Burden and risk factors for Pseudomonas aeruginosa community-acquired pneumonia:a Multinational Point Prevalence Study of Hospitalised Patients

Pseudornonas aeruginosa is a challenging bacterium to treat due to its intrinsic resistance to the antibiotics used most frequently in patients with community-acquired pneumonia (CAP). Data about the global burden and risk factors associated with P. aeruginosa-CAP are limited. We assessed the multinational burden and specific risk factors associated with P. aeruginosa-CAP. We enrolled 3193 patients in 54 countries with confirmed diagnosis of CAP who underwent microbiological testing at admission. Prevalence was calculated according to the identification of P. aeruginosa. Logistic regression analysis was used to identify risk factors for antibiotic-susceptible and antibiotic-resistant P. aeruginosa-CAP. The prevalence of P. aeruginosa and antibiotic-resistant P. aeruginosa-CAP was 4.2% and 2.0%, respectively. The rate of P. aeruginosa CAP in patients with prior infection/colonisation due to P. aeruginosa and at least one of the three independently associated chronic lung diseases (i.e. tracheostomy, bronchiectasis and/or very severe chronic obstructive pulmonary disease) was 67%. In contrast, the rate of P. aeruginosa-CAP was 2% in patients without prior P. aeruginosa infection/colonisation and none of the selected chronic lung diseases. The multinational prevalence of P. aeruginosa-CAP is low. The risk factors identified in this study may guide healthcare professionals in deciding empirical antibiotic coverage for CAP patients

Exploring Collaborative Work for the Creation of Interdisciplinary Units Centered on Intercultural Citizenship.

In this work we report on a collaborative project at a large Northeastern University, in which we explored how to best collaborate to develop interdisciplinary teaching units, which integrate intercultural citizenship (Byram, 2008) into world languages, mathematics and social studies sixth grade curricula. We argue for the importance of addressing current critical areas in education. After introducing a framework that allows teachers to focus on the development of intercultural citizenship while at the same time fostering skills in the diverse content areas, we report on how we worked with a group of graduate students, teachers and administrators in order to co-design interdisciplinary units focused on intercultural citizenship. An example of such an interdisciplinary unit is provided along with lessons learned about how we can facilitate this type of interdisciplinary collaboration. Our recommendations are based on qualitative analyses of the notes, memos and observations documented by the authors. Specifically, we share four emergent themes that illustrate how this group of educators successfully collaborated in this project: (1) Respecting disciplinary identities and boundaries, (2) Extending the understanding beyond the disciplines, (3) Ensuring a collaborative learning environment, and (4) Offering opportunities to continue the work beyond the course

The phonological development of a trilingual child: facts and factors

This article investigates the early phonological development of a trilingual child who is acquiring Spanish, Mandarin and Taiwanese simultaneously. By examining the natural speech data recorded between the age of 1; 3 and 2; 0, the article reports the age of emergence and stabilization of the vowels and consonants, speech accuracy and phonological error patterns in each language. The data show that by the age of two the child is able to produce most of the vowels in the three languages. However, there are cross-linguistic differences in the rate of acquisition of consonants and speech accuracy: the child's Spanish consonant inventory develops faster than the other two languages, while the child has statistically significantly higher speech accuracy in Taiwanese than in Spanish, which is in turn higher than that in Mandarin. There is also evidence of interaction or interference between the languages, e. g. the existence of unusual error patterns. These facts are interpreted in the context of phonological saliency of the three phonological systems and language input

Impact of phenylephrine administration on cerebral tissue oxygen saturation and blood volume is modulated by carbon dioxide in anaesthetized patients †

BACKGROUND: Multiple studies have shown that cerebral tissue oxygen saturation ([Image: see text]) is decreased after phenylephrine treatment. We hypothesized that the negative impact of phenylephrine administration on [Image: see text] is affected by arterial blood carbon dioxide partial pressure ([Image: see text]) because CO(2) is a powerful modulator of cerebrovascular tone. METHODS: In 14 anaesthetized healthy patients, i.v. phenylephrine bolus was administered to increase the mean arterial pressure ∼20–30% during hypocapnia, normocapnia, and hypercapnia. [Image: see text] and cerebral blood volume (CBV) were measured using frequency domain near-infrared spectroscopy, a quantitative technology. Data collection occurred before and after each treatment. RESULTS: Phenylephrine caused a significant decrease in [Image: see text] during hypocapnia [[Image: see text]=−3.4 (1.5)%, P<0.001], normocapnia [[Image: see text]=−2.4 (1.5)%, P<0.001], and hypercapnia [[Image: see text]=−1.4 (1.5)%, P<0.01]. Decreases in [Image: see text] were significantly different between hypocapnia, normocapnia, and hypercapnia (P<0.001). Phenylephrine also caused a significant decrease in CBV during hypocapnia (P<0.01), but not during normocapnia or hypercapnia. CONCLUSION: The negative impact of phenylephrine treatment on [Image: see text] and CBV is intensified during hypocapnia while blunted during hypercapnia

Effect of phenylephrine and ephedrine bolus treatment on cerebral oxygenation in anaesthetized patients

BACKGROUND: How phenylephrine and ephedrine treatments affect global and regional haemodynamics is of major clinical relevance. Cerebral tissue oxygen saturation ([Image: see text])-guided management may improve postoperative outcome. The physiological variables responsible for [Image: see text] changes induced by phenylephrine and ephedrine bolus treatment in anaesthetized patients need to be defined. METHODS: A randomized two-treatment cross-over trial was conducted: one bolus dose of phenylephrine (100–200 µg) and one bolus dose of ephedrine (5–20 mg) were given to 29 ASA I–III patients anaesthetized with propofol and remifentanil. [Image: see text], mean arterial pressure (MAP), cardiac output (CO), and other physiological variables were recorded before and after treatments. The associations of changes were analysed using linear-mixed models. RESULTS: The CO decreased significantly after phenylephrine treatment [▵CO=−2.1 (1.4) litre min(−1), P<0.001], but was preserved after ephedrine treatment [▵CO=0.5 (1.4) litre min(−1), P>0.05]. The [Image: see text] was significantly decreased after phenylephrine treatment [▵[Image: see text]=−3.2 (3.0)%, P<0.01] but preserved after ephedrine treatment [▵[Image: see text]=0.04 (1.9)%, P>0.05]. CO was identified to have the most significant association with [Image: see text] (P<0.001). After taking CO into consideration, the other physiological variables, including MAP, were not significantly associated with [Image: see text] (P>0.05). CONCLUSIONS: Associated with changes in CO, [Image: see text] decreased after phenylephrine treatment, but remained unchanged after ephedrine treatment. The significant correlation between CO and [Image: see text] implies a cause–effect relationship between global and regional haemodynamics

Polysomnographic diagnosis of REM sleep behavior disorder:a change is needed

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