Antimicrobials: A Global Alliance For Optimizing Their Rational Use In Intra-abdominal Infections (agora)

Intra-abdominal infections (IAI) are an important cause of morbidity and are frequently associated with poor prognosis, particularly in high-risk patients. The cornerstones in the management of complicated IAIs are timely effective source control with appropriate antimicrobial therapy. Empiric antimicrobial therapy is important in the management of intra-abdominal infections and must be broad enough to cover all likely organisms because inappropriate initial antimicrobial therapy is associated with poor patient outcomes and the development of bacterial resistance. The overuse of antimicrobials is widely accepted as a major driver of some emerging infections (such as C. difficile), the selection of resistant pathogens in individual patients, and for the continued development of antimicrobial resistance globally. The growing emergence of multi-drug resistant organisms and the limited development of new agents available to counteract them have caused an impending crisis with alarming implications, especially with regards to Gram-negative bacteria. An international task force from 79 different countries has joined this project by sharing a document on the rational use of antimicrobials for patients with IAIs. The project has been termed AGORA (Antimicrobials: A Global Alliance for Optimizing their Rational Use in Intra-Abdominal Infections). The authors hope that AGORA, involving many of the world's leading experts, can actively raise awareness in health workers and can improve prescribing behavior in treating IAIs.11NIAID NIH HHS [R01 AI117211

Antimicrobials: a global alliance for optimizing their rational use in intra-abdominal infections (AGORA)

Intra-abdominal infections (IAI) are an important cause of morbidity and are frequently associated with poor prognosis, particularly in high-risk patients. The cornerstones in the management of complicated IAIs are timely effective source control with appropriate antimicrobial therapy. Empiric antimicrobial therapy is important in the management of intra-abdominal infections and must be broad enough to cover all likely organisms because inappropriate initial antimicrobial therapy is associated with poor patient outcomes and the development of bacterial resistance. The overuse of antimicrobials is widely accepted as a major driver of some emerging infections (such as C. difficile), the selection of resistant pathogens in individual patients, and for the continued development of antimicrobial resistance globally. The growing emergence of multi-drug resistant organisms and the limited development of new agents available to counteract them have caused an impending crisis with alarming implications, especially with regards to Gram-negative bacteria. An international task force from 79 different countries has joined this project by sharing a document on the rational use of antimicrobials for patients with IAIs. The project has been termed AGORA (Antimicrobials: A Global Alliance for Optimizing their Rational Use in Intra-Abdominal Infections). The authors hope that AGORA, involving many of the world's leading experts, can actively raise awareness in health workers and can improve prescribing behavior in treating IAIs

Ten golden rules for optimal antibiotic use in hospital settings: the WARNING call to action

Antibiotics are recognized widely for their benefits when used appropriately. However, they are often used inappropriately despite the importance of responsible use within good clinical practice. Effective antibiotic treatment is an essential component of universal healthcare, and it is a global responsibility to ensure appropriate use. Currently, pharmaceutical companies have little incentive to develop new antibiotics due to scientific, regulatory, and financial barriers, further emphasizing the importance of appropriate antibiotic use. To address this issue, the Global Alliance for Infections in Surgery established an international multidisciplinary task force of 295 experts from 115 countries with different backgrounds. The task force developed a position statement called WARNING (Worldwide Antimicrobial Resistance National/International Network Group) aimed at raising awareness of antimicrobial resistance and improving antibiotic prescribing practices worldwide. The statement outlined is 10 axioms, or “golden rules,” for the appropriate use of antibiotics that all healthcare workers should consistently adhere in clinical practice

Disturbance energy norms: a critical analysis

The question of which norm should be used to characterize the fluctuating disturbance energy in studies on thermoacoustic instabilities remains a topic of continued debate. In this paper we formulate a strategy for developing mathematically consistent norms that do not support spurious growth of disturbance energy in the absence of ‘physical’ sources of energy. A critical analysis of various disturbance energy norms existing in literature is conducted and important conclusions regarding positive definitiveness and susceptibility to exhibiting unphysical growth are drawn. It is shown that the energy norm proposed by Cantrell and Hart [Interaction between sound and flow in acoustic cavities: mass, momentum and energy considerations, Journal of Acoustical Society of America 36 (1964) 697–706] and Myers' first order disturbance energy norm [Transport of energy by disturbances in arbitrary steady flow, Journal of Fluid Mechanics 226 (1991) 383–400] are positive definite if M0 < 1 and M0 < 1/√γ, respectively, where M0 is the magnitude of the local mean flow Mach number, γ is the ratio of specific heats at constant pressure and volume and the stipulated conditions should be met at every point in the flow domain. Our analysis shows that the disturbance energy norm proposed by Chu [On the energy transfer to small disturbances in fluid flow (part I), Acta Mechanica 1 (1965) 215–234] does not exhibit unphysical growth. It is also shown that this property is not unique to Chu's disturbance energy norm and there exists a family of norms which satisfy this requirement. The analysis also leads to an interesting interpretation of the acoustic energy conservation principle of Cantrell and Hart. The potential held by various disturbance energy norms for exhibiting fictitious growth is quantified using tools from nonmodal stability theory. It is concluded that if the mean flow Mach number is small, Myers' norm is a suitable measure of the disturbance energy

On Chu's disturbance energy

Chu [On the energy transfer to small disturbances in fluid flow (part I), Acta Mechanica 1 (1965) 215–234] proposed a positive definite energy norm for characterizing the level of fluctuation in a disturbance. In the absence of heat transfer at the boundaries, work done by boundary or body forces, heat and material sources of energy, this norm is a monotone, non-increasing function of time. In this paper, we show that Chu's disturbance energy defines an inner product, with respect to which the conservation equations of fluid motion linearized about a uniform base flow are self-adjoint. This ensures that the eigenvectors of the linearized operator are orthogonal to each other, and the property that the energy norm is a non-increasing function of time in the absence of physical sources of energy follows as an immediate consequence. Examples from numerical simulations of Euler equations are presented to highlight the importance of choosing an energy norm that is consistent with the underlying physics. We demonstrate that the disturbance energy as measured by Chu's norm does not exhibit spurious transient growth in the absence of physical sources of energy and hence is suitable for analyzing thermoacoustic instability

A Novel Fuzzy Expert System for the Identification of Severity of Carpal Tunnel Syndrome

The diagnosis of carpal tunnel syndrome, a peripheral nerve disorder, at the earliest possible stage is very crucial because if left untreated it may cause permanent nerve damage reducing the chances of successful treatment. Here a novel Fuzzy Expert System designed using MATLAB is proposed for identification of severity of CTS. The data used were the nerve conduction study data obtained from Kannur Medical College, India. It consists of thirteen input fields, which include the clinical values of the diagnostic test and the clinical symptoms, and the output field gives the disease severity. The results obtained match with the expert’s opinion with 98.4% accuracy and high degrees of sensitivity and specificity. Since quantification of the intensity of CTS is a crucial step in the electrodiagnostic procedure and is important for defining prognosis and therapeutic measures, such an expert system can be of immense use in those regions where the service of such specialists may not be readily available. It may also prove useful in combination with other systems in providing diagnostic and predictive medical opinions and can add value if introduced into the routine clinical consultations to arrive at the most accurate medical diagnosis in a timely manner

Sound production by vorticity fluctuations in a stagnation point flow

A linear mechanism for the emergence of acoustic waves from aperiodic vorticity disturbances is presented for a simple stagnation point flow. The non-modal approach, which made possible the discovery of a similar mechanism in unbounded shear flows, is employed. The phenomenon is shown to be closely related to the non-normal nature of the linearized operator governing the evolution of small perturbations about the mean flow. The vorticity disturbance acts as an acoustic source by interacting with the mean velocity gradient and drives the acoustic waves in a non-resonant manner. The physical mechanism by which the acoustic and vortical components of the disturbance exchange energy with the mean flow is presented. The proposed mechanism is relevant for numerous applications involving mass addition or removal, such as aeroacoustic instabilities in a solid rocket motor. Similar phenomena are expected to occur in accelerated flows, like the flow in a nozzle. Numerical simulations using a high order, dispersion relation preserving scheme is used to demonstrate how a localized vorticity disturbance of small amplitude generates sound waves when strained by the gradients in the base flow. The simulations reveal that the vorticity disturbance acts as a quadrupole source of sound, whose origin is explained using physical arguments. Linear simulations using a spectral code verify the results of the nonlinear simulations performed at small amplitude

Root canal configuration of human permanent mandibular first molars of an indo-dravidian population based in Southern India: An In vitro study

Aim: This study aims to analyze root canal configuration of human permanent mandibular first molars of an indo-Dravidian population based in southern India. Materials and Methods: A total of 1147 mandibular first permanent molars were collected, cleansed, and stored. The number of roots was recorded, access preparations made, pattern of orifices recorded after pulpal floor debridement, dye injected into the canals using apical negative pressure and subjected to a clearing technique. They were then analyzed using a stereo microscope and the canal configurations recorded (Vertucci). The number of roots, the pattern of orifices and canal configuration were recorded. Results: The pattern of orifices was triangular (87.9%), rectangular (8.5%), C-shaped (3.0%), and two orifice pattern (0.6%). About 95.6% of teeth had two roots, and 4.4% had three roots. The most common canal system configuration in mesial root was Vertucci type IV (52.3%), followed by type II (35%). Root canal configuration of the distal root revealed type I configuration in 62.7%, followed by types II (14.5%) and IV (12.4%). The distolingual root had a type I configuration. Conclusion: Awareness of canal configuration, adequate clinical skills, use of specialized techniques of diagnosis, debridement and obturation will pave the way for successful treatment outcomes