Standards of Practice in Acute Ischemic Stroke Intervention: International Recommendations

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Extensively drug-resistant Acinetobacter baumannii in a Thai hospital: a molecular epidemiologic analysis and identification of bactericidal Polymyxin B-based combinations

BACKGROUND: Limited knowledge of the local molecular epidemiology and the paucity of new effective antibiotics has resulted in an immense challenge in the control and treatment of extensively drug-resistant (XDR) Acinetobacter baumannii infections in Thailand. Antimicrobial combination regimens may be the only feasible treatment option in such cases. We sought to characterize the local molecular epidemiology and assess the bactericidal activity of various antibiotics individually and in combination against XDR A. baumannii in a Thai hospital. METHODS: All XDR A. baumannii isolates from Thammasat University Hospital were collected between October 2010 and May 2011. Susceptibility testing was conducted according to reference broth dilution methods. Pulse-field gel electrophoresis was used to genotype the isolates. Carbapenemase genes were detected using polymerase chain reaction. In vitro testing of clinically-relevant concentrations of imipenem, meropenem, doripenem, rifampicin and tigecycline alone and in combination with polymyxin B was conducted using multiple combination bactericidal testing. RESULTS: Forty-nine polymyxin B-susceptible XDR A. baumannii isolates were identified. bla(OXA-23) and bla(OXA-51) genes were detected in all isolates. Eight clonally related clusters were identified, resulting in the initiation of several infection control measures. Imipenem, meropenem, doripenem, rifampicin, and tigecycline in combination with PB respectively, exhibited bactericidal killing in 100%, 100%, 98.0%, 100% and 87.8% isolates respectively at 24 hours. CONCLUSION: Molecular epidemiologic analysis can aid the early detection of infection outbreak within the institution, resulting in the rapid containment of the outbreak. Imipenem/meropenem/rifampicin in combination with polymyxin B demonstrated consistent bactericidal effect against 49 bla(OXA-23)-harbouring XDR A. baumannii clinical isolates, suggesting a role of combination therapy in the treatment of these infections

Maintenance Strategies for used equipment under lease

Abstract: Purpose – The aim of this research is to determine the optimal upgrade and preventive maintenance actions that minimize the total expected cost (maintenance costs+penalty costs). Design/methodology/approach – The problem is a four-parameter optimization with two parameters being k-dimensional. The optimal solution is obtained by using a four-stage approach where at each stage a one-parameter optimization is solved. Findings – Upgrading action is an extra option before the lease of used equipment, in addition to preventive maintenance action. Upgrading action makes equipment younger and preventive maintenance action lowers the ROCOF. Practical implications – There is a growing trend towards leasing equipment rather than owning it. The lease contract contains penalties if the equipment fails often and repairs are done within reasonable time period. This implies that the lessor needs to look at optimal preventive maintenance strategies in the case of new equipment lease, and upgrade actions plus preventive maintenance in the case of used equipment lease. The paper deals with this topic and is of great significant to business involved with leasing equipment. Originality/value – Nowadays many organizations are interested in leasing equipment and outsourcing maintenance. The model in this paper addresses the preventive maintenance problem for leased equipment. It provides an approach to dealing with this problem

Optimal “Sporadic” and Systematic Preventive Maintenance Policy for Leased Equipment under Various Operating Conditions

Part 2: Knowledge Discovery and SharingInternational audienceIn this paper, the considered system corresponds to a specific equipment proposed for leasing. This equipment is leased to several lessees who use it under various working conditions. The aims of this paper consist in determining optimal maintenance plans which minimize maintenance costs. Two maintenance policies are compared : systematic policy (imperfect preventive maintenance actions are performed, with the same effectiveness factor, after each mission) and “sporadic” policy (imperfect preventive maintenance action can be performed after a mission with its optimal effectiveness factor)