The Impact of Multidrug-Resistant Organisms on Outcomes in Patients with Diabetic Foot Infections

Background. Multidrug-resistant organisms (MDROs) are important diabetic foot infection (DFI) pathogens. This study evaluated the impact of DFIs associated with MDRO pathogens (DFI-MDRO) on clinical outcomes. Methods. Adults admitted to Detroit Medical Center from January 2012 to December 2015 with culture-positive DFI were included. Associations between outcomes and DFI-MDRO (evaluated as a single group that included methicillin-resistant Staphylococcus aureus [MRSA], vancomycin-resistant enterococci, Enterobacteriaceae resistant to third-generation cephalosporin [3GCR-EC], Acinetobacter baumannii, and Pseudomonas aeruginosa) were analyzed. Outcomes included above- and below-knee lower extremity amputation (LEA), readmissions, and mortality within a year after DFI. A propensity score predicting the likelihood of having DFI-MDRO was computed by comparing patients with DFI-MDRO with patients with DFI with non-MDRO pathogens (DFI-non-MDRO). Using conditional logistic regression, DFI-MDRO was analyzed as an independent variable after patients in the MDRO and non-MDRO groups were matched by propensity score. Results. Six hundred forty-eight patients were included, with a mean age ± SD of 58.4 ± 13.7. Most patients in the cohort presented with chronic infection (75%). DFI-MDRO occurred in greater than one-half of the cohort (n = 364, 56%), and MRSA was the most common MDRO (n = 224, 62% of the DFI-MDRO group). In propensity-matched analyses, DFI-MDRO was not associated with 1-year LEA or readmissions, but was associated with recurrent DFI episodes (odds ratio, 2.1; 95% confidence interval, 1.38–3.21). Conclusions. DFI-MDRO was associated with a 2-fold increased risk of recurrent DFI compared with patients with DFI-non-MDRO

Re-thinking the southern British oppida: networks, kingdoms and material culture

Copyright © 2010 SAGE Publications. Open access article.This article examines the role of a range of large settlements in late Iron Age and early Roman southern Britain (c. 100 BC–AD 70) conventionally described as oppida. After reviewing current perspectives on the function and chronology of British oppida, new insights are provided through the statistical analysis of assemblages of brooches and imported ceramics at a broad sample of sites. Analysis of material culture reveals distinct similarities and differences between several groups of sites, often transcending regional traditions and supposed tribal boundaries. This patterning is primarily explained by the emergence of new forms of political organization prior to Roman annexation, particularly the creation of the Southern and Eastern Kingdoms

Die rechtliche Regelung des Instituts der kostenlosen Rechtshilfe in der Republik Kroatien mit besonderer Berücksichtigung der gesetzlichen Regelungen in den postjugoslawischen Staaten

“Pravo i pravdu nećemo nikome prodati, uskratiti ili odgoditi.” 40. paragraf Velike povelje sloboda Pravo na pristup pravosuđu (access to justice) jedno je od temeljnih ljudskih prava. Ostvarivanje toga prava uvelike ovisi o dostupnosti pravne pomoći svim građanima bez obzira na njihov socioekonomski status. Stoga je postojanje učinkovitog sustava besplatne pravne pomoći u svakoj zemlji jedan od temeljnih jamaca ostvarivanja ljudskih prava u svakodnevnom životu. U radu se razmatra razvoj i uređenje instituta besplatne pravne pomoći u Republici Hrvatskoj te u ostalim postjugoslavenskim državama s ciljem regionalnog prikaza njegova uređenja.«To no one will we sell, to no one will we refuse or delay, right or justice» 40th paragraph of the Magna Charta The paper considers the development and regulation of the institute of legal aid in the Republic of Croatia and in the other post-Yugoslav states with the aim of providing a regional outline of their regulation. In recent years legislators in the post-Yugoslav states have been increasingly involved in the regulation of legal aid and, in order to develop modern legal systems, they adopted laws aimed at ensuring and protecting the right to legal aid. The normative activities for regulating legal aid began with the constitutional guarantee for such aid, and were made effective by the provisions of the criminal codes and the civil procedure acts. Later, under the influence of the acquis communautaire of the modern European states they were to be included in the provisions of separate laws of the post-Yugoslav states. This shows that there was an evolution in the development of the right to legal aid, not only as the right to such aid in the form of good will and charity of the state, but also as one of the fundamental human rights guaranteed by constitutional and legal norms.“Niemandem werden wir Recht oder Gerechtigkeit verkaufen, verweigern oder verzögern.“ Magna Carta, § 40 In dieser Arbeit werden die Entwicklung und Regelung des Instituts der kostenlosen Rechtshilfe in der Republik Kroatien und in den anderen postjugoslawischen Staaten erörtert, wodurch seine Regelung in der Region dargestellt werden soll. In den letzten Jahren ist die Regelung des Anspruchs auf kostenlose Rechtshilfe zu einer wichtigen Aufgabe für die Gesetzgeber in den postjugoslawischen Staaten geworden, die zwecks Aufbau moderner Rechtsordnungen Gesetze verabschiedeten, deren Gegenstand die Wahrnehmung und der Schutz des Rechts auf kostenlose Rechtshilfe ist. Die normative Aktivität zur Einrichtung der kostenlosen Rechtshilfe begann mit der Verfassungsgarantie des Rechtsanspruches auf kostenlose Rechtshilfe, die in den Bestimmungen der Straf- und der Zivilprozessordnung ihren konkreten Niederschlag fanden, um sich unter dem Einfluss der Trends in der Gesetzgebung der modernen europäischen Staaten zu Bestimmungen in Sondergesetzen der postjugoslawischen Staaten zu verwandeln. Dies belegt eine Evolution in der Entwicklung des Rechtsanspruchs auf kostenlose Rechtshilfe als nicht allein des Anspruchs auf Hilfe in Form einer wohltäterischen Geste von staatlichem guten Willen, sondern als eines Grundrechts, das durch Verfassungs- und Gesetzesnormen garantiert wird

Regulating inflammation through the anti-inflammatory enzyme platelet-activating factor-acetylhydrolase

Platelet-activating factor (PAF) is one of the most potent lipid mediators involved in inflammatory events. The acetyl group at the sn-2 position of its glycerol backbone is essential for its biological activity. Deacetylation induces the formation of the inactive metabolite lyso-PAF. This deacetylation reaction is catalyzed by PAF-acetylhydrolase (PAF-AH), a calcium independent phospholipase A2 that also degrades a family of PAF-like oxidized phospholipids with short sn-2 residues. Biochemical and enzymological evaluations revealed that at least three types of PAF-AH exist in mammals, namely the intracellular types I and II and a plasma type. Many observations indicate that plasma PAF AH terminates signals by PAF and oxidized PAF-like lipids and thereby regulates inflammatory responses. In this review, we will focus on the potential of PAF-AH as a modulator of diseases of dysregulated inflammation

Essentially biased: why people are fatalistic about genes

We propose that people are genetic essentialists—that is, they tend to think of genetic attributions as being immutable, of a specific etiology, natural, and dividing people into homogenous and discrete groups. Although there are rare conditions where genes operate in these kinds of deterministic ways, people overgeneralize from these to the far more common conditions where genes are not at all deterministic. These essentialist biases are associated with some harmful outcomes such as racism, sexism, pessimism in the face of illnesses, political polarization, and support for eugenics, while at the same time they are linked with increased tolerance and sympathy for gay rights, mental illness, and less severe judgments of responsibility for crime. We will also discuss how these essentialist biases connect with the burgeoning direct-to-consumer genomics industry and various kinds of genetic engineering. Overall, these biases appear rather resistant to efforts to reduce them, although genetics literacy predicts weaker essentialist tendencies

A two-sided cornelian intaglio from Thurleigh, Bedfordshire, England

This note describes a double sided gem showing on one side an armed youth and on the other a thunderbolt and discusses the circumstances by which a gem, certainly not a Magical Amulet, came into being. The stone is of significance for the history of provincial glyptics and a pointer to local workshop practice in Britain and Gaul.Cette note décrit une gemme à double face montrant sur une face un jeune homme armé et sur l’autre un éclair. On s’interroge sur les circonstances dans lesquelles une gemme, certainement pas une Amulette Magique, a pu être fabriquée. La pierre est d’une importance significative pour l’histoire de la glyptique provinciale et un indice révélateur de la pratique des ateliers indigènes de Grande-Bretagne et de Gaule