The Cretan Mesolithic in context: new data from Livari Skiadi (SE Crete)

Investigations at Livari (south-eastern Crete) produced a small Mesolithic chipped stone assemblage, whose techno-typological characteristics situate it within an ‘early Holocene Aegean island lithic tradition’ (9000–7000 cal BC). The material provides antecedent characteristics for the lithics of Crete’s founder Neolithic population at Knossos (c. 7000–6500/6400 cal BC). The idiosyncrasies of the Knossian material can be viewed as a hybrid lithic tradition that emerged from interaction between migrant Anatolian farmers and indigenous hunter-gatherers. Small quantities of Melian obsidian at Livari attest to early Holocene maritime insular networks, knowledge of which likely enabled the first farmers’ successful voyage to Crete.Raziskave na najdišču Livari (na jugovzhodnu Krete) so pokazale navzočnost drobnega mezolitskega kamnitega inventarja, katerega tehnološke in tipološke značilnosti ga postavljajo v okvir ‘zgodnje holocenske egejske tradicije kamnitih artefaktov’ (9000–7000 cal BC). Ta material predstavlja predhodnike tipov kamnitih orodij, ki so značilna za kretsko ustanoviteljsko neolitsko populacijo v Knossosu (ok. 7000–6500/6400 cal BC). Značilnosti materiala iz Knossosa kažejo na hibridne tradicije v tipologiji kamnitih artefaktov, ki so se pojavile kot posledica interakcije med migranti – poljedelci iz Anatolije in domorodnimi lovci in nabiralci. Manjša količina obsidiana iz Melosa na najdišču Livari pa kaže na zgodnje holocensko morsko omrežje, ki je potekalo med otoki, kar je omogočalo prvim poljedelcem, da so pridobili znanje za uspešno plovbo do Krete

Measures of User experience in a Streptococcal pharyngitis and Pneumonia Clinical Decision Support Tools

Objective: To understand clinician adoption of CDS tools as this may provide important insights for the implementation and dissemination of future CDS tools. Materials and Methods: Clinicians (n=168) at a large academic center were randomized into intervention and control arms to assess the impact of strep and pneumonia CDS tools. Intervention arm data were analyzed to examine provider adoption and clinical workflow. Electronic health record data were collected on trigger location, the use of each component and whether an antibiotic, other medication or test was ordered. Frequencies were tabulated and regression analyses were used to determine the association of tool component use and physician orders. Results: The CDS tool was triggered 586 times over the study period. Diagnosis was the most frequent workflow trigger of the CDS tool (57%) as compared to chief complaint (30%) and diagnosis/antibiotic combinations (13%). Conversely, chief complaint was associated with the highest rate (83%) of triggers leading to an initiation of the CDS tool (opening the risk prediction calculator). Similar patterns were noted for initiation of the CDS bundled ordered set and completion of the entire CDS tool pathway. Completion of risk prediction and bundled order set components were associated with lower rates of antibiotic prescribing (OR 0.5; CI 0.2-1.2 and OR 0.5; CI 0.3-0.9, respectively). Discussion: Different CDS trigger points in the clinician user workflow lead to substantial variation in downstream use of the CDS tool components. These variations were important as they were associated with significant differences in antibiotic ordering. Conclusions: These results highlight the importance of workflow integration and flexibility for CDS success

Nutrient intake during pregnancy and adherence to dietary recommendations: The mediterranean phime cohort

Few studies provide a detailed description of dietary habits during pregnancy, despite the central role of nutrition for the health of the mother and offspring. This paper describes the dietary habits, energy and nutrient intake in pregnant women from four countries belonging to the Mediterranean PHIME cohort (Croatia, Greece, Italy and Slovenia) and evaluates their adherence to the European Food Safety Authority (EFSA) recommendations. A total of 1436 women were included in the present analysis. Maternal diet was assessed using a food frequency questionnaire (FFQ). The mean macro and micronutrient intakes were estimated and compared with the dietary reference values (DRVs). The percentage distribution of the 16 food groups in the total intake of each macronutrient was estimated. All women shared a similar diet during pregnancy; almost all the women in the four countries exceeded the DRV for sugars, and the total fat intake was above the DRV in most women in all the countries, as was the contribution of saturated fatty acids (SFAs) to the total energy intake. In all four countries, we observed an increased risk of micronutrient deficiency for iron, folate and vitamin D. Shared guidelines, implemented at both the national and European level, are essential to improve the maternal nutritional status during pregnancy

In vitro antimicrobial effects of aztreonam, colistin, and the 3-drug combination of aztreonam, ceftazidime and amikacin on metallo-β-lactamase-producing Pseudomonas aeruginosa

<p>Abstract</p> <p>Background</p> <p>There are limited choice of antimicrobial agents to treat infection with metallo-<it>β</it>-lactamase-producing <it>Pseudomonas aeruginosa</it>. We evaluate the antimicrobial effects of aztreonam alone, colistin alone and the 3-drug combination of aztreonam, ceftazidime and amikacin on 23 strains of metallo-<it>β</it>-lactamase-producing <it>P. aeruginosa </it>by time-killing tests.</p> <p>Methods</p> <p>Strains used were from different hospitals in Japan and had different pulse-field gel electrophoresis patterns by restriction with <it>Spe</it>I. The minimum inhibitory concentrations of 11 antimicrobial agents (piperacillin, piperacillin/tazobactam, imipenem, meropenem, aztreonam, ceftazidime, amikacin, tobramycin, arbekacin, ciprofloxacin and colistin) were determined using the agar dilution test. The effects of aztreonam, colistin and the combination of aztreonam, ceftazidime and amikacin were determined by time-killing studies.</p> <p>Results</p> <p>Bacteriostatic effects after 6 hours of drug exposure were observed in 12 strains (52.2%) of 23 strains of metallo-<it>β</it>-lactamase-producing <it>P. aeruginosa </it>with 48 mg/l aztreonam, in 19 strains (82.6%) with the 3-drug combination of 16 mg/l aztreonam, 16 mg/l ceftazidime, and 4 mg/l amikacin, and in 23 strains (100%) with 2 mg/l colistin. Bactericidal effects after 6 h drug exposure were observed in 1 strain (4.3%) with 48 mg/l aztreonam, in 8 strains (30.4%) with the 3-drug combination and in all 23 strains (100%) with 2 mg/l colistin.</p> <p>Conclusion</p> <p>Evaluation of <it>in vitro </it>antimicrobial effects on metallo-<it>β</it>-lactamase-producing <it>P. aeruginosa </it>revealed relatively good effects of the 3-drug combination of aztreonam, ceftazidime and amikacin and marked effects of colistin.</p

CTX-M-1 extended-spectrum β-lactamase-producing Proteus mirabilis in Greece

To examine the dissemination of CTX-M-type extended-spectrum β-lactamases (ESBLs) in clinical isolates of Proteus mirabilis, 91 nonrepetitive ESBL-producing P. mirabilis were collected from infected patients in a tertiary Greek hospital during September, 2001, to May, 2004. A bla CTX-M gene was amplified in one isolate (strain A328), but bla CTX-M was not detected in any of the remaining ESBL producers. Sequencing results showed that P. mirabilis A328 produced a CTX-M-1 enzyme while PCR mapping of the genetic element carrying blaCTX-M-1 revealed that the gene was located downstream of an ISEcp1B element. The cefotaxime resistance determinant was easily transferable and carried on a 70-kb plasmid. The emergence of CTX-M-1-producing P. mirabilis indicates the need for early recognition of such strains to be able to control their spread in our hospital and community environment. © Mary Ann Liebert, Inc

A fatal case of Ludwig&apos;s angina and mediastinitis caused by an unusual microorganism, Gemella morbillorum

We present a case of Ludwig&apos;s angina in a 48-y-old immunocompetent male caused by an unusual pathogen, Gemella morbillorum. The infection was complicated with mediastinitis and despite aggressive management of the disease the patient died after 12 d of hospitalization. This is the first reported case of Ludwig&apos;s angina caused by G. morbillorum and emphasizes that the disease remains a potentially lethal infection. © 2005 Taylor &amp; Francis

Outbreak caused by a multidrug-resistant Klebsiella pneumoniae clone carrying blaVIM-12 in a university hospital

From November 2006 to April 2007, nine nonrepetitive isolates of Klebsiella pneumoniae with reduced susceptibility or resistance to carbapenems were recovered from clinical specimens from separate patients hospitalized in a tertiary care hospital. The imipenem-EDTA synergy test was positive for all isolates. PCR, sequencing, and transferability experiments revealed the novel balVIM-12 metallo-β-lactamase gene, which was plasmid mediated and located in a class 1 integron. Pulsed-field gel electrophoresis demonstrated a single macrorestriction pattern, indicating the clonal spread of VIM-12-producing K. pneumoniae. Copyright © 2008, American Society for Microbiology. All Rights Reserved