A Case of Complicated Urinary Tract Infection: Klebsiella pneumoniae Emphysematous Cystitis Presenting as Abdominal Pain in the Emergency Department

This case report describes an atypical presentation of an atypical disease entity: Emphysematous Cystitis, a rapidly progressive, ascending urinary tract infection, in an emergency department (ED) patient whose chief complaint was abdominal pain and who had a urinalysis not consistent with the diagnosis of cystitis

Necrotizing Fasciitis of the Paraspinous Muscles

Necrotizing fasciitis (NF) is a rare and lethal soft tissue infection that requires urgent surgical intervention. It is most often found in the extremities occurring with precipitating trauma or in immunocompromised states. Signs and symptoms are often vague or missing making early diagnosis very difficult. Our patient presented with flank pain and altered mental status but no known precipitating factors. Computed Tomography showed gas within and around the right paraspinous muscle suspicious for NF. Given NF’s high lethality, early suspicion by emergency physicians of NF in patients with soft tissue infections or with systemic findings of unknown etiology is necessary

Development of GIS- and GPS-Based Intelligent Network-Level Road Maintenance and Rehabilitation System

A user-friendly road maintenance and rehabilitation (M&R) system has been developed to find cost effective strategies for maintaining road networks in a serviceable condition. Pavement condition data and spatial road network data were collected using a GPS palmtop, segregated and arranged spatially on a GIS platform. The M&R toolbox, developed in GIS software TransCAD macros (computer program), performs various modules which provide prioritization of maintenance of each link in the network using a priority index approach, suitable rehabilitation strategies, link-wise budget requirements, effect of available budget on vehicle operating cost and road roughness. Furthermore, additional lane requirements based on volume and capacity ratio and its design were also considered. The developed M&R system was implemented for a small part of road network in Mumbai (Bombay) metropolitan area in India. It was identified that the enhanced M&R system, developed in this study, is effective in day-to-day road maintenance and helpful in the decision making process for planning and scheduling of road M&R work

Ferron as an Analytical Reagent for Extractive Separation of Molybdenum

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Enhanced Translation of a Chloroplast-Expressed RbcS Gene Restores Small Subunit Levels and Photosynthesis in Nuclear RbcS Antisense Plants

Ribulose-1,5-bisphosphate carboxylase/oxygenase (Rubisco) is a key enzyme that converts atmospheric carbon to food and supports life on this planet. Its low catalytic activity and specificity for oxygen leads to photorespiration, severely limiting photosynthesis and crop productivity. Consequently, Rubisco is a primary target for genetic engineering. Separate localization of the genes in the nuclear and chloroplast genomes and a complex assembly process resulting in a very low catalytic activity of hybrid Rubisco enzymes have rendered several earlier attempts of Rubisco engineering unsuccessful. Here we demonstrate that the RbcS gene, when integrated at a transcriptionally active spacer region of the chloroplast genome, in a nuclear RbcS antisense line and expressed under the regulation of heterologous (gene 10) or native (psbA) UTRs, results in the assembly of a functional holoenzyme and normal plant growth under ambient CO2 conditions, fully shortcircuiting nuclear control of gene regulation. There was ≈150-fold more RbcS transcript in chloroplast transgenic lines when compared with the nuclear RbcS antisense line, whereas the wild type has 7-fold more transcript. The small subunit protein levels in the gene 10/RbcS and psbA/RbcS plants were 60% and 106%, respectively, of the wild type. Photosynthesis of gene 10/RbcS plants was approximately double that of the antisense plants, whereas that of psbA/RbcS plants was restored almost completely to the wild-type rates. These results have opened an avenue for using chloroplast engineering for the evaluation of foreign Rubisco genes in planta that eventually can result in achieving efficient photosynthesis and increased crop productivity

What stage are low-income and middle-income countries (LMICs) at with patient safety curriculum implementation and what are the barriers to implementation? A two-stage cross-sectional study.

OBJECTIVES: The improvement of safety in healthcare worldwide depends in part on the knowledge, skills and attitudes of staff providing care. Greater patient safety content in health professional education and training programmes has been advocated internationally. While WHO Patient Safety Curriculum Guides (for Medical Schools and Multi-Professional Curricula) have been widely disseminated in low-income and middle-income countries (LMICs) over the last several years, little is known about patient safety curriculum implementation beyond high-income countries. The present study examines patient safety curriculum implementation in LMICs. METHODS: Two cross-sectional surveys were carried out. First, 88 technical officers in Ministries of Health and WHO country offices were surveyed to identify the pattern of patient safety curricula at country level. A second survey followed that gathered information from 71 people in a position to provide institution-level perspectives on patient safety curriculum implementation. RESULTS: The majority, 69% (30/44), of the countries were either considering whether to implement a patient safety curriculum or actively planning, rather than actually implementing, or embedding one. Most organisations recognised the need for patient safety education and training and felt a safety curriculum was compatible with the values of their organisation; however, important faculty-level barriers to patient safety curriculum implementation were identified. Key structural markers, such as dedicated financial resources and relevant assessment tools to evaluate trainees' patient safety knowledge and skills, were in place in fewer than half of organisations studied. CONCLUSIONS: Greater attention to patient safety curriculum implementation is needed. The barriers to patient safety curriculum implementation we identified in LMICs are not unique to these regions. We propose a framework to act as a global standard for patient safety curriculum implementation. Educating leaders through the system in order to embed patient safety culture in education and clinical settings is a critical first step

An Inverse Method for Policy-Iteration Based Algorithms

We present an extension of two policy-iteration based algorithms on weighted graphs (viz., Markov Decision Problems and Max-Plus Algebras). This extension allows us to solve the following inverse problem: considering the weights of the graph to be unknown constants or parameters, we suppose that a reference instantiation of those weights is given, and we aim at computing a constraint on the parameters under which an optimal policy for the reference instantiation is still optimal. The original algorithm is thus guaranteed to behave well around the reference instantiation, which provides us with some criteria of robustness. We present an application of both methods to simple examples. A prototype implementation has been done