Daptomycin for methicillin-resistant Staphylococcus epidermidis native-valve endocarditis: a case report

Coagulase-negative staphylococci (CoNS) have been increasing in importance as a cause of native valve endocarditis (NVE). Most cases of NVE caused by CoNS are attributable to Staphylococcus epidermidis. NVE caused by CoNS acquired in a nosocomial setting may differ from cases acquired in the community in several ways. It may be associated with hemodialysis, the presence of a long-term indwelling central catheter or pacemaker, or a recent invasive procedure; nosocomial cases may have a higher rate of methicillin resistance among CoNS isolates, and so be more likely to be treated with vancomycin. Unfortunately, NVE caused by methicillin-resistant CoNS has been associated with significantly higher rates of persistent bacteremia and in-hospital mortality than methicillin-susceptible isolates. The poor outcomes in these cases point to the need for alternative therapies with potent activity against methicillin-resistant CoNS. In our medical center, a 76-year-old man presented with native-valve endocarditis and positive blood cultures for methicillin-resistant Staphylococcus epidermidis (MRSE). During each of three 6-week courses of treatment with vancomycin, blood cultures were negative, but they once again became positive for MRSE when vancomycin was discontinued. The minimum inhibitory concentration of the MRSE isolates for vancomycin remained stable at 2 μg/mL. Eventually, treatment with daptomycin was initiated (500 mg [7 mg/kg]) 3 times/week for 6 weeks. Over the following year, no positive cultures for MRSE were detected

Lived Experience of Caregivers of Relatives with Alcohol and Opiate Dependence (A phenomenological study)

Substance abuse is a relapsing chronic illness. In 2014, an estimated 27 million persons reported using illicit drugs in the United States (SAMHSA, 2014). Substance abuse negatively impacts societies, productivity, healthcare costs and families. Families play an important role in relapse prevention and sobriety. With adequate family support, substance abuse positively responds to treatment. Many individuals (about 66 million Americans) play the role as an informal caregiver for a relative with chronic illnesses such as substance abuse but few studies exist on the caregiving experiences. What we know about the family caregiving experience is restricted to data from quantitative studies which do not explain the complexities and competing challenges that exist. Different approaches are thereby needed to deepen our understanding of the family caregiver burden of living with a relative with substance abuse problems. Such studies will enable us to understand the original experience and moment of learning of a relative’s substance abuse problems, decision making and support that follows thereafter. This moment calls for major decision making and encounter with treatment services. The purpose of this study was to explore the lived experience of caregivers of relatives with alcohol and opiate dependence. This study utilized Max van Manen’s (2014) Phenomenology of Practice. Ten participants (N=10) were recruited for this study. Van Manen’s guided existential inquiry was used in the analysis of experiential material collected through interviews. Four main themes emerged from the data: (1) Being in the moment: the extension of the self; (2) The dawn of reality: the being of acceptance; (3) Deciding in the moment: the healthcare experience; (4) Uncertainties and struggle: a lifelong process. These themes described how the participants: experienced, accepted and processed a relative’s substance abuse problem, encountered treatment services and experienced the uncertainties and struggles involved in caring for a relative with substance abuse problems. Two main findings emerged from these themes; the impact of guilt and stigma on seeking care and the need to see addiction as a disease instead of as a moral character failure. This calls for coalitions with stakeholders to decrease stigma, enhance acceptance process and increase access to treatment

P-36 The Delta-Crossing Number for Links

An m-component link is an embedding of m circles into 3-dimensional space; a 1-component link is called a knot. The diagram for a link may be drawn so that all crossings occur within delta tangles, collections of three crossings as appear in a delta move. The delta crossing number is defined to be the minimal number of delta tangles in such a diagram. The delta crossing number has been well-studied for knots but not for links with multiple components. Using bounds we determine the delta crossing number for several 2-component links with up to 8 crossings as well as for Tait\u27s infinite family of 3-component links with unknotted components. Moreover, we prove that the difference between the delta crossing number and the delta unlinking number can be arbitrarily large

SISTEM INFORMASI ESTIMASI BIAYA DAN PENGECEKAN STATUS PENGECATAN MOBIL PADA BENGKEL RAHMAT JAYA MOTOR

Bengkel Rahmat Jaya Motor merupakan bengkel pengecatan yang melayani perbaikanbody mobil. Untuk mendapatkan informasi status pengecatan mobil dan estimasi biaya, pelanggan biasanya datang langsung ke bengkel atau menghubungi melalui telepon yang terbatas hanya pada jam kerja dan selain hari libur bengkel. Pembuatan sistem informasi berbasis web akan membantu bengkel Rahmat Jaya Motor dalam menyediakan informasi estimasi biaya dan status pengecatan secara online. Perancangan sistem membahas mengenai konsep dari sistem yang akan dibuat untuk memenuhi kebutuhan kepada userdan memberikan gambaran secara umum kepada usertentang sistem yang baru. Sistem informasi estimasi biaya dan pengecekan status pengecatan mobil dapat digunakan oleh admin, manajer, dan pelanggan. Pada halaman admin dapat menjalankan sistem informasi untuk melakukan pengolahan data estimasi dan data servis mobil. Pada halaman manajer dapat menjalankan sistem informasi untuk melakukan pencetakan data servis mobil. Pada halaman pelanggan dapat menjalankan sistem informasi untuk melakukan tanya jawab seputar perbaikan bodydan pengecatan mobil. Berdasarkan implementasi yang dilakukan maka dapat disimpulkan bahwa sistem informasi estimasi biaya dan pengecekan status pengecatan mobil berfungsi sebagai media promosi dan publikasi yang dapat menyediakan informasi secara online mengenai estimasi biaya dan status pengecatan mobil juga pelanggan dapat mengetahui perkiraan biaya pengecatan mobil secara online, sehingga dapat membantu pelanggan dalam merencanakan anggaran untuk perbaikan body dan pengecatan mobil

Scottish Mission factor in the development of the Presbyterian Church of Ghana: 1917-1957

Though it was political reasons that caused the First World War its consequences were felt not only in the political realm but in the religious also. The political intrigues and the acrimony that culminated in the war generated intense enmity between Britain and her allies on the one hand and Germany on the other. In the process the Basel Mission was forced out of Ghana by the British on suspicion that the Mission, which had strong German connection, had sympathies for Germany. It was this action taken by the British that necessitated the recruitment of another missionary body to oversee the work that had been done by the Basel Mission and the choice fell on the United Free Church of Scotland which was represented in Ghana by what came to be known as the Scottish Mission. The appearance of the United Free Church of Scotland on the religious scene of Ghana therefore is a classic example of how international politics and war affected and shaped world missionary outreach programme in the early 20th century.The United Free Church accepted the challenge in spite of extreme financial and logistical problems face by the church at this time because it felt that the opportunity to come to Ghana was created by Providence. From 1917 till 1950 when the church became fully autonomous therefore the United Free Church and its subsidiary body the Scottish Mission worked to preserve the gains of the Basel Mission and developed new structures and institutions to extend the influence of the Presbyterian Church of Ghana and to make it an indigenous church. Though the Basel Mission was allowed to return to Ghana at the end of 1925, it was the Scottish Mission that continued to set the agenda for the church.Unlike the work of the United Free Church of Scotland in Jamaica, Calabar or Malawi the work in Ghana was not originally planned within the scope of its world evangelistic xi outreach. It was accidental and this had some influence on the Scottish Mission's approach to their work in Ghana.This thesis examines the circumstances surrounding the coming of the United Free Church of Scotland to Ghana in the Scottish Mission and more importantly the role it played in the building and development of the Presbyterian Church of Ghana

Remote sensing of energy and water fluxes over Volta Savannah catchments in West Africa

The deterioration of the West African savannah in the last three decades is believed to be closely linked with about 0.5 C rise in temperature leading to evaporation losses and declining levels of the Volta Lake in Ghana. Although hydrological models can be used to predict climate change impacts on the regional hydrology, spatially-observed ground data needed for this purpose are largely unavailable. This thesis seeks to address this problem by developing improved methods for estimating energy and water fluxes (e.g. latent heat [ET]) from remotely sensed data and to demonstrate how these may be used to parameterize hydrological models. The first part of the thesis examines the potential of the Penman-Monteith method to estimate local-scale ET using groundbased hydrometeorological observations, vegetation coefficients and environmental data. The model results were compared with pan observations, scintillometer (eddy correlation) measurements and the Thomthwaite empirical method. The Penman- Monteith model produced better evaporation estimates (~3.90 mm day(^-1) for the Tamale district) than its counterpart methods. The Thomthwaite, for example, overestimated predictions by 5.0-11.0 mm day(^-1). Up-scaling on a monthly time scale and parameterization of the Grindley soil moisture balance model with the Thomthwaite and Penman-Monteith data, however, produced similar estimates of actual evaporation and soil moisture, which correlated strongly (R(^2) = 0.95) with water balance estimates. To improve ET estimation at the regional-scale, the second part of the thesis develops spatial models through energy balance modelling and data up-scaling methods, driven by radiometric measurements from recent satellite sensors such as the Landsat ETM+, MODIS and ENVISAT-AATSR. The results were validated using estimates from the Penman-Monteith method, field observations, detailed satellite measurements and published data. It was realised that the MODIS sensor is a more useful source of energy and water balance parameters than AA TSR. For example, stronger correlations were found between MODIS estimates of ET and other energy balance variables such as NDVI, surface temperature and net radiation (R(^2) = 0.67-0.73) compared with AATSR estimates (R(^2) = 0.31-0.40). There was also a good spatial correlation between MODIS and Landsat ETM+ results (R(^2) = 0.71), but poor correlations were found between AATSR and Landsat data (R(^2) = 0.0-0.13), which may be explained by differences in instrument calibration. The results further showed that ET may be underestimated with deviations of ~2.0 mm day 1 when MODIS/AATSR measurements are validated against point observations because of spatial mismatch. The final part of the thesis demonstrates the application of the ET model for predicting runoff (Q) using a simplified version of the regional water balance equation. This is followed byanalysis of flow sensitivity to declining scenarios of biomass volume. The results showed the absence of Q for >90% of the study area during the dry season due largely to crude model approximation and lack of rainfall data, which makes model testing during the wet season important. Runoff prediction may be improved if spatial estimates of rainfall, ET and geographical data (e.g. land-use/cover maps, soil & geology maps and DEM) could be routinely derived from satellite imagery

Visible Light-assisted Deconstruction/Refunctionalization of Strained and Unstrained N-Cycloalkylanilines

The exploitation of ring strain as a driving force to facilitate chemical reactions is a well-appreciated principle in organic chemistry. Of the strained carbocycles frequently explored in this respect, cyclopropane ring systems have drawn considerably more interest among synthetic chemists than their homolog, the cyclobutane ring systems, even though the strain energy of cyclobutane (26.7 kcal/mol) is similar to that of cyclopropane (27.5 kcal/mol). We have previously developed a [4+2] annulation reaction for the synthesis of aniline-substituted six-membered carbocycles under photoredox catalysis via the oxidative cleavage of N-cyclobutylanilines. The key reaction involved in this method is a ring-opening process of cyclobutylanilines via single-electron oxidation of the anilines under visible light photoredox conditions to presumably generate distonic radical cation intermediates which possess bimodal reactivity due to the presence of a nucleophilic carbon radical moiety (site Y) and an electrophilic iminium ion moiety (site X) that are spatially separated. We have hitherto successfully achieved orthogonal 1,4-difunctionalization of the two reactive sites by using phenyl allyl sulfone or α-CF3-styrene as radical acceptor to capture the radical at Y and TMSCN as nucleophile to intercept the iminium ion at X respectively. The first of the three works described in this dissertation further exploits isocyanides (or isonitriles)—“stereoelectronic chameleons” that exhibit dichotomous reactivity—as radical acceptors in the difunctionalization of the bimodal amine distonic radical cations to afford both symmetrical and unsymmetrical N-substituted 2,6-diaminopimelonitriles in poor to good yields. This represents the first-ever report of a successful synthetic methodology that exploits the ambivalent reactivities of both distonic radical cations and isocyanides.Again, we report the development of a novel methodology for the synthesis of aminoalkynes from various N-substituted cyclobutane substrates via a sequential visible-light-assisted ring-opening and distal alkynylation with alkynyl hypervalent iodine (III) reagents. An in situ-generated distonic radical cation intermediate possessing resonance-stabilized iminium ion site mediates the transformation of the substrates into various pharmaceutically important nitrogen heterocycles. This methodology constitutes only the second example of aminoalkyne synthesis employing the cycloalkylamine deconstruction/refunctionalization strategy. Finally, we report the first-ever aromatization-promoted, visible-light-assisted deconstructive functionalization of unstrained medium-to-large-sized cycloalkanones using diamines as an activator of the ring cleavage for the synthesis of remotely functionalized quinazolinones. The protocol features an amido radical-mediated C(sp3)-C(sp3) cleavage via an aromatization/radical acceptor-driven ring-opening synergy, without the involvement of transition metals, exogenous oxidants, or chelation assistance. In addition, the reaction exhibits a broad substrate scope, good to excellent product yields, and high regioselectivities