Diagnostic Stewardship: A Clinical Decision Rule for Blood Cultures in Community-Onset Methicillin-Resistant Staphylococcus aureus (MRSA) Skin and Soft Tissue Infections

INTRODUCTION: The emergence, spread and persistence of methicillin-resistant Staphylococcus aureus (MRSA) as a causative pathogen in community-onset (CO) skin and soft tissue infections (SSTIs) have resulted in substantial changes in the management of these infections. The indications for obtaining blood cultures in patients with CO-MRSA SSTIs remain poorly defined. The objectives of this study were to derive and validate a clinical decision rule that predicts the probability of MRSA bacteremia in CO-MRSA SSTIs and to identify a low-risk population for whom blood cultures may be safely omitted. METHODS: This was a retrospective, case-control study with an internal temporal validation cohort conducted at two large urban academic medical centers. Hospitalized adults with CO-MRSA SSTI between 2010 and 2018 were included. Independent predictors of MRSA bacteremia were identified through multivariable logistic regression. A decision rule was derived using weighted coefficient-based scoring. The decision rule was validated in an internal temporal validation cohort. RESULTS: A total of 307 patients (155 cases and 152 controls) were included in the derivation cohort. A decision rule was created with a major criterion defined as purulent cellulitis and minor criteria defined as abnormal temperature, intravenous drug use, leukocytosis, tachycardia, body mass index \u3c 25 kg/m CONCLUSION: The decision rule developed and validated in this study provides a standardized, evidenced-based approach to determine the need for blood cultures based on bacteremia risk

An integrated neuromechanical model of the mouse to study neural control of locomotion

The 11th International Symposium on Adaptive Motion of Animals and Machines. Kobe University, Japan. 2023-06-06/09. Adaptive Motion of Animals and Machines Organizing Committee.Poster Session P7

Surface Deformation Behavior of BSTOA Ti-6Al-4V during Laser Shock Processing

The surface of a beta solution treated and overaged (BSTOA) Ti-6Al-4V alloy specimen deformed by laser shock processing was studied using electron backscatter diffraction (EBSD), scanning electron microscopy (SEM), and atomic force microscopy (AFM). Slip steps were observed within grains oriented with their c-axis nearly parallel to the specimen surface normal. Based on the slip step traces and orientation information, the slip planes were determined to be (11{bar 2}2) for grains with their c-axis within 15{sup o} of the specimen surface normal and (11{bar 2}1) for grains with their c-axis between 15{sup o} and 40{sup o} away from the specimen surface normal. Although both these planes are known to belong to twinning systems, (11{bar 2}2)<11{bar 2}{bar 3}> and (11{bar 2}1)<11{bar 2}{bar 6}> respectively, the latter has not been observed to operate as a slip system. Examination of the Taylor factors associated with these slip systems shows that the grains with slip steps have the lowest Taylor factors. Determination of localized lattice rotations showed a unique behavior in grains with slip steps, such that all the lattice rotations were concentrated about the steps, with almost no orientation variations in between slip steps. This distribution indicates that stress concentrations exist at the slip steps, which could potentially affect the performance of the material

Prediction of the geomechanical state of the rock mass when mining salt deposits with stowing

The technogenic impact of mining on the environment is analyzed and the transition to geotechnology with stowing to reduce the impact of mining operations is proposed. The results of the research work devoted to the justification of parameters of the development of salt deposits with stowing and the definition of the influence of stowing on the dynamics of deformation of the underworked rock massif are presented. The relevance of research aimed at creating a safe and efficient technology for the transition from systems with natural maintenance of stoping space to systems with stowing has been substantiated.  The results of studies on qualitative and quantitative assessment of the state of the rock massif (by the finite element method using FLAC3D software), worked out by combines, are given and the dynamics of the impact of mining operations on the rock mass and the change in the maximum stresses during the hardening of the stowing in the chambers are revealed. The numerical modeling method is used to analyze the conditions of change in the state of the underworked rock mass, to establish the mechanisms of its deformation at various stages of development. It is recommended to use this approach for geotechnical assessment of the rock mass state in conditions of using development systems of different classes

The study of vancomycin use and its adverse reactions associated to patients of a brazilian university hospital

<p>Abstract</p> <p>Background</p> <p>Vancomycin is an antibiotic of growing importance in the treatment of hospital infections, with particular emphasis on its value in the fight against methicillin-resistant <it>Staphylococcus aureus</it>. However its usage profile must be evaluated to assure maximum benefit and minimum risk.</p> <p>Findings</p> <p>A cross-sectional retrospective study was carried out among inpatients that received vancomycin in a Brazilian quaternary hospital. The occurrence of adverse reactions reported was evaluated in medical records relating to patients taking vancomycin during a one year period. Males comprised 52% (95% CI: 41.7-60.2%) of the sample population, with a mean age of 50.6 (95% CI: 47.2-54.0) years and mean treatment period of 9.7 (95% CI: 8.0-11.5) Days. It was verified that nephrotoxicity occurred in 18.4% (95% CI: 11.3-27.5) of patients, Red man syndrome occurred in 2% (95% CI 0.2-7.2), while the occurrence of thrombocytopenia was 7.1% (95% CI: 2.9-14.2).</p> <p>Conclusions</p> <p>It may be noted that even after 50 years of use, adverse reactions associated with vancomycin continue with high frequency, presenting a public health problem, especially considering its current use in cases of multidrug resistant infections. In this context, we emphasize the importance of intensive pharmacovigilance in hospital as a surveillance tool after drug approval by the sanitary authority.</p

Mechanisms for Tuning Engineered Nanomaterials to Enhance Radiation Therapy of Cancer.

Engineered nanomaterials that produce reactive oxygen species on exposure to X- and gamma-rays used in radiation therapy offer promise of novel cancer treatment strategies. Similar to photodynamic therapy but suitable for large and deep tumors, this new approach where nanomaterials acting as sensitizing agents are combined with clinical radiation can be effective at well-tolerated low radiation doses. Suitably engineered nanomaterials can enhance cancer radiotherapy by increasing the tumor selectivity and decreasing side effects. Additionally, the nanomaterial platform offers therapeutically valuable functionalities, including molecular targeting, drug/gene delivery, and adaptive responses to trigger drug release. The potential of such nanomaterials to be combined with radiotherapy is widely recognized. In order for further breakthroughs to be made, and to facilitate clinical translation, the applicable principles and fundamentals should be articulated. This review focuses on mechanisms underpinning rational nanomaterial design to enhance radiation therapy, the understanding of which will enable novel ways to optimize its therapeutic efficacy. A roadmap for designing nanomaterials with optimized anticancer performance is also shown and the potential clinical significance and future translation are discussed