Mortality Following Clostridioides difficile Infection in Europe : A Retrospective Multicenter Case-Control Study

We aimed to describe the clinical presentation, treatment, outcome and report on factors associated with mortality over a 90-day period in Clostridioides difficile infection (CDI). Descriptive, univariate, and multivariate regression analyses were performed on data collected in a retrospective case-control study conducted in nine hospitals from seven European countries. A total of 624 patients were included, of which 415 were deceased (cases) and 209 were still alive 90 days after a CDI diagnosis (controls). The most common antibiotics used previously in both groups were β-lactams; previous exposure to fluoroquinolones was significantly (p = 0.0004) greater in deceased patients. Multivariate logistic regression showed that the factors independently related with death during CDI were older age, inadequate CDI therapy, cachexia, malignancy, Charlson Index, long-term care, elevated white blood cell count (WBC), C-reactive protein (CRP), bacteraemia, complications, and cognitive impairment. In addition, older age, higher levels of WBC, neutrophil, CRP or creatinine, the presence of malignancy, cognitive impairment, and complications were strongly correlated with shortening the time from CDI diagnosis to death. CDI prevention should be primarily focused on hospitalised elderly people receiving antibiotics. WBC, neutrophil count, CRP, creatinine, albumin and lactate levels should be tested in every hospitalised patient treated for CDI to assess the risk of a fatal outcome

Unique Role of Vimentin Networks in Compression Stiffening of Cells and Protection of Nuclei from Compressive Stress

In this work, we investigate whether stiffening in compression is a feature of single cells and whether the intracellular polymer networks that comprise the cytoskeleton (all of which stiffen with increasing shear strain) stiffen or soften when subjected to compressive strains. We find that individual cells, such as fibroblasts, stiffen at physiologically relevant compressive strains, but genetic ablation of vimentin diminishes this effect. Further, we show that unlike networks of purified F-actin or microtubules, which soften in compression, vimentin intermediate filament networks stiffen in both compression and extension, and we present a theoretical model to explain this response based on the flexibility of vimentin filaments and their surface charge, which resists volume changes of the network under compression. These results provide a new framework by which to understand the mechanical responses of cells and point to a central role of intermediate filaments in response to compression

Healthcare-associated pneumonia in acute care hospitals in European union/European economic area countries: an analysis of data from a point prevalence survey, 2011 to 2012

An aim of the ECDC point prevalence survey (PPS) in European Union/European Economic Area acute care hospitals was to acquire standardised healthcare-associated infections (HAI) data. We analysed one of the most common HAIs in the ECDC PPS, healthcare-associated pneumonia (HAP). Standardised HAI case definitions were provided and countries were advised to recruit nationally representative subsets of hospitals. We calculated 95% confidence intervals (CIs) around prevalence estimates and adjusted for clustering at hospital level. Of 231,459 patients in the survey, 2,902 (1.3%; 95% CI: 1.2–1.3) fulfilled the case definition for a HAP. HAPs were most frequent in intensive care units (8.1%; 95% CI: 7.4–8.9) and among patients intubated on the day of the survey (15%; 95% CI: 14–17; n = 737 with HAP). The most frequently reported microorganism was Pseudomonas aeruginosa (17% of 1,403 isolates), followed by Staphylococcus aureus (12%) and Klebsiella spp. (12%). Antimicrobial resistance was common among isolated microorganisms. The most frequently prescribed antimicrobial group was penicillins, including combinations with beta-lactamase inhibitors. HAPs occur regularly among intubated and non-intubated patients, with marked differences between medical specialities. HAPs remain a priority for preventive interventions, including surveillance. Our data provide a reference for future prevalence of HAPs at various settings

Organization and training at national level of antimicrobial stewardship and infection control activities in Europe: an ESCMID cross-sectional survey

Antimicrobial stewardship (AMS) and Infection prevention and control (IPC) are two key complementary strategies that combat development and spread of antimicrobial resistance. The ESGAP (ESCMID Study Group for AMS), EUCIC (European Committee on Infection Control) and TAE (Trainee Association of ESCMID) investigated how AMS and IPC activities and training are organized, if present, at national level in Europe. From February 2018 to May 2018, an internet-based cross-sectional survey was conducted through a 36-item questionnaire, involving up to three selected respondents per country, from 38 European countries in total (including Israel), belonging to the ESGAP/EUCIC/TAE networks. All 38 countries participated with at least one respondent, and a total of 81 respondents. Education and involvement in AMS programmes were mandatory during the postgraduate training of clinical microbiology and infectious diseases specialists in up to one-third of countries. IPC was acknowledged as a specialty in 32% of countries. Only 32% of countries had both guidance and national requirements regarding AMS programmes, in contrast to 61% for IPC. Formal national staffing standards for AMS and IPC hospital-based activities were present in 24% and 63% of countries, respectively. The backgrounds of professionals responsible for AMS and IPC programmes varied tremendously between countries. The organization and training of AMS and IPC in Europe are heterogeneous and national requirements for activities are frequently lacking

Application of multi-valued weighting logical functions in the analysis of a degree of importance of construction parameters on the example of hydraulic valves

In the optimization process, changes in the construction parameters value influence the behaviour of functions depending on time. Weighting logical coefficients for the stabilisation time are taken into consideration here, i.e., a shorter (better) stabilisation time has a more important (bigger) value of the weighting coefficient. An example of applying weighting logical functions in the analysis of a degree of importance of construction parameters of a hydraulic valve is presented in the paper

Optimization of machine systems including a complex coefficient of complexity for multi-valued decision trees

Skierowany graf zależności przepływu informacji opisuje powiązania wielkości wejściowych, wyjściowych oraz zmiennych decyzyjnych w analizowanym układzie maszynowym. Przetłumaczenie skierowanego grafu zależności na strukturę rozgrywającą parametrycznie, pozwala na określenie obszaru rozwiązań dopuszczalnych i wybór procedury optymalizacyjnej. Struktura drzewiasta, o najmniejszej wartości kompleksowego współczynnika posiada najmniejszy stopień złożoności decyzyjnej. Możliwe jest zastosowanie kompleksowego współczynnika złożoności dla wielowartościowych drzew decyzyjnych w opisie strukturalnych procesów optymalizacji układów maszynowych, według zagadnień minimalizacji funkcji logicznych.Different graph solutions mean connections between input and output data as well as decision variables of the analyzed system (eg in the machine system). The graph distribution from any vertex in the first stage leads to a tree structure with cycles, and next to a general tree game structure. Algorithmic way to create graphical structures out of a mathematical model describes the optimization method of systematic exploration. Tree structure, with the lowest values of complexity level is the simplest structure. It is possible to apply a complex coefficient of complexity for multi valued decision trees in the description of the processes of structural optimization of the machine according to the issues of minimizing logic functions

Game-tree structures with the complex complexity level as a tool in knowledge engineering

The paper concerns application of the dependence graphs and game- tree structures with the complex complexity level as a tool in knowledge engineering. Different graph solutions mean connections between input and output data as well as decision variables of the analyzed system. The graph distribution from any vertex in the first stage leads to a tree structure with cycles, and next to a general tree game structure. Game-tree structures from each node have different shape and properties. Algorithmic way to create graphical structures out of a mathematical model describes the optimization method of systematic exploration. Tree structure, with the lowest values of complexity level is the simplest structure

Application of Multi-Valued Weighting Logical Functions in the Analysis of a Degree of Importance of Construction Parameters on the Example of Hydraulic Valves

In the optimization process, changes in the construction parameters value influence the behaviour of functions depending on time. Weighting logical coefficients for the stabilisation time are taken into consideration here, i.e., a shorter (better) stabilisation time has a more important (bigger) value of the weighting coefficient. An example of applying weighting logical functions in the analysis of a degree of importance of construction parameters of a hydraulic valve is presented in the pape