The Global Alliance for Infections in Surgery : defining a model for antimicrobial stewardship-results from an international cross-sectional survey

Background: Antimicrobial Stewardship Programs (ASPs) have been promoted to optimize antimicrobial usage and patient outcomes, and to reduce the emergence of antimicrobial-resistant organisms. However, the best strategies for an ASP are not definitively established and are likely to vary based on local culture, policy, and routine clinical practice, and probably limited resources in middle-income countries. The aim of this study is to evaluate structures and resources of antimicrobial stewardship teams (ASTs) in surgical departments from different regions of the world. Methods: A cross-sectional web-based survey was conducted in 2016 on 173 physicians who participated in the AGORA (Antimicrobials: A Global Alliance for Optimizing their Rational Use in Intra-Abdominal Infections) project and on 658 international experts in the fields of ASPs, infection control, and infections in surgery. Results: The response rate was 19.4%. One hundred fifty-six (98.7%) participants stated their hospital had a multidisciplinary AST. The median number of physicians working inside the team was five [interquartile range 4-6]. An infectious disease specialist, a microbiologist and an infection control specialist were, respectively, present in 80.1, 76.3, and 67.9% of the ASTs. A surgeon was a component in 59.0% of cases and was significantly more likely to be present in university hospitals (89.5%, p <0.05) compared to community teaching (83.3%) and community hospitals (66.7%). Protocols for pre-operative prophylaxis and for antimicrobial treatment of surgical infections were respectively implemented in 96.2 and 82.3% of the hospitals. The majority of the surgical departments implemented both persuasive and restrictive interventions (72.8%). The most common types of interventions in surgical departments were dissemination of educational materials (62.5%), expert approval (61.0%), audit and feedback (55.1%), educational outreach (53.7%), and compulsory order forms (51.5%). Conclusion: The survey showed a heterogeneous organization of ASPs worldwide, demonstrating the necessity of a multidisciplinary and collaborative approach in the battle against antimicrobial resistance in surgical infections, and the importance of educational efforts towards this goal.Peer reviewe

AI is a viable alternative to high throughput screening: a 318-target study

: High throughput screening (HTS) is routinely used to identify bioactive small molecules. This requires physical compounds, which limits coverage of accessible chemical space. Computational approaches combined with vast on-demand chemical libraries can access far greater chemical space, provided that the predictive accuracy is sufficient to identify useful molecules. Through the largest and most diverse virtual HTS campaign reported to date, comprising 318 individual projects, we demonstrate that our AtomNet® convolutional neural network successfully finds novel hits across every major therapeutic area and protein class. We address historical limitations of computational screening by demonstrating success for target proteins without known binders, high-quality X-ray crystal structures, or manual cherry-picking of compounds. We show that the molecules selected by the AtomNet® model are novel drug-like scaffolds rather than minor modifications to known bioactive compounds. Our empirical results suggest that computational methods can substantially replace HTS as the first step of small-molecule drug discovery

Global age-sex-specific mortality, life expectancy, and population estimates in 204 countries and territories and 811 subnational locations, 1950–2021, and the impact of the COVID-19 pandemic: a comprehensive demographic analysis for the Global Burden of Disease Study 2021

Background: Estimates of demographic metrics are crucial to assess levels and trends of population health outcomes. The profound impact of the COVID-19 pandemic on populations worldwide has underscored the need for timely estimates to understand this unprecedented event within the context of long-term population health trends. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 provides new demographic estimates for 204 countries and territories and 811 additional subnational locations from 1950 to 2021, with a particular emphasis on changes in mortality and life expectancy that occurred during the 2020–21 COVID-19 pandemic period. Methods: 22 223 data sources from vital registration, sample registration, surveys, censuses, and other sources were used to estimate mortality, with a subset of these sources used exclusively to estimate excess mortality due to the COVID-19 pandemic. 2026 data sources were used for population estimation. Additional sources were used to estimate migration; the effects of the HIV epidemic; and demographic discontinuities due to conflicts, famines, natural disasters, and pandemics, which are used as inputs for estimating mortality and population. Spatiotemporal Gaussian process regression (ST-GPR) was used to generate under-5 mortality rates, which synthesised 30 763 location-years of vital registration and sample registration data, 1365 surveys and censuses, and 80 other sources. ST-GPR was also used to estimate adult mortality (between ages 15 and 59 years) based on information from 31 642 location-years of vital registration and sample registration data, 355 surveys and censuses, and 24 other sources. Estimates of child and adult mortality rates were then used to generate life tables with a relational model life table system. For countries with large HIV epidemics, life tables were adjusted using independent estimates of HIV-specific mortality generated via an epidemiological analysis of HIV prevalence surveys, antenatal clinic serosurveillance, and other data sources. Excess mortality due to the COVID-19 pandemic in 2020 and 2021 was determined by subtracting observed all-cause mortality (adjusted for late registration and mortality anomalies) from the mortality expected in the absence of the pandemic. Expected mortality was calculated based on historical trends using an ensemble of models. In location-years where all-cause mortality data were unavailable, we estimated excess mortality rates using a regression model with covariates pertaining to the pandemic. Population size was computed using a Bayesian hierarchical cohort component model. Life expectancy was calculated using age-specific mortality rates and standard demographic methods. Uncertainty intervals (UIs) were calculated for every metric using the 25th and 975th ordered values from a 1000-draw posterior distribution. Findings: Global all-cause mortality followed two distinct patterns over the study period: age-standardised mortality rates declined between 1950 and 2019 (a 62·8% [95% UI 60·5–65·1] decline), and increased during the COVID-19 pandemic period (2020–21; 5·1% [0·9–9·6] increase). In contrast with the overall reverse in mortality trends during the pandemic period, child mortality continued to decline, with 4·66 million (3·98–5·50) global deaths in children younger than 5 years in 2021 compared with 5·21 million (4·50–6·01) in 2019. An estimated 131 million (126–137) people died globally from all causes in 2020 and 2021 combined, of which 15·9 million (14·7–17·2) were due to the COVID-19 pandemic (measured by excess mortality, which includes deaths directly due to SARS-CoV-2 infection and those indirectly due to other social, economic, or behavioural changes associated with the pandemic). Excess mortality rates exceeded 150 deaths per 100 000 population during at least one year of the pandemic in 80 countries and territories, whereas 20 nations had a negative excess mortality rate in 2020 or 2021, indicating that all-cause mortality in these countries was lower during the pandemic than expected based on historical trends. Between 1950 and 2021, global life expectancy at birth increased by 22·7 years (20·8–24·8), from 49·0 years (46·7–51·3) to 71·7 years (70·9–72·5). Global life expectancy at birth declined by 1·6 years (1·0–2·2) between 2019 and 2021, reversing historical trends. An increase in life expectancy was only observed in 32 (15·7%) of 204 countries and territories between 2019 and 2021. The global population reached 7·89 billion (7·67–8·13) people in 2021, by which time 56 of 204 countries and territories had peaked and subsequently populations have declined. The largest proportion of population growth between 2020 and 2021 was in sub-Saharan Africa (39·5% [28·4–52·7]) and south Asia (26·3% [9·0–44·7]). From 2000 to 2021, the ratio of the population aged 65 years and older to the population aged younger than 15 years increased in 188 (92·2%) of 204 nations. Interpretation: Global adult mortality rates markedly increased during the COVID-19 pandemic in 2020 and 2021, reversing past decreasing trends, while child mortality rates continued to decline, albeit more slowly than in earlier years. Although COVID-19 had a substantial impact on many demographic indicators during the first 2 years of the pandemic, overall global health progress over the 72 years evaluated has been profound, with considerable improvements in mortality and life expectancy. Additionally, we observed a deceleration of global population growth since 2017, despite steady or increasing growth in lower-income countries, combined with a continued global shift of population age structures towards older ages. These demographic changes will likely present future challenges to health systems, economies, and societies. The comprehensive demographic estimates reported here will enable researchers, policy makers, health practitioners, and other key stakeholders to better understand and address the profound changes that have occurred in the global health landscape following the first 2 years of the COVID-19 pandemic, and longer-term trends beyond the pandemic

Urethral diverticulum with proximal urethral stricture: An unusual presentation

Urethral diverticulum with distal stricture is a common entity. We are presenting a rare case of urethral diverticulum with proximal stricture. This is an uncommon case of a 55- year-old male paraplegic patient, who had urethrocutaneous fistula with distal urethral diverticulum and proximal urethral stricture. The patient was successfully managed by single-stage diverticulectomy and urethroplasty

Pre-Detection of Kitchen fires due to Auto-ignition of cooking oil and LPG leakage in Indian kitchen

Presence of cooking oils and Liquefied Petroleum Gas (LPG) make it an ideal combination for fire hazard in Indian kitchen. Approximately 16% of domestic fire accidents in India originate from the kitchens. In the present work, a microcontroller based fire detection system is designed to collect data of the parameters (e.g., temperature, concentration of gases) around the Indian kitchen cooking appliances due to oil heating and alert the possible fire event. Experiments were conducted by heating cooking oils typically used in India such as sunflower, soybean, groundnut and mustard oil. The kitchen environment was instrumented to measure temperatures and carbon monoxide concentrations which were collected using a data acquisition system. Based on the observations and analysis of the experimental data, an algorithm was developed to predict potential occurrence of fire. The algorithm includes CO monitoring in the kitchen ventilation (exhaust). The algorithm is incorporated in a microcontroller based fire detection kit to provide a multi- level response to the fire threat. It can, for example, (i) alert the home occupant through an alarm; (ii) send Short Messages (SMS); and (iii) cut off the LPG (fuel) supply to cooktop. The system was also used to monitor LPG concentration (LPG Sensor) and unattended cooking (Presence or absence of human beings using PIR motion sensor) in the kitchen. The developed fire safety system is a modular and low cost kit which is intended to save loss of property and lives due to kitchen fires.by Akshay Jain, Prateek Nyati, Nakul Nuwal, Chinamy Ghoroi and P. D. Gandh

Kitchen Fire Safety System

Fire occurrence in Indian home is well documented. Presence of cooking oils and appliances used for preparing food along with presence of Liquefied Petroleum Gas (LPG) as a source of energy make it ideal combination of fire hazard at kitchen. Statistical data in India show that approximately 16% of fires in Indian home originate in the kitchen. Many of these fires are suspected to be due to distracted or unattended cooking. A research project was designed to collect data on the conditions (e.g., temperature, gases, smoke) around the Indian kitchen cooking appliance while heating the oil using a LPG stove appliance. Experiments were conducted by heating cooking oils typically used in India such as sunflower oil, soybean oil, groundnut oil and mustard oil. The kitchen appliance environment was instrumented to measure temperatures and carbon monoxide concentration. The data generated during experiments were collected using a data acquisition system which collected the oil temperatures, and carbon monoxide (CO) concentration measured in the kitchen ventilation system (chimney). Based on the observations and analysis of the experimental data, a multi-sensor algorithm was developed to predict potential occurrence of fire. The algorithm includes oil temperature and CO measurement in the kitchen ventilation. The algorithm has been incorporated in a microprocessor based fire detector kit to provide a multi-level response to the fire threat. It can, for example, (i) alert the home occupant through an alarm; (ii) send Short Messaging Service (SMS); (iii) call the occupant; and (iv)cut off the LPG (fuel) supply to cooktop.by Prateek Nyati, Akshay Jain, Nakul Nuwal, and Chinmay Ghoro

UL – IIT Gandhinagar kitchen fire safety system

Fire occurrence in Indian home is well documented. Presence of cooking oils and appliances used for preparing food along with presence of Liquefied Petroleum Gas (LPG) as a source of energy make it ideal combination of fire hazard at kitchen. Statistical data in India show that approximately 16% of fires in Indian home originate in the kitchen. Many of these fires are suspected to be due to distracted or unattended cooking. A research project was designed to collect data on the conditions (e.g., temperature, gases, smoke) around the Indian kitchen cooking appliance while heating the oil using a LPG stove appliance. Experiments were conducted by heating cooking oils typically used in India such as sunflower oil, soybean oil, groundnut oil and mustard oil. The kitchen appliance environment was instrumented to measure temperatures and carbon monoxide concentration. The data generated during experiments were collected using a data acquisition system which collected the oil temperatures, and carbon monoxide (CO) concentration measured in the kitchen ventilation system (chimney). Based on the observations and analysis of the experimental data, a multi-sensor algorithm was developed to predict potential occurrence of fire. The algorithm includes oil temperature and CO measurement in the kitchen ventilation. The algorithm has been incorporated in a microprocessor based fire detector kit to provide a multi-level response to the fire threat. It can, for example, (i) alert the home occupant through an alarm; (ii) send Short Messaging Service (SMS); (iii) call the occupant; and (iv)cut off the LPG (fuel) supply to cooktop. More testing is required to validate and tune the performance of the algorithm for the range of stove and ventilation design parameters in the Indian kitchen. In addition, research is also required to better document the performance of the system to reduce and nuisance situations in the Indian kitchen. The IIT Gandhinagar fire safety system is a modular and low cost kit which can save loss of property and lives due to kitchen fire.Fire Protection Research Foundationby Akshay Jain, Prateek Nyati, Nakul Nuwal and Chinamy Ghoroi et al.

Conversion of a CNG Powered Auto Rickshaw to an Electric Rickshaw Designed for Indian Conditions

Three wheeler taxis, commonly known as auto rickshaw are a popular means of transport in developing countries. However, low efficiencies and poor maintenance are common (especially in India). This results in high fossil fuel consumption, and very high urban air pollution due to these vehicles. Electrification of auto-rickshaw, therefore, is a potential solution to reduce dependence on fossil fuels, and reduce environmental pollution. However, this conversion is not straightforward. In this work, we investigate some of the challenges of converting an existing combustion engine powered auto-rickshaw to an electric auto rickshaw (electric vehicle (EV)). The cost of conversion to EV and sufficient charge storage capacity for driving range are important factors in the viability of such a conversion. The solution developed here is a design for low total ownership cost for short-range transport. The factors that affect the total cost of ownership are local availability of components, performance efficiency, actual cost of conversion, and skills available with local technicians. These constraints move the most suitable configuration away from configurations that are more typical in the developed economies, such as Li-Ion Batteries and brush-less DC motors (BLDC) to more affordable and well-known technologies such as lead acid batteries and permanent magnet DC motors (PMDC). In this paper, the relative merits of various configurations of batteries, motors and power transmission systems are discussed. Design variables are optimized for a specific top speed and driving range via simulations. The design is evaluated by on-road testing of the modified vehicle. The design challenges are described and the safety aspects and concerns are highlighted. An over-the-life cost comparison of the electrification of the rickshaw with conventional engine powered rickshaws is also discussed.by Rounak Mehta, Preet Shah, Harsh Gupta, Prathamesh Bhat, Vaibhav Gandhi, Kimaya Kale, Madan Taldevkar, Akash Singh, Chinmay Ghoroi, Atul Bhargav and Amey Karni