Chapter 9 Moral Responsibility and the Justification of Policies to Preserve Antimicrobial Effectiveness

Restrictive policies that limit antimicrobial consumption, including therapeutically justified use, might be necessary to tackle the problem of antimicrobial resistance. We argue that such policies would be ethically justified when forgoing antimicrobials constitutes a form of easy rescue for an individual. These are cases of mild and self-limiting infections in otherwise healthy patients whose overall health is not significantly compromised by the infection. In such cases, restrictive policies would be ethically justified because they would coerce individuals into fulfilling a moral obligation they independently have. However, to ensure that such justification is the strongest possible, states also have the responsibility to ensure that forgoing antimicrobials is as easy as possible for patients by implementing adequate compensation measures

Comparing the Functional Independence Measure and the interRAI/MDS for use in the functional assessment of older adults: a review of the literature

<p>Abstract</p> <p>Background</p> <p>The rehabilitation of older persons is often complicated by increased frailty and medical complexity - these in turn present challenges for the development of health information systems. Objective investigation and comparison of the effectiveness of geriatric rehabilitation services requires information systems that are comprehensive, reliable, valid, and sensitive to clinically relevant changes in older persons. The Functional Independence Measure is widely used in rehabilitation settings - in Canada this is used as the central component of the National Rehabilitation Reporting System of the Canadian Institute of Health Information. An alternative system has been developed by the interRAI consortium. We conducted a literature review to compare the development and measurement properties of these two systems.</p> <p>Methods</p> <p>English language literature published between 1983 (initial development of the FIM) and 2008 was searched using Medline and CINAHL databases, and the reference lists of retrieved articles. Relevant articles were summarized and charted using the criteria proposed by Streiner. Additionally, attention was paid to the ability of the two systems to address issues particularly relevant to older rehabilitation clients, such as medical complexity, comorbidity, and responsiveness to small but clinically meaningful improvements.</p> <p>Results</p> <p>In total, 66 articles were found that met the inclusion criteria. The majority of FIM articles studied inpatient rehabilitation settings; while the majority of interRAI/MDS articles focused on nursing home settings. There is evidence supporting the reliability of both instruments. There were few articles that investigated the construct validity of the interRAI/MDS.</p> <p>Conclusion</p> <p><b>A</b>dditional psychometric research is needed on both the FIM and MDS, especially with regard to their use in different settings and with different client groups.</p

delta C-13 and delta N-15 variations in organic matter pools, Mytilus spp. and Macoma balthica along the European Atlantic coast

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Treatment of subcutaneous phaeohyphomycosis and prospective follow-up of 17 kidney transplant recipients

Background: Subcutaneous phaeohyphomycosis in solid organ recipients may have an adverse outcome.Objective. We sought to describe the disease course, treatment, and outcome of allograft function in kidney transplant recipients with phaeohyphomycosis.Methods: Seventeen patients were followed for a mean period of 25.4 months to analyze the clinical response to treatment.Results: There was no treatment failure or relapsing disease among 12 patients who completed treatment. Two patients were still in treatment with disease remission. One patient discontinued the study during treatment with partial remission, one died after finishing treatment with disease remission, and one was dropped from the study because contact was lost. Immunosuppresive regimens were not changed. Two of 17 patients had a significant reduction in allograft function.Limitations: the follow-up time was short and the number of patients was small.Conclusions. the outcome of phaeohyphomycosis in kidney transplant recipients was favorable with minimal impact on renal allograft function. (J Am Acad Dermatol 2009;61:977-85.)Universidade Federal de São Paulo, Dept Dermatol, São Paulo, BrazilUniversidade Federal de São Paulo, Dept Med, Div Nephrol, São Paulo, BrazilUniversidade Federal de São Paulo, Dept Med, Div Infect Dis, São Paulo, BrazilUniversidade Federal de São Paulo, Div Cellular Biol, São Paulo, BrazilUniversidade Federal de São Paulo, Dept Dermatol, São Paulo, BrazilUniversidade Federal de São Paulo, Dept Med, Div Nephrol, São Paulo, BrazilUniversidade Federal de São Paulo, Dept Med, Div Infect Dis, São Paulo, BrazilUniversidade Federal de São Paulo, Div Cellular Biol, São Paulo, BrazilWeb of Scienc

On the Response of pH to Inorganic Nutrient Enrichment in Well-Mixed Coastal Marine Waters

Recent concerns about declining pH in the surface ocean in response to anthropogenic increases of carbon dioxide (CO2) in the atmosphere have raised the question of how this declining baseline of oceanic pH might interact with the much larger diel and seasonal variations of pH in coastal marine ecosystems. Nutrient enrichment, which can amplify both production and respiration, has the potential to reduce or exacerbate the impacts of ocean acidification in coastal waters. Here, we present results from a multi-year experiment in which replicate phytoplankton-based mesocosms with a 5-m deep well-mixed water column (salinity = 27–31) and intact benthic community were exposed to a gradient in daily inorganic nitrogen (N), phosphorous (P), and silica (Si) addition. We show that the response of water column pH to nutrient enrichment was the greatest during the autotrophic winter-spring period, and there was no significant decline in pH across treatments during the heterotrophic summer-fall period. We believe that the differences in response lie in the seasonal cycles of production and respiration, where spring production peaks are large and discrete, and respiration is more temperature-driven but occurs diffusely throughout the year. The observed basification associated with enhanced nutrient inputs may have consequences for phytoplankton community structure, some species of submersed aquatic vegetation, cycling of Si, and perhaps other ecological processes