofloxacin, penicillin/β-lactamase inhibitor, piperacillin/tazobactam, meropenem, and doripenem (P < 0.05). The prevalence of CRKP and CREC both correlated negatively with consumption of aminoglycosides (P < 0.01). The prevalence of CRKP in our hospital increased as the forecast predicted based on an autoregressive integrated moving average model. This study provides alarming messages for members participating in antimicrobial stewardship programs, including the increasing prevalence of CRKP, the increasing consumption of broad-spectrum antibiotics, and the positive correlation between them.
COVID-19-associated mold infection (CAMI) is defined as development of mold infections in COVID-19 patients. Co-pathogenesis of viral and fungal infections include the disruption of tissue barrier ...following SARS CoV-2 infection with the damage in the alveolar space, respiratory epithelium and endothelium injury and overwhelming inflammation and immune dysregulation during severe COVID-19. Other predisposing risk factors permissive to fungal infections during COVID-19 include the administration of immune modulators such as corticosteroids and IL-6 antagonist. COVID-19-associated pulmonary aspergillosis (CAPA) and COVID-19-associated mucormycosis (CAM) is increasingly reported during the COVID-19 pandemic. CAPA usually developed within the first month of COVID infection, and CAM frequently arose 10–15 days post diagnosis of COVID-19. Diagnosis is challenging and often indistinguishable during the cytokine storm in COVID-19, and several diagnostic criteria have been proposed. Development of CAPA and CAM is associated with a high mortality despiteappropriate anti-mold therapy. Both isavuconazole and amphotericin B can be used for treatment of CAPA and CAM; voriconazole is the primary agent for CAPA and posaconazole is an alternative for CAM. Aggressive surgery is recommended for CAM to improve patient survival. A high index of suspicion and timely and appropriate treatment is crucial to improve patient outcome.
This study explores the emergence and productivity of word order usage in Mandarin-speaking typically-developing (TD) children and children with autism spectrum disorder (ASD), and examines how this ...emergence relates to frequency of use in caregiver input. Forty-two caregiver-child dyads participated in video-recorded 30-min semi-structured play sessions. Eleven children with ASD were matched with 10 20-month-old TD children and another 11 children with ASD were matched with 10 26-month-old TD children, on expressive language. We report four major findings: (1) Preschool Mandarin-speaking children with ASD produced word order structures with pervasive ellipsis at similar rates to language-matched TD children, but also displayed differences from TD children in their usage of SVt and VtO frames; (2) Grammatical productivity was observed in both TD children and children with ASD; moreover, children with ASD with higher expressive language produced less stereotyped language; (3) Both TD children and children with ASD heard a range of word orders in their caregivers' input, with TD children's input greater in amount and complexity; however, caregivers of both groups also showed no age/language-related changes in word order usage; (4) Few word-order-specific correlations emerged between caregivers and their children; however, strong correlations were observed for mean length of utterances (MLU) for both groups: Caregivers who produced longer/more complex utterances had children who did the same. Taken together, it seems that despite their pragmatic deficits, the early grammatical knowledge of word order in Mandarin-exposed children with ASD is well preserved and in general follows the typical developmental pattern. Moreover, caregiver input is broadly rather than finely tuned to the linguistic development of TD children and children with ASD, and plays a more important role in children's general syntactic development than in specific word order acquisition. Thus, early word order usage in preschool Mandarin-speaking TD children and children with ASD may be influenced by both caregiver input and child abilities.
Non-institutionalised older adults is the majority of older adults in Hong Kong. The study aimed to examine erosive tooth wear (ETW) and its association with dental conditions and oral hygiene habits ...among non-institutionalised older adults in Hong Kong.
This cross-sectional study recruited dentate adults aged 60 or above from nine elderly daycare centres in the five main districts of Hong Kong. The study consists of a questionnaire survey and a clinical examination. A researcher used a questionnaire to collected the participants' demographic information, oral hygiene habits such as toothbrushing habits and dental visit behaviour. A calibrated examiner performed an oral examination in the daycare elderly centre to assess the ETW using basic erosive wear (BEWE) criteria. Oral hygiene was recorded using visible plaque index. Prosthetic status was recorded using the World Health Organization criteria. Logistic regression was used to examine the correlation between ETW and the dental conditions and oral hygiene habits.
This study recruited 433 dentate adults and 333 adults were female (77%). Their age ranged from 60 to 99 years and their mean age was 74 years (SD = 7). They all had ETW (BEWE > 0). Over half of them (57%) had BEWE score of 3, indicating severe ETW. Analysis showed increasing age (OR = 1.030, p = 0.029) and older adults with untreated dental caries had higher odds (OR = 1.822, p = 0.002) of presenting severe ETW. No other associations were found between the ETW and the factors studied.
Hong Kong non-institutionalised older adults aged 60 or above had ETW and more than half of them had severe ETW. Increasing age and having untreated dental caries were associated with severe ETW.
Abstract Background /Purpose : The purpose of this study is to investigate the predominant clones of carbapenem-resistant Acinetobacter baumannii (CRAB) in our hospital in Taiwan by pulsed-field gel ...electrophoresis (PFGE) and multilocus sequence typing (MLST) technique. Methods We collected 108 non-duplicate A. baumannii clinical blood isolates from January 2012 to December 2013 in MacKay Memorial Hospital. PFGE and MLST were used for typing the A. baumannii isolates and for investigation of the predominant clones. Bacteria isolates were screened by polymerase chain reaction for the presence of the carbapenemase-encoding genes. Results All 108 isolates were classified as 33 pulsotypes by PFGE. The predominant clones were pulsotype 10 (12.04%) in 2012 and pulsotype 8 (16.67%) in 2013, respectively. The 31 predominant pulsotype isolates were typed by MLST, and ST787 (54.84%) and ST455 (45.16%) were identified. All isolates carried blaOXA-51-like genes, and blaOXA-23-like genes was founded in 101 isolates (93.52%). Other identified resistance genes included blaOXA-24-like and blaOXA-IMP. Conclusion To the best of our knowledge, this study is the first to describe the microbiological characteristics of CRAB ST787, which carried high genetic resistance to carbapenem, but remained susceptible to colistin. CRAB ST787 was the predominant clone in our hospital in the study period.
Background/Purpose Influenza infection has different clinical presentations and outcomes in children and adults, and bacterial coinfection is associated with significantly higher morbidity and ...mortality. This study compared the clinical features in children and adults hospitalized for influenza virus infection and the role of concomitant bacteremia. Methods A retrospective observational cohort study was conducted by a review of medical records of all consecutive patients admitted for influenza infection between April 1, 2009 and February 28, 2011. Results Of the 1203 patients, 76.2% were children, and ranged in age from 1 month to 99 years, with a mortality of 3.1% for adults; no children died. Pneumonia, acute respiratory distress syndrome, acute respiratory failure, septic shock, and cardiovascular complications were more common in adults. Bacteremia was more common in adults than in children (3.5% vs. 0.4%). C-reactive protein (CRP) > 4 mg/dL and a longer hospital stay occurred more often in children with bacteremia than in the group without bacteremia. In adults with bacteremia, acute respiratory failure, septic shock, and cardiovascular complications were more common, with a mortality of 50% versus 1.4% compared with those without bacteremia, and thrombocytopenia and increased CRP were independent risk factors. Using receiver operating characteristic analysis, CRP ≥ 14 mg/dL had a sensitivity of 90.0% and a specificity of 80.0%. Conclusion Influenza infection in adults is associated with increased risk of complications, bacteremia, and mortality compared with that in children. Bacteremia in adults with influenza is associated with increased complications and mortality; thrombocytopenia and elevated CRP levels could identify those at risk.
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