Resistant Gram-Negative Urinary Tract Bacterial Infections

Urinary tract infection (UTI) is one of the most common infections in both the community as well in hospital settings. It is mostly caused by Gram-negative bacteria (GNBs). Over the past two decades, GNBs have developed complex mechanisms of resistance against most of the potent antibiotics. This has been a global challenge which has been identified by the World Health Organization as “one of the greatest threats to human health.” This crisis is mostly attributed to the overuse and misuse of these medications, as well as lack of new drug antimicrobials by the pharmaceutical industry. This resulted in prolonged hospital stay, marked increase in the cost as well as increase in morbidity and mortality. Furthermore, it increases the risks and complications of urological procedures. In this chapter, we review the management of the most common and challenging group of resistant Gram-negative organisms, the extended-spectrum β-lactamases producing organisms (ESBL) and the carbapenem-resistant organisms (CRE/CRP). The latter group includes carbapenem-resistant Enterobacteriaceae (CRE), as well as Pseudomonas aeruginosa carbapenemases (CRP). When treating these infections, clinicians have few effective antimicrobials options. A critical step in managing these organisms is the early recognition and appropriate empiric therapy. Both showed morbidity and mortality benefits

Influence of Vitamins and Exogenous Enzymes Combination on alleviating Heat Stress in Lactating Ewes under Egyptian Summer Conditions

The present experiment was designed to study the effects of vitamin mixtures and exogenous enzymes ZADO® in alleviaties heat stress in ewes in summer temperatures (25-44°C) compared with winter temperatures (8-22°C). Fifty lactating Ossimi ewes were divided randomly into 5 treatment groups. In summer, the experiment included four treatments: (i) control i.e., normal summer conditions, no supplements (control 2), (ii) ewes supplemented with 10 g/head/day of ZADO® mixed in the concentrate, (iii) ewes supplemented with vitamin AD3E (250 mg/kg BW) and C (45 mg/kg BW) mixture, and (iv) ewes supplemented with ZADO® and vitamin mixture as above. In winter, the treatment comprised of assessments only under normal winter condition (8 to 22°C) without any additives (control 1). Blood and milk samples from each ewe were collected biweekly throughout lactation. Results indicate that plasma total protein, total lipids and glucose, and milk production and composition were decreased (P<0.01) in summer compared with winter. Addition of ZADO® increased plasma total protein, glucose, milk production, protein and lactose as compared with summer control (control 2). Vitamin mixture increased (P<0.01) plasma total protein, milk production and milk protein, but had no effect on total lipids, glucose, milk fat and lactose. Combination of vitamin mixture with ZADO® addition increased the ability of lactating ewes to alleviate hea

Implementation of Direction Control Algorithms for Fixed Wings UAV

The demand for unmanned aircraft vehicles, UAV, has grown quite significantly in recent years. It is therefore important to implement efficient and accurate computer controlled navigation algorithms on such vehicles to guarantee the successful and reliable delivery of the vehicle to its final destination. This paper describes algorithms that use the Global Positioning system data to navigate from the current position to the destination point. The algorithm continuously adjusts the direction of flight thus ensuring the shortest path to the target. The algorithm has been successfully tested within Khartoum Province

An Abdominal Aortic Aneurysm, Intramural Thrombus and Moderate Leak in an Asian Man Presenting with Acute Gastroenteritis

Introduction: Missing a leaking abdominal aortic aneurysm (AAA) is common in medical practice because few at-risk patients have a history of AAA and many have an unusual presentation. Background: AAA is less common among Asians than white Caucasians of the same age. Our patient had no significant risk factors apart from age and sex and had an unusual presentation. Patient and Methods: A 67-year-old Asian man presented to the emergency room (ER) with a 1-day history of nausea, vomiting, diarrhoea, fever and abdominal pain. He was febrile, dehydrated. and had marked tenderness at the right iliac fossa. Laboratory findings suggested bacterial gastroenteritis but this did not explain the localized tenderness at the right iliac fossa. Result and Discussion: A CT scan of the abdomen revealed an AAA arising above the origins of the renal arteries, an intramural thrombus, a retroperitoneal haematoma and a leak extending to the right iliac fossa. The patient was transferred to another hospital and underwent exploratory laparotomy, surgical repair of the aneurysm, and aortobi-iliac grafting with removal of the thrombus. The patient was discharged in good shape 3 weeks after surgery. Without the CT scan of the abdomen, the AAA could have been missed and the patient treated for severe gastroenteriti

Dimensões configuracionais e valor compartilhado : um estudo em rede de padarias comunitárias

Orientador : Prof. Dr. Fernando Antonio Prado GimenezDissertação (mestrado) - Universidade Federal do Paraná, Setor de Ciências Sociais Aplicadas, Programa de Pós-Graduação em Administração. Defesa: Curitiba, 17/12/2015Inclui referências : f.120-131Resumo: O tema da sustentabilidade gera muito interesse por parte dos pesquisadores. A partir das discussões da sustentabilidade corporativa e da responsabilidade social empresarial surge o modelo da criação de valor compartilhado. Ao estabelece-lo, Porter e Kramer (2006, 2011) consideram que a partir da responsabilização das organizações em obter melhores condições para meio ambiente e sociedade pode-se obter melhores resultados econômicos para si. Para tanto, o reconhecimento de novos mercados, busca por melhoria na cadeia produtiva e por meio da exploração de clusters, as organizações poderão criar valor compartilhado. Por se tratar de um modelo ainda pouco explorado no cenário nacional optou-se nesse estudo observá-lo sob a lente da abordagem das configurações. Esta busca compreendeu a relação entre os imperativos - estratégia, estrutura e liderança- que combinados podem contribuir para um melhor desempenho organizacional. Para vislumbrar os arranjos configuracionais que mais se associam com a criação de valor compartilhado, optou-se por estudar uma associação de empreendimentos solidários, pautados nas premissas da economia solidária estes revelam em sua estratégia a busca por ganhos econômicos para sua sobrevivência e perenidade ao mesmo tempo que consideram aspectos socioambientais visando obter resultados positivos para sociedade. Atuando dentro de uma esfera capitalista, estes empreendimentos enfrentam os mesmos desafios de uma organização que busca acúmulo de capital. Nesse contexto, objetivando buscar explicações mais abrangentes sobre os arranjos configuracionais em uma rede formada por empreendimentos solidários e sua relação com o desempenho na criação de valor compartilhado, adotou-se a abordagem das configurações, criação de valor compartilhado e atuação em redes como arcabouço teórico deste trabalho. Dessa forma, a presente pesquisa teve como objetivo identificar quais arranjos configuracionais e relacionamento de redes associaram-se ao desempenho de criação de valor compartilhado em uma associação de padarias comunitárias da grande Curitiba-PR. Para atender o objetivo da pesquisa, foram conjugadas as dimensões de atitude empreendedora, modo administrativo, conteúdo estratégico, relacionamento em rede e criação de valor compartilhado em um levantamento censitário realizado com 28 padarias comunitárias que compõem a associação de padarias comunitárias "Fermento na Massa". Para análise dos dados foi implementada uma análise de clusters que identificou dois agrupamentos, o primeiro, contando com vinte padarias apresentou melhor desempenho de criação de valor compartilhado, já o segundo agrupamento, com oito padarias apresentou resultados inferiores. Os resultados obtidos a partir dessa pesquisa reforçam que diferentes arranjos obtidos por meio dos imperativos das configurações e os graus de relacionamento de redes exercem influência no desempenho da organização, observado nessa pesquisa sob a lente da criação de valor compartilhado. Palavras chave: abordagem das configurações, criação de valor compartilhado, economia solidária.Abstract: The sustentability affair draws a lot of the researchers attention. The debate regarding corporative sustentability and corporate social responsibility gave birth to the concept of "creating shared value". When conceiving it, Porter and Kramer (2006, 2011) realized private corporations would also profit from promoting environmental and social welfare. Corporations would create shared value by identifying new markets, optimizing the productive chains and exploring clusters. Since the brazilian marketplace still overlooks this concept, this study opted to observe it through a configurational approach. This search included the relation between the musts - strategy, structure and leadership - which when combined can contribute for a better organizational performance. In order to identify the configurational arrangements that relate the most to creating shared value, this study opted to analyze shared business ventures that, guided by solidary economy premises, pursue financial gains for its own survival and perpetuation at the same time that consider socioenvironmental and positive results for the society. By acting inside a capitalist environment, these entrepeunerships face the same challenges that an organization that aims for capital accumulation would. In such context, for better and deeper explanations about the configurational arrangements within a net of solidary entrepeunerships and its relations with the shared value creation performance, it was adopted a configurational approach, creation of shared value and networking as this study's theoretical framework. Therefore, the present research aimed to identify witch configurational arrangements and networks associated with better shared value creation performance in a solidary bakeries association within the metropolitan zone of Curitiba, Parana. In order to accomplish the research objectives, it were considered the entrepeneur attitude, the administrative structure, the strategy content, the networking and the shared value creation within the 28 comunitary bakeries that make up the "Fermento na Massa" association. For data analysing, it was implemented a cluster analysis that identified two agroupments: the first, counting with twenty bakeries, showed better performance on shared value creation, and the second, with eight bakeries, showed lower results. These outcomes reinforce the idea that different arrangements obtained by the configurationals musts and network levels have an influence on organizations performance, which was noted by the shared value approach of this study. Key-words: Configurational approach. Create shared value. Solidary economy

Evaluation of Parametric Limitations in Simulating Greenhouse Gas Fluxes from Irish Arable Soils Using Three Process-Based Models

The senior author gratefully acknowledges the funding by the Science, Technology, Research and Innovation for the Environment (STRIVE) Programme of the Irish Government under the National Development Plan 2007-2013 and the Department of the Environment, Heritage and Local Government. The authors would like to thanks Phillip O’Brien (EPA) for extending technical and relevant support; Mike Williams, Mike Jones and Matt Saunders (TCD), Komsan Rueangritsarakul and Mohamed Helmy (UCD) for supplying experimental data for modelling work; as well as Tom Bolger and Tommy Gallagher (UCD) for providing administrative support.Peer reviewedPublisher PD

Hemodialysis associated dysautonomia; Effect of optimization of dialysis and nutrition: A prospective study

Background: Autonomic neuropathy is common among hemodialysis patients, even if they are asymptomatic. The aim of this study is to assess the effect of optimization of patients' dialysis and nutrition on the presence of autonomic dysfunction in these patients guided by sympathetic skin response (SSR) test. Methods: Fifteen patients on maintenance hemodialysis (12 males and 3 females) their age ranged from 24 to 67 years, most of them were on bicarbonate dialysis were included in our study. Initially, the patients were assessed clinically and by laboratory investigations and their dialysis was assessed by studying their urea kinetic modeling. Their nutrition was assessed by laboratory parameters and by calculating the normalized protein catabolic rate (nPCR). Their autonomic functions were assessed by clinical examination, hand grip and SSR test. Dialysis dose was readjusted to achieve a target kt/v value of 1.3/session thrice weekly. Also, their nutrition was reviewed to achieve nPCR of 1.2 gm/kg/day and caloric intake of 30-40 KCal/kg/day through diet manipulation and support. They were reassessed after 3 months. Results: Analysis of the data showed a statistically significant improvement of the observed subclinical autonomic neuropathy evidenced by a significant change in the hand grip (p = 0.044), and a high statistically significant improvement in the sympathetic skin response test parameters (both amplitude and latency) (p=0.001) after optimization of both hemodialysis and nutrition status. Conclusion: Improving dialysis and patients nutrition by using urea kinetic modeling is valuable in improving their autonomic functions as assessed by SSR test

Evaluation of the ECOSSE model to predict heterotrophic soil respiration by direct measurements

Acknowledgements This work contributes to the ELUM (Ecosystem Land Use Modelling & Soil Carbon GHG Flux Trial) project, which was commissioned and funded by the Energy Technologies Institute (ETI), and to Carbo-BioCrop (http://www.carbobiocrop.ac.uk; a NERC funded project; NE/H010742/1), UKERC Phase II and III (NERC; NE/H013237/1), MAGLUE (http://www.maglue.ac.uk; an EPSRC funded project; EP/M013200/1) and as part of the Seventh Framework For Research Programme of the EU, within the EUROCHAR project (N 265179) and EXPEER within WU FP7-Infrastructures. We acknowledge the use of the E-OBS dataset from the EU-FP6 project ENSEMBLES (http://ensembles-eu.metoffice.com) and the data providers in the ECA&D project (http://www.ecad.eu). We thank two anonymous reviewers and Dr William van Dijk for their valuable suggestions.Peer reviewedPostprin

One-stage lingual augmented urethroplasty in repair of distal penile hypospadias

AbstractObjectivesTo evaluate the outcome of augmentation of shallow urethral plate by lingual graft in repair of distal penile hypospadias.Patients and methodsBetween June 2008 and May 2011, the procedure was performed on 23 patients with mean age 2.3 years (range 1–3). All patients had distal penile hypospadias; 11 sub coronal and 12 coronal. The urethral plate was less than 8mm in all patients and 3 of them had history of previous hypospadias surgery. All procedures were carried out under general anesthesia using 4× magnifying loupe. After penile degloving and dorsal incision of the urethral plate, the lingual graft was harvested and sutured to the edges of the incised urethral plate from the hypospadias opening to the tip of the penis. The neourethra was closed and an intervening flap was fixed over the neourethra as a barrier against fistula formation.ResultsSuccess rate was 87% as 20/23 patients were cured without any permanent complication throughout the follow up period. None of patients suffered meatal stenosis or required regular urethral dilatation. Three patients developed urethrocutaneous fistula, of which two closed spontaneously and one required surgical repair 6 months later. Two patients had failed procedures and delayed re-intervention was performed due to complete loss of the graft in one of them and repair disruption following infection in the other. Two patients had post-operative pain in the graft harvesting site which disappeared within days.ConclusionThe one-stage lingual augmented urethral plate urethroplasty offers promising outcomes for repair of distal penile hypospadias with narrow urethral plate

Autoimmune Complications after Hematopoietic Stem Cell Transplantation in Children with Nonmalignant Disorders

Background. Hematopoietic stem cell transplantation (HSCT) remains the only curative treatment for many nonmalignant disorders, such as autoimmune disorders, inborn metabolic disorders, hemoglobinopathies, and immunodeficiency disorders. Autoimmune complications (AICs) after HSCT, such as autoimmune cytopenias, autoimmune hepatitis, primary biliary cirrhosis, and autoimmune cutaneous manifestations, are still neither well defined nor characterized. Patients. Between 2000 and 2012, 92 patients (47 males, 45 females) were treated with HSCT in our hospital, 51 with congenital hemoglobinopathies, 19 with primary immunodeficiency disease, 10 with metabolic disorders, five with Fanconi anemia, three with aplastic anemia, and four with familial hemophagocytic lymphohistiocytosis. Results. Mean age at HSCT was 6.4 years (range, 0.2–32 years) and mean duration of followup after HSCT was 6.81 years (range, 1–11 years). Sixteen (17.4%) patients developed chronic GVHD and five (5.4%) showed sclerodermatous features. Five (5.4%) patients were diagnosed with scleroderma manifestations, six (6.5%) with vitiligo, six (6.5%) with autoimmune hemolytic anemia (AIHA), six (6.5%) with idiopathic thrombocytopenia, three (3.3%) with mild leucopenia, two (2.2%) with aplastic anemia, two (2.2%) (one boy, one girl) with autoimmune thyroid disease, and one (1.1%) with autoimmune hepatitis. Conclusions. It was concluded that AICs are clinically significant complications after HSCT that contribute to morbidity but not to mortality. AICs are more frequent after HSCT for metabolic disorders, and sclerodermatous GVHD is more significant in children who underwent allogeneic HSCT for hemoglobinopathies. The potential to identify risk factors for AICs could lead to less morbidity and mortality and to maintain the patient’s quality of life