Optimal management of urinary tract infections in older people

Urinary tract infections (UTI) occur frequently in older people. Unfortunately, UTI is commonly overdiagnosed and overtreated on the basis of nonspecific clinical signs and symptoms. The diagnosis of a UTI in the older patient requires the presence of new urinary symptoms, with or without systemic symptoms. Urinalysis is commonly used to diagnose infection in this population, however, the evidence for its use is limited. There is overwhelming evidence that asymptomatic bacteriuria should not be treated. Catheter associated urinary tract infection accounts for a significant amount of hospital-associated infection. Indwelling urinary catheters should be avoided where possible and alternatives sought. The use of narrow spectrum antimicrobial agents for urinary tract infection is advocated. Local guidelines are now widely used to reflect local resistance patterns and available agents. Guidelines need to be updated to reflect changes in antimicrobial prescribing and a move from broad to narrow spectrum antimicrobials

Genetic islands of Streptococcus agalactiae strains NEM316 and 2603VR and their presence in other Group B Streptococcal strains

BACKGROUND: Streptococcus agalactiae (Group B Streptococcus; GBS) is a major contributor to obstetric and neonatal bacterial sepsis. Serotype III strains cause the majority of late-onset sepsis and meningitis in babies, and thus appear to have an enhanced invasive capacity compared with the other serotypes that cause disease predominantly in immunocompromised pregnant women. We compared the serotype III and V whole genome sequences, strains NEM316 and 2603VR respectively, in an attempt to identify genetic attributes of strain NEM316 that might explain the propensity of strain NEM316 to cause late-onset disease in babies. Fourteen putative pathogenicity islands were described in the strain NEM316 whole genome sequence. Using PCR- and targeted microarray- strategies, the presence of these islands were assessed in a diverse strain collection including 18 colonizing isolates from healthy pregnant women, and 13 and 8 invasive isolates from infants with early- and late-onset sepsis, respectively. RESULTS: Side-by-side comparison of the strain NEM316 and strain 2603VR genomes revealed that they are extremely similar, with the only major difference being the capsulation loci and mobile genetic elements. PCR and Comparative Genome Hybridization (CGH) were used to define the presence of each island in 39 GBS isolates. Only islands I, VI, XII, and possibly X, met criteria of a true pathogenicity island, but no significant correlation was found between the presence of any of the fourteen islands and whether the strains were invasive or colonizing. Possible associations were seen between the presence of island VI and late-onset sepsis, and island X and early-onset sepsis, which warrant further investigation. CONCLUSION: The NEM316 and 2603VR strains are remarkable in that their whole genome sequences are so similar, suggesting that the capsulation loci or other genetic differences, such as pathogenicity islands, are the main determinants of the propensity of serotype III strains to cause late-onset disease. This study supports the notion that GBS strain NEM316 has four putative pathogenicity islands, but none is absolutely necessary for disease causation, whether early- or late-onset sepsis. Mobile genetic elements are a common feature of GBS isolates, with each strain having its own peculiar burden of transposons, phages, integrases and integrated plasmids. The majority of these are unlikely to influence the disease capacity of an isolate. Serotype associated disease phenotypes may thus be solely related to differences in the capsulation loci

SOCIAL CAPITAL AND HOUSEHOLD INCOME DISTRIBUTIONS: EVIDENCE FROM MICHIGAN AND ILLINOIS

Social capital is a resource increasingly recognized as having important economic and social consequences. Robison and Siles (1999) examined some of these consequences at the U.S. state level and this study extends their efforts. Their 1999 study found important connections between the distributions of social capital and the distributions of household incomes. This study asks if the relationships between social capital and household incomes discovered at the state level are also present at the community level.Consumer/Household Economics, Institutional and Behavioral Economics,

Space Climate Manifestation in Earth Prices - from Medieval England Up to Modern Usa

In this study we continue to search for possible manifestations of space weather influence on prices of agricultural products and consumables. We note that the connection between solar activity and prices is based on the causal chain that includes several nonlinear transition elements. These non-linear elements are characterized by threshold sensitivity to external parameters and lead to very inhomogeneous local sensitivity of the price to space weather conditions. It is noted that "soft type" models are the most adequate for description of this class of connections. Two main observational effects suitable for testing causal connections of this type of sensitivity are considered: burst-like price reactions on changes in solar activity and price asymmetry for selected phases of the sunspot cycle. The connection, discovered earlier for wheat prices of Medieval England, is examined in this work on the basis of another 700-year data set of consumable prices in England. Using the same technique as in the previous part of our work (Pistilnik and Yom Din 2004) we show that statistical parameters of the interval distributions for price bursts of consumables basket and for sunspot minimum states are similar one to another, like it was reported earlier for wheat price bursts. Possible sources of these consistencies between three different multiyear samples are discussed. For search of possible manifestations of the "space weather - wheat market" connection in modern time, we analyze dynamics of wheat prices in the USA in the twentieth century. We show that the wheat prices revealed a maximum/minimum price asymmetry consistent with the phases of the sunspot cycle. We discuss possible explanations of this observed asymmetry, unexpected under conditions of globalization of the modern wheat market.Comment: First International Symposium on Space Climate: Direct and Indirect Observations of Long-Term Solar Activity, 20-23 June 2004, Oulu, Finlan

Can aquaculture benefit the extreme poor? A case study of landless and socially marginalized Adivasi (ethnic) communities in Bangladesh

AbstractThe Adivasi Fisheries Project, aimed at diversifying livelihood options for resource-poor Adivasi (ethnic) communities in the North and Northwest of Bangladesh, was implemented during 2007–9. Aquaculture and related technologies were introduced to a total of 3594 resource-poor Adivasi households. Baseline and end-line surveys were applied to assess the changes in their livelihoods following intervention. Household incomes of project participants rose significantly (p≤0.01), which was attributed to the increased share of aquaculture and related enterprises from 15% in 2007 to nearly 30% in 2009 in terms of annual household incomes. By contrast, the contribution of aquaculture to household incomes remained virtually unchanged (p>0.05) among non-project participants. The monthly frequency of fish, meat and egg consumption increased between 2007 and 2009 (p≤0.01), confirming improved food and nutrition security among project participants. Although non-project participants also slightly increased their fish consumption, it remained significantly lower (p≤0.01) than that of the project participants. The results from the present study contradict the prevailing view that aquaculture is inappropriate for landless, socially marginalized and extremely poor communities by demonstrating its relevance to improving livelihoods, provided that a diversified approach is followed and interventions are tailored to needs and capabilities of target households

Cryogenic and room temperature strength of sapphire jointed by hydroxide-catalysis bonding

Hydroxide-catalysis bonding is a precision technique used for jointing components in opto-mechanical systems and has been implemented in the construction of quasi-monolithic silica suspensions in gravitational wave detectors. Future detectors are likely to operate at cryogenic temperatures which will lead to a change in test mass and suspension material. One candidate material is mono-crystalline sapphire. Here results are presented showing the influence of various bonding solutions on the strength of the hydroxide-catalysis bonds formed between sapphire samples, measured both at room temperature and at 77 K, and it is demonstrated that sodium silicate solution is the most promising in terms of strength, producing bonds with a mean strength of 63 MPa. In addition the results show that the strengths of bonds were undiminished when tested at cryogenic temperatures

The Anatomy of the Infrarenal Lumbar Splanchnic Nerves in Human Cadavers: implications for retroperitoneal nerve-sparing surgery

Injury to the nerves of the aortic- and superior hypogastric plexuses during retroperitoneal surgery often results in significant post-operative complications, including retrograde ejaculation and/or loss of seminal emission in males. Although previous characterizations of these plexuses have done well to provide a basis for understanding the typical anatomy, additional research into the common variations of these plexuses could further optimize nerve-sparing techniques for retroperitoneal surgery. To achieve this, the present study aimed to document the prevalence and positional variability of the infrarenal lumbar splanchnic nerves (LSNs) through gross dissection of 26 human cadavers. In almost all cases, two LSNs were observed joining each side of the aortic plexus, with 48% (left) and 33% (right) of specimens also exhibiting a third joining inferior to the left renal vein. As expected, the position of the LSNs varied greatly between specimens. That said, the vast majority (98%) of LSNs joining the aortic plexus were found to originate from the lumbar sympathetic trunk above the level of the inferior mesenteric artery. It was also found that, within specimens, adjacent LSNs often coursed in parallel. In addition to these nerves, 85% of specimens also demonstrated retroaortic LSN(s) that were angled more inferior compared with the other LSNs (P \u3c 0.05), and exhibited a unique course between the aorta/common iliac arteries and the left common iliac vein before joining the superior hypogastric plexus below the aortic bifurcation. These findings may have significant implications for surgeons attempting nerve-sparing procedures of the sympathetic nerves in the infrarenal retroperitoneum such as retroperitoneal lymphadenectomies. We anticipate that the collective findings of the current study will help improve such retroperitoneal nerve-sparing surgical procedures, which may assist in preserving male ejaculatory function post-operatively

PROCESS VALIDATION IN CALCULATING MEDIAN PROXIMITY IN TIBIOFEMORAL CARTILAGE DEFORMATION UNDER FULL BODY LOADING

INTRODUCTION Knee osteoarthritis (OA) is characterized by progressive and irreversible degradation of tibiofemoral (TF) cartilages. Anterior cruciate ligament (ACL) rupture is a known risk factor for post-traumatic OA (PTOA) [1]. However, there are currently no in-vivo tests to diagnose pre-radiographic PTOA. Following injury, the cartilage macromolecular matrix weakens, cartilage swells and consequently cartilage softness increases [2]. This research investigates the in-vivo effects of ACL injury on cartilage deformation magnitude and rate under full body loading. The objective of this project was to determine the consequences of cartilage model mesh types and incremental mesh simplifications on the accuracy of resultant TF cartilage proximities. METHODS The affected knee of a 37 year old male PTOA subject (ACL deficient for 6 years) was imaged using Magnetic Resonance Imaging (FIESTA sequence; 3T GE Discovery 750). 3D TF bone and cartilage models were generated in Amira (VSG, Germany). The subject performed a 10 minute standing task in the Dual Fluoroscopic (DF) laboratory. DF images (32LP/mm) were collected at 6Hz. Bone alignments were reconstructed from DF images using AutoScoper (Brown University, USA) and cartilage models were co-registered. TF cartilage surface proximity was determined as the surface normal distance from each triangular mesh face onto the opposing cartilage. (Matlab, v2014b, The MathWorks, USA). The effects on surface proximities of three types of triangular cartilage surface meshes, generated in Amira, were analysed: 1) Basic Simplification - reducing face numbers with variable mesh size; 2) Remeshed Surface – isotropic mesh; 3) Iteratively Smoothed Remeshed Surface. Face numbers were reduced at 10% increments from the original surface for each surface type. RESULTS Median proximity errors for the Remeshed Surface were consistently smaller than the other mesh types across all four cartilage surface compartments. The medial tibial plateau displayed a rapid increase in error (Figure 1) indicating a high sensitivity to model simplification. This may have been due to its more complex surface geometry. The maximum acceptable error was chosen to match the minimum detectable displacement of 0.05mm for this DF system [3]. DISCUSSION AND CONCLUSIONS The findings of this investigation identified differences in the error of cartilage surface proximities under loading due to the use of different mesh types and simplifications. The smoothing technique used by Amira did not consistently converge to a surface and the variable triangle size in Basic Simplification affected the computation of proximity, resulting in unpredictable error spikes in cartilage surface proximity calculations. The results suggest that surface modeling parameters are surface geometry specific. The limiting case of the medial tibial plateau showed the optimal simplification was 0.594mm triangle mesh side length (40% of the original faces). These results inform ongoing work toward an in-vivo pre-radiographic diagnostic of PTOA