Opinion statementPurpose of review To provide a review of literature that discusses some of the most successful antimicrobial stewardship interventions reported across institutions worldwide in response to increased c...
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Opinion statementPurpose of review To provide a review of literature that discusses some of the most successful antimicrobial stewardship interventions reported across institutions worldwide in response to increased clostridium difficile infection (cDI) rates. Recent findings Although many different types of antimicrobial reduction practices have been proven effective, differences in resources across varying sizes of institutions may make some interventions more attainable than other. Regardless of available resources, an initial assessment of the correlation of positive laboratory tests to clinical disease is necessary to quantify the true burden of hospital-onset cDIs (HO-cDI). Infection prevention programs, in conjunction with antimicrobial reduction interventions, and the appropriate identification of patients to undergo laboratory testing, are key components of a HO-cDI reduction program. clostridium difficile is an important cause of serious healthcare-associated infections (HAIs), causing adverse consequences for patients including, but not limited to, increased length of hospital stay, healthcare costs, and mortality. Since the early 2000s, there has been a notable increase in cDI. Antimicrobial stewardship programs (ASPs) have responded to this public health threat with a number of different strategies including antimicrobial use reduction, education, appropriate testing, and multiple other interventions. Along with providing a literature review on ASP interventions to address the cDI threat, we describe our experience in successfully reducing HO-cDI at Northwestern Memorial Hospital with the use of multiple interventions.
Road accidents in the world are re-occurring *** accidents are attributed to vehicular brake pad *** safety can be sought through the use of sensors to alert the drivers before the occurrence of any failure due to wor...
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Road accidents in the world are re-occurring *** accidents are attributed to vehicular brake pad *** safety can be sought through the use of sensors to alert the drivers before the occurrence of any failure due to worn-out brake pad;Hence brake pad sensor serves as an effective way to enhance vehicle *** this study,a non-disposable brake pad sensor was designed and fabricated to enable imminent failure alert in order to reduce the risk of road *** research approach involved the development of a software component of the *** software includes a Mikro c Pro(to write the program and compile into machine language)using a *** control aspect of the system(sensor)was developed by using Proteus Design *** designed circuitry was fabricated and tested in simulated *** test results indicated that,during normal operating condition,the tri-colour LED emits green colour signifying that the brake pad is in good condition(the integrity of the sensor connection is maintained)also the amber appearance signifying that the pad should be replaced.
Hepatitis c virus(HcV) is the main cause of chronic liver disease and cirrhosis in Western countries. Over time, the majority of cirrhotic patients develop hepatocellular carcinoma(Hcc), one of the most common fatal c...
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Hepatitis c virus(HcV) is the main cause of chronic liver disease and cirrhosis in Western countries. Over time, the majority of cirrhotic patients develop hepatocellular carcinoma(Hcc), one of the most common fatal cancers worldwide- fourth for incidence rate. A high public health priority need is the development of biomarkers to screen for liver disease progression and for early diagnosis of Hcc development, particularly in the high risk population represented by HcV-positive patients with cirrhosis. Several studies have shown that serological determination of a novel biomarker, squamous cell carcinoma antigen-immunoglobulins M(SccA-Ig M), might be useful to identify patients with progressive liver disease. In the initial part of this review we summarize the main clinical studies that have investigated this new circulating biomarker on HcV-infected patients, providing evidence that in chronic hepatitis c SccA-Ig M may be used to monitor progression of liver disease, and also to assess the virological response to antiviral treatment. In the last part of this review we address other, not less important, clinical applications of this biomarker in hepatology.
Hepatitis c infection and chronic kidney disease are major health burden worldwide. Hepatitis c infection is associated with a wide range of extra-hepatic manifestations in various organs including the kidneys. A stro...
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Hepatitis c infection and chronic kidney disease are major health burden worldwide. Hepatitis c infection is associated with a wide range of extra-hepatic manifestations in various organs including the kidneys. A strong association between hepatitis c and chronickidney disease has come to light. Hemodialysis in supporting the end stage renal disease patients unfortunately carries a risk for hepatitis c infection. Despite much improvement in the care of this group of patients,the prevalence of hepatitis c infection in hemodialysis patients is still higher than the general population. Hepatitis c infection has a negative effect on the survival of hemodialysis and renal transplant patients. Treatment of hepatitis c in end stage renal disease patients using conventional or pegylated interferon with or without ribavirin remains a clinical challenge with low response rate,high dropout rate due to poor tolerability and many unmet needs. The approval of new direct acting antiviral agents for hepatitis c may dramatically change the treatment approach in hepatitis c infected patients with mild to moderate renal impairment. However it remains to be confirmed if the newer Hepatitis c therapies are safe in individuals with severe renal impairment. This review article discusses the relationship between hepatitis c and chronic kidney disease,describe the various types of renal diseases associated with hepatitis c and the newer as well as the existing treatments for hepatitis c in the context of this subpopulation of hepatitis c patients.
Non-organ-specific autoantibodies and thyroid autoantibodies have been frequently found in chroniccarriers of hepatitis c virus(HcV). With respect to endomysial antibodies and tissue transglutaminase, it is controver...
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Non-organ-specific autoantibodies and thyroid autoantibodies have been frequently found in chroniccarriers of hepatitis c virus(HcV). With respect to endomysial antibodies and tissue transglutaminase, it is controversial whether the prevalence of glutenrelated seromarkers is higher in patients with HcV. In such cases, in addition to acknowledging any currently existing autoimmune disease, recognizing the risk of the patient developing an autoimmune disease during interferon(IFN)-based treatment must be a principle concern. From a clinical point-of-view, the presence of autoantibodies arouses suspicion that an autoimmunedisease may be present or may be precipitated by IFNbased HcV treatment. In this paper, we review the prevalence of autoantibodies in individuals with hepatitis c, the clinical significance of these autoantibodies, and the approach recommended for such situations.
In spite of years of intense research, graphene continues to produce surprising results. Recently, it was experimentally observed that under certain conditions graphene can self-drive its tearing and peeling from subs...
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In spite of years of intense research, graphene continues to produce surprising results. Recently, it was experimentally observed that under certain conditions graphene can self-drive its tearing and peeling from substrates. This process can generate long, micrometer sized, folded nanoribbons without the action of any external forces. Also, during this cracking-like propagation process, the width of the graphene folded ribbon continuously decreases and the process only stops when the width reaches about few hundreds nanometers in size. It is believed that interplay between the strain energy of folded regions, breaking of carbon-carbon covalent bonds, and adhesion of graphene-graphene and graphene-substrate are the most fundamental features of this process, although the detailed mechanisms at atomic scale remain unclear. In order to gain further insights on these processes we carried out fully atomistic reactive molecular dynamics simulations using the AIREBO potential as available in the LAMMPS computational package. Although the reported tearing/peeling experimental observations were only to micrometer sized structures, our results showed that they could also occur at nanometer scale. Our preliminary results suggest that the graphene tearing/peeling process originates from thermal energy fluctuations that results in broken bonds, followed by strain release that creates a local elastic wave that can either reinforce the process, similar to a whip cracking propagation, or undermine it by producing carbon dangling bonds that evolve to the formation of bonds between the two layers of graphene. As the process continues in time and the folded graphene decreases in width, the carbon-carbon bonds at the ribbon edge and interlayer bonds get less stressed, thermal fluctuations become unable to break them and the process stops.
In this work, we present the results of investigation of the nanoporous material - carbon fabrics, which is used as electrodes in rechargeable energy storage capacitors (ultracapacitors). The impurity composition in t...
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In this work, we present the results of investigation of the nanoporous material - carbon fabrics, which is used as electrodes in rechargeable energy storage capacitors (ultracapacitors). The impurity composition in the fabrics, the influence of thermal annealing conditions on the impurity concentration is studied. The performed studies resulted in determination of the investigated carbon material structure, determination of impurity composition of carbon material and change of impurity content depending on thermal treatment in vacuum at different temperatures and time intervals. The optimum temperature range for the treatment of carbon fabrics in vacuum that is important for its application in energy storage devices is found.
Hepatitis c virus (HcV) was discovered in 1989, before that it was commonly known as transfusion associated non A non B hepatitis. It rapidly assumed the role of leading cause of cirrhosis and liver cancer and a leadi...
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Hepatitis c virus (HcV) was discovered in 1989, before that it was commonly known as transfusion associated non A non B hepatitis. It rapidly assumed the role of leading cause of cirrhosis and liver cancer and a leading indication for liver transplant globally. For over two decades the treatment was suboptimal with the use of pegylated interferon and ribavirin combination across all genotypes. The vaccine development also failed for over two decades. However a major breakthrough happened in December 2013 when the Food and Drug Administration (FDA) approved the first pan genotypic oral directly acting drug Sofosbuvir. Since then many new directly acing drugs have been approved through fast track by the FDA. Today we have directly acting antiviral agents for all HcV patients providing cure rates of over 90%. Looking into this success the World Health Organization has set targets for 2030 for HcV elimination. There are several countries which have formed strategies to achieve this goal and others are still thinking to develop their own strategies. The availability of generics have reduced the prices substantially, however the problem is so gigantic that unless proper operational strategies for elimination are developed by the developing world especially by china and Pakistan, the two counties having the largest existing pool of HcV patients, the goals of elimination may not come true.
Primary liver cancer represents the 4th most common tumor in males (4% of all cancers) and the 7th most common tumor in females (2.3% of all cancers), with a prevalence of 53/100,000 in males and 22/100,000 in females...
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Primary liver cancer represents the 4th most common tumor in males (4% of all cancers) and the 7th most common tumor in females (2.3% of all cancers), with a prevalence of 53/100,000 in males and 22/100,000 in females (male-to-female ratio = 2:1). In the majority of the cases, hepatocellular carcinoma (Hcc) develops in patients with cirrhosis and thus the risk factors for Hcc and chronic liver disease are overlapping. Viral infections (hepatitis B virus, hepatitis c virus), alcohol and fat (nonalcoholic fatty liver disease/non-alcoholic steatohepatitis) represent the main risk factors for development of Hcc on cirrhotic liver. Several prospective studies reported that at present Hcc does represent the first cause of death of cirrhotic patients, while in the past morbidity and mortality in cirrhosis were mainly determined by other non-neoplasticcomplications of the disease. From a clinical point of view, staging systems in Hcc should define outcome prediction and treatment assignment. Due to the nature of Hcc, the main prognostic variables are the tumor stage, liver function and performance status. The most accepted clinical classification of Hcc has been proposed by the Barcelona clinic Liver cancer. The BcLc staging system has come to be widely accepted in clinical practice and is also being used for many clinical trials of new drugs to treat Hcc. Therefore, it has become thede facto staging system that is used.
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