Impact of time to appropriate therapy on mortality in patients with vancomycin-intermediate Staphylococcus aureus infection

Despite the increasing incidence of vancomycin-intermediate Staphylococcus aureus (VISA) infections, few studies have examined the impact of delay in receipt of appropriate antimicrobial therapy on outcomes in VISA patients. We examined the effects of timing of appropriate antimicrobial therapy in a cohort of patients with sterile-site methicillin-resistant S. aureus (MRSA) and VISA infections. In this single-center, retrospective cohort study, we identified all patients with MRSA or VISA sterile-site infections from June 2009 to February 2015. Clinical outcomes were compared according to MRSA/VISA classification, demographics, comorbidities, and antimicrobial treatment. Thirty-day all-cause mortality was modeled with Kaplan-Meier curves. Multivariate logistic regression analysis (MVLRA) was used to determine odds ratios for mortality. We identified 354 patients with MRSA (n = 267) or VISA (n = 87) sterile-site infection. Fifty-five patients (15.5%) were nonsurvivors. Factors associated with mortality in MVLRA included pneumonia, unknown source of infection, acute physiology and chronic health evaluation (APACHE) II score, solid-organ malignancy, and admission from skilled care facilities. Time to appropriate antimicrobial therapy was not significantly associated with outcome. Presence of a VISA infection compared to that of a non-VISA S. aureus infection did not result in excess mortality. Linezolid use was a risk for mortality in patients with APACHE II scores of ≥14. Our results suggest that empirical vancomycin use in patients with VISA infections does not result in excess mortality. Future studies should (i) include larger numbers of patients with VISA infections to confirm the findings presented here and (ii) determine the optimal antibiotic therapy for critically ill patients with MRSA and VISA infections

The Development of a Myoelectric Training Tool for Above-Elbow Amputees

The objective of above-elbow myoelectric prostheses is to reestablish the functionality of missing limbs and increase the quality of life of amputees. By using electromyography (EMG) electrodes attached to the surface of the skin, amputees are able to control motors in myoelectric prostheses by voluntarily contracting the muscles of their residual limb. This work describes the development of an inexpensive myoelectric training tool (MTT) designed to help upper limb amputees learn how to use myoelectric technology in advance of receiving their actual myoelectric prosthesis. The training tool consists of a physical and simulated robotic arm, signal acquisition hardware, controller software, and a graphical user interface. The MTT improves over earlier training systems by allowing a targeted muscle reinnervation (TMR) patient to control up to two degrees of freedom simultaneously. The training tool has also been designed to function as a research prototype for novel myoelectric controllers. A preliminary experiment was performed in order to evaluate the effectiveness of the MTT as a learning tool and to identify any issues with the system. Five able-bodied participants performed a motor-learning task using the EMG controlled robotic arm with the goal of moving five balls from one box to another as quickly as possible. The results indicate that the subjects improved their skill in myoelectric control over the course of the trials. A usability survey was administered to the subjects after their trials. Results from the survey showed that the shoulder degree of freedom was the most difficult to control

Evaluation of Diagnosis Techniques Used for Spinal Injury Related Back Pain

Back pain is a prevalent condition affecting much of the population at one time or the other. Complications, including neurological ones, can result from missed or mismanaged spinal abnormalities. These complications often result in serious patient injury and require more medical treatment. Correct diagnosis enables more effective, often less costly treatment methods. Current diagnosis technologies focus on spinal alterations. Only approximately 10% of back pain is diagnosable, with current diagnostic technologies. The objective of this paper is to investigate and evaluate based on specific criteria current diagnosis technique. Nine diagnostic techniques were found in the literature, namely, discography, myelography, single photon emission computer tomography (SPECT), computer tomography (CT), combined CT & SPECT, magnetic resonance imaging (MRI), upright and kinematic MRI, plain radiography and cineradiography. Upon review of the techniques, it is suggested that improvements can be made to all the existing techniques for diagnosing back pain. This review will aid health service developers to focus on insufficient areas, which will help to improve existing technologies or even develop alternative ones

Orthodontic Bracket Manufacturing Tolerances and Dimensional Differences between Select Self-Ligating Brackets

In all manufacturing processes there are tolerances; however, orthodontic bracket manufacturers seldom state the slot dimensional tolerances. This experiment develops a novel method of analyzing slot profile dimensions using photographs of the slot. Five points are selected along each wall, and lines are fitted to define a trapezoidal slot shape. This investigation measures slot height at the slot's top and bottom, angles between walls, slot taper, and the linearity of each wall. Slot dimensions for 30 upper right central incisor self-ligating stainless steel brackets from three manufacturers were evaluated. Speed brackets have a slot height 2% smaller than the nominal 0.559 mm size and have a slightly convergent taper. In-Ovation brackets have a divergent taper at an average angle of 1.47 degrees. In-Ovation is closest to the nominal value of slot height at the slot base and has the smallest manufacturing tolerances. Damon Q brackets are the most rectangular in shape, with nearly 90-degree corners between the slot bottom and walls. Damon slot height is on average 3% oversized

Inhibition of inducible nitric oxide synthase limits nitric oxide production and experimental aneurysm expansion

AbstractPurpose: Nitric oxide (NO), frequently cited for its protective role, can also generate toxic metabolites known to degrade elastin. Both abdominal aortic aneurysms (AAAs) and inducible nitric oxide synthase (iNOS) are associated with inflammatory states, yet the relationship between NO production by iNOS and AAA development is unknown. The current study examines iNOS expression, NO production, and the effects of selective inhibition of iNOS by aminoguanidine in experimental AAA. Methods: An intra-aortic elastase infusion model was used. Control rats received intra-aortic saline infusion and postoperative intraperitoneal saline injections (Group 1). In the remaining groups, intra-aortic elastase infusion was used to induce aneurysm formation. These rats were treated with intraperitoneal injections of saline postoperatively (Group 2), aminoguanidine postoperatively (Group 3), or aminoguanidine preoperatively and postoperatively (Group 4). Aortic diameter and plasma nitrite/nitrate levels were measured on the day of surgery and postoperative day 7. Aortas were harvested for biochemical and histologic analysis on postoperative day 7. Results: Infusion of elastase produced AAAs (P <.001) with significant production of iNOS (P <.05) and nitrite/nitrate (P <.003) compared with controls. Selective inhibition of iNOS with aminoguanidine in elastase-infused aortas significantly reduced aneurysm size (P <.01) compared with elastase infusion alone. Aminoguanidine-treated rats displayed suppression of iNOS expression and plasma nitrite/nitrate production not significantly different from the control group. Histologic evaluation revealed equivalent inflammatory infiltrates in elastase-infused groups. Conclusion: Expression of iNOS is induced and plasma nitrite/nitrate levels are increased in experimental AAA. Inhibition of iNOS limits NO production and iNOS expression, resulting in smaller aneurysm size. NO production by iNOS plays an important role with detrimental effects during experimental aneurysm development. (J Vasc Surg 2001;33:579-86.

De novo meningitis caused by Propionibacterium acnes in a patient with metastatic melanoma

Propionibacterium acnes is a known cause of postneurosurgical meningitis; however, it is rarely implicated in de novo meningitis. Herein we report a case of a 49-year-old male with de novo meningitis caused by P. acnes with metastatic melanoma as the only identified risk factor for his infection

Antibiotic prophylaxis is associated with subsequent resistant infections in children with an initial extended-spectrum-cephalosporin-resistant Enterobacteriaceae infection

ABSTRACT The objective of this study was to assess the association between previous antibiotic use, particularly long-term prophylaxis, and the occurrence of subsequent resistant infections in children with index infections due to extended-spectrum-cephalosporin-resistant Enterobacteriaceae . We also investigated the concordance of the index and subsequent isolates. Extended-spectrum-cephalosporin-resistant Escherichia coli and Klebsiella spp. isolated from normally sterile sites of patients aged &lt;22 years were collected along with associated clinical data from four freestanding pediatric centers. Subsequent isolates were categorized as concordant if the species, resistance determinants, and fumC-fimH ( E. coli ) or tonB ( Klebsiella pneumoniae ) type were identical to those of the index isolate. In total, 323 patients had 396 resistant isolates; 45 (14%) patients had ≥1 subsequent resistant infection, totaling 73 subsequent resistant isolates. The median time between the index and first subsequent infections was 123 (interquartile range, 43 to 225) days. In multivariable Cox proportional hazards analyses, patients were 2.07 times as likely to have a subsequent resistant infection (95% confidence interval, 1.11 to 3.87) if they received prophylaxis in the 30 days prior to the index infection. In 26 (58%) patients, all subsequent isolates were concordant with their index isolate, and 7 (16%) additional patients had at least 1 concordant subsequent isolate. In 12 of 17 (71%) patients with E. coli sequence type 131 (ST131)-associated type 40-30, all subsequent isolates were concordant. Subsequent extended-spectrum-cephalosporin-resistant infections are relatively frequent and are most commonly due to bacterial strains concordant with the index isolate. Further study is needed to assess the role prophylaxis plays in these resistant infections. </jats:p

The G11.11-0.12 Infrared-Dark Cloud: Anomalous Dust and a Non-Magnetic Isothermal Model

The G11.11-0.12 Infrared-Dark Cloud has a filamentary appearance, both in absorption against the diffuse 8micron Galactic background, and in emission from cold dust at 850micron. Detailed comparison of the dust properties at these two wavelengths reveals that standard models for the diffuse interstellar dust in the Galaxy are not consistent with the observations. The ratio of absorption coefficients within the cloud is kappa_8/kappa_850 <= 1010, which is well below that expected for the diffuse ISM where kappa_8/kappa_850 ~ 1700. This may be due to the formation of ice mantles on the dust and grain coagulation, both of which are expected within dense regions of molecular clouds. The 850micron emission probes the underlying radial structure of the filament. The profile is well represented by a marginally resolved central region and a steeply falling envelope, with Sigma(r) proportional to r^(-a), where a <= 3, indicating that G11.11-0.12 is the first observed filament with a profile similar to that of a non-magnetic isothermal cylinder.Comment: 13 pages, 4 figures, accepted for publication by ApJ Letter

Photometry using the Infrared Array Camera on the Spitzer Space Telescope

We present several corrections for point source photometry to be applied to data from the Infrared Array Camera (IRAC) on the Spitzer Space Telescope. These corrections are necessary because of characteristics of the IRAC arrays and optics and the way the instrument is calibrated in-flight. When these corrections are applied, it is possible to achieve a ~2% relative photometric accuracy for sources of adequate signal to noise in an IRAC image.Comment: 16 pages, 13 figures. Accepted for publication in the Publications of the Astronomical Society of the Pacifi