Thinking beyond the colon-small bowel Involvement in clostridium difficile infection

Small intestinal Clostridium difficile seems to be increasing in incidence. The spectrum of Clostridium difficile infection (CDI) has definitely expanded with small bowel involvement. They are more frequently reported in patients with inflammatory bowel disease (IBD) who have undergone total colectomy or patients with Ileal anal pouch anastomosis. The most common presentation is increased ileostomy output with associated dehydration. High clinical suspicion, early recognition and appropriate treatment are the keys to successful resolution. The increase in the number of these patients may actually reflect an increase in the rising incidence of CDI in general or increasing virulence of the organism. Heightened public awareness and initiation of prompt preventive measures are the keystones to control of this infection. This disease is no longer limited to the colon and physicians should be educated to think beyond the colon in patients with CDI

Could pre-diabetes be considered a clinical condition? opinions from an endocrinologist and a cardiologist

The prevalence of pre-diabetes is increasing worldwide and may start 7 to 10 years before the clinical diagnosis of diabetes. In this stage the presence and accumulation of risk factors is common and already implies an increase in cardiovascular risk. Likewise, the onset of cardiovascular diseases (CVD), mainly coronary artery disease (CAD), peripheral vascular disease and cerebrovascular disease can also take place, all of which account for high rates of morbidity and mortality worldwide. Considering pre-diabetes as a clinical entity, non-pharmacological and pharmacological treatments are indicated with drugs which have shown clinical benefits related to reduction in morbidity and mortality. However, there is still need for new long-term studies to assess the real benefits of several new therapeutical approaches, as well as its cost-effectiveness

FEM Substructuring for the Vibrational Characterization of a Petrol Engine

In this work the vibrational behavior of a 4-cylinder, 4-stroke, petrol engine has been simulated by leveraging on a reduced modelling strategy, based on the Component Mode Synthesis (CMS), adopted to reduce the size of the full FEM model of the engine. The FEM model of the engine, comprising all of its sub-components, has been preliminary characterized from the vibrational standpoint; subsequently, the CMS has been adopted in order to reduce the FEM model size. Frequency Response Function (FRF) analyses have been used to identify the resonant frequencies and mode shapes of the different FEM models, and the so-obtained results have been compared showing a very good agreement. The reduced model has been able to reproduce with a high accuracy the vibration response at the engine mounts. The adopted reduced modelling strategy turned out to be effective in lowering the computational burden, keeping, at the same time, an accurate replication of the engine vibrational behavior. Runtimes have been significantly reduced from 24 hours for the full FEM model to less than 2 hours for the reduced model

A multidimensional implicit approach to gender stereotypes

: Research has widely explained gender inequalities in terms of gender stereotypes, according to which women are considered more nurturing, empathic, and emotional but less competent - than men. Recent evidence highlights that especially women are portrayed along multiple dimensions. In this research, we adopted an implicit Semantic Misattribution procedure to detect whether gender stereotypes have a multidimensional structure and are differently attributed to men and women. Results showed that Competence and Dominance-related terms were considered more masculine ones. In contrast, Morality and Physical Attractiveness were attributed to feminine ideograms to a higher and significant extent than masculine ones. Sociability was related to feminine and masculine ideograms almost to the same extent. The gathered evidence provided a multidimensional picture even composed of more judgment dimensions with reference to women highlighting how it can be difficult for them to meet all those multiple expectancies

Neural networks for fatigue crack propagation predictions in real-time under uncertainty

Crack propagation analyses are fundamental for all mechanical structures for which safety must be guaranteed, e. g. as for the aviation and aerospace fields. The estimation of life for structures in presence of defects is a process inevitably affected by numerous and unavoidable uncertainty and variability sources, whose effects need to be quantified to avoid unexpected failures or excessive conservativism. In this work, residual fatigue life prediction models have been created through neural networks for the purpose of performing probabilistic life predictions of damaged structures in real-time and under stochastically varying input parameters. In detail, five different neural network architectures have been compared in terms of accuracy, computational runtimes and minimum number of samples needed for training, so to determine the ideal architecture with the strongest generalization power. The networks have been trained, validated and tested by using the fatigue life predictions computed by means of simulations developed with FEM and Monte Carlo methods. A real-world case study has been presented to show how the proposed approach can deliver accurate life predictions even when input data are uncertain and highly variable. Results demonstrated that the “H1-L1” neural network has been the best model, achieving an accuracy (Mean Square Error) of 4.8e-7 on the test dataset, and the best and the most stable results when decreasing the amount of data. Additionally, since requiring only very few parameters, its potential applicability for Structural Health Monitoring purposes in small cost-effective GPU devices resulted to be attractive

A descriptive pharmacokinetic/pharmacodynamic analysis of continuous infusion ceftazidime-avibactam for treating DTR gram-negative infections in a case series of critically ill patients undergoing continuous veno-venous haemodiafiltration (CVVHDF)

Purpose: To explore pharmacokinetic/pharmacodynamic (PK/PD) profile of continuous infusion (CI) ceftazidime-avibactam for treating difficult-to-treat resistant Gram-negative (DTR-GN) infections in critical patients undergoing continuous venovenous haemodiafiltration (CVVHDF). Materials and methods: Patients treated with CI ceftazidime-avibactam for DTR-GN infections during CVVHDF were retrospectively assessed. Ceftazidime and avibactam concentrations were measured at steady-state and the free fraction (fCss) was calculated. Total clearance (CLtot) of both agents were calculated and the impact of CVVHDF intensity was assessed by linear regression. The joint PK/PD target of ceftazidime-avibactam was defined as optimal when both fCss/MIC≥4 for ceftazidime and fCss/CT > 1 for avibactam were achieved. Relationship between ceftazidime-avibactam PK/PD targets and microbiological outcome was assessed. Results: Eight patients with DTR-GN infections were retrieved. Median fCss were 84.5 (73.7–87.7 mg/L) for ceftazidime and 24.8 mg/L (20.7–25.8 mg/L) for avibactam. Median CLtot was 2.39 L/h (2.05–2.96 L/h) for ceftazidime and 2.56 L/h (2.12–2.98 L/h) for avibactam. Median CVVHDF dose was 38.6 mL/h/kg (35.9–40.0 mL/kg/h). CLtot were linearly correlated with CVVHDF dose (r = 0.53;p = 0.03, and r = 0.64;p = 0.006, respectively). The joint PK/PD targets were optimal granting microbiological eradication in all the assessable cases. Conclusion: CI administration of 1.25–2.5 g q8h ceftazidime-avibactam may allow prompt attainment and maintenance of optimal joint PK/PD targets during high-intensity CVVHDF