Attributable deaths and disability-adjusted life-years caused by infections with antibiotic-resistant bacteria in the EU and the European Economic Area in 2015: a population-level modelling analysis

Background: Infections due to antibiotic-resistant bacteria are threatening modern health care. However, estimating their incidence, complications, and attributable mortality is challenging. We aimed to estimate the burden of infections caused by antibiotic-resistant bacteria of public health concern in countries of the EU and European Economic Area (EEA) in 2015, measured in number of cases, attributable deaths, and disability-adjusted life-years (DALYs). Methods: We estimated the incidence of infections with 16 antibiotic resistance–bacterium combinations from European Antimicrobial Resistance Surveillance Network (EARS-Net) 2015 data that was country-corrected for population coverage. We multiplied the number of bloodstream infections (BSIs) by a conversion factor derived from the European Centre for Disease Prevention and Control point prevalence survey of health-care-associated infections in European acute care hospitals in 2011–12 to estimate the number of non-BSIs. We developed disease outcome models for five types of infection on the basis of systematic reviews of the literature. Findings: From EARS-Net data collected between Jan 1, 2015, and Dec 31, 2015, we estimated 671 689 (95% uncertainty interval [UI] 583 148–763 966) infections with antibiotic-resistant bacteria, of which 63·5% (426 277 of 671 689) were associated with health care. These infections accounted for an estimated 33 110 (28 480–38 430) attributable deaths and 874 541 (768 837–989 068) DALYs. The burden for the EU and EEA was highest in infants (aged <1 year) and people aged 65 years or older, had increased since 2007, and was highest in Italy and Greece. Interpretation: Our results present the health burden of five types of infection with antibiotic-resistant bacteria expressed, for the first time, in DALYs. The estimated burden of infections with antibiotic-resistant bacteria in the EU and EEA is substantial compared with that of other infectious diseases, and has increased since 2007. Our burden estimates provide useful information for public health decision-makers prioritising interventions for infectious diseases

Cardiovascular magnetic resonance in patients with pectus excavatum compared with normal controls

<p>Abstract</p> <p>Purpose</p> <p>To assess cardiothoracic structure and function in patients with pectus excavatum compared with control subjects using cardiovascular magnetic resonance imaging (CMR).</p> <p>Method</p> <p>Thirty patients with pectus excavatum deformity (23 men, 7 women, age range: 14-67 years) underwent CMR using 1.5-Tesla scanner (Siemens) and were compared to 25 healthy controls (18 men, 7 women, age range 18-50 years). The CMR protocol included cardiac cine images, pulmonary artery flow quantification, time resolved 3D contrast enhanced MR angiography (CEMRA) and high spatial resolution CEMRA. Chest wall indices including maximum transverse diameter, pectus index (PI), and chest-flatness were measured in all subjects. Left and right ventricular ejection fractions (LVEF, RVEF), ventricular long and short dimensions (LD, SD), mid-ventricle myocardial shortening, pulmonary-systemic circulation time, and pulmonary artery flow were quantified.</p> <p>Results</p> <p>In patients with pectus excavatum, the pectus index was 9.3 ± 5.0 versus 2.8 ± 0.4 in controls (P < 0.001). No significant differences between pectus excavatum patients and controls were found in LV ejection fraction, LV myocardial shortening, pulmonary-systemic circulation time or pulmonary flow indices. In pectus excavatum, resting RV ejection fraction was reduced (53.9 ± 9.6 versus 60.5 ± 9.5; P = 0.013), RVSD was reduced (P < 0.05) both at end diastole and systole, RVLD was increased at end diastole (P < 0.05) reflecting geometric distortion of the RV due to sternal compression.</p> <p>Conclusion</p> <p>Depression of the sternum in pectus excavatum patients distorts RV geometry. Resting RVEF was reduced by 6% of the control value, suggesting that these geometrical changes may influence myocardial performance. Resting LV function, pulmonary circulation times and pulmonary vascular anatomy and perfusion indices were no different to controls.</p

EQ-5D in Central and Eastern Europe : 2000-2015

Objective: Cost per quality-adjusted life year data are required for reimbursement decisions in many Central and Eastern European (CEE) countries. EQ-5D is by far the most commonly used instrument to generate utility values in CEE. This study aims to systematically review the literature on EQ-5D from eight CEE countries. Methods: An electronic database search was performed up to July 1, 2015 to identify original EQ-5D studies from the countries of interest. We analysed the use of EQ-5D with respect to clinical areas, methodological rigor, population norms and value sets. Results: We identified 143 studies providing 152 country-specific results with a total sample size of 81,619: Austria (n=11), Bulgaria (n=6), Czech Republic (n=18), Hungary (n=47), Poland (n=51), Romania (n=2), Slovakia (n=3) and Slovenia (n=14). Cardiovascular (20%), neurologic (16%), musculoskeletal (15%) and endocrine/nutritional/metabolic diseases (14%) were the most frequently studied clinical areas. Overall 112 (78%) of the studies reported EQ VAS results and 86 (60%) EQ-5D index scores, of which 27 (31%) did not specify the applied tariff. Hungary, Poland and Slovenia have population norms. Poland and Slovenia also have a national value set. Conclusions: Increasing use of EQ-5D is observed throughout CEE. The spread of health technology assessment activities in countries seems to be reflected in the number of EQ-5D studies. However, improvement in informed use and methodological quality of reporting is needed. In jurisdictions where no national value set is available, in order to ensure comparability we recommend to apply the most frequently used UK tariff. Regional collaboration between CEE countries should be strengthened

Pratos e mais pratos: louças domésticas, divisões culturais e limites sociais no Rio de Janeiro, século XIX

Reply to ten comments on a paper published in the last issue of this journal. The discussion follows along six main lines: History museums, identity, ideology and the category of nation; the need of material collections and their modalities: patrimonial, operational, virtual; theater versus laboratory; visitors and their ambiguities; Public History: the museum and the academy.Resposta aos comentários de dez especialistas que contribuíram no debate de texto publicado no último número desta revista. A discussão orientou-se segundo seis tópicos principais: museus históricos, identidade, ideologia e a categoria de nação; a necessidade de acervos materiais e suas modalidades: acervo patrimonial, operacional, virtual; teatro versus laboratório; o público e suas ambigüidades; História Pública: o museu e a Academia

The 1983 Temperature Gradient and Heat Flow Drilling Project for the State of Washington

During the Summer of 1983, the Washington Division of Geology and Earth Resources carried out a three-hole drilling program to collect temperature gradient and heat flow information near potential geothermal resource target areas. The project was part of the state-coupled US Department of Energy Geothermal Program. Richardson Well Drilling of Tacoma, Washington was subcontracted through the State to perform the work. The general locations of the project areas are shown in figure 1. The first hole, DNR 83-1, was located within the Green River valley northwest of Mount St. Helens. This site is near the Green River Soda Springs and along the projection of the Mount St. Helens--Elk Lake seismic zone. The other two holes were drilled near Mount Baker. Hole DNR 83-3 was sited about 1/4 km west of the Baker Hot Springs, 10.5 km east of Mount Baker, while hole DNR 83-5 was located along Rocky Creek in the Sulphur Creek Valley. The Rocky Creek hole is about 10 km south-southwest of the peak. Two other holes, DNR 83-2 and DNR 83-4, were located on the north side of the Sulphur Creek Valley. Both holes were abandoned at early stages of drilling because of deep overburden and severe caving problems. The sites were apparently located atop old landslide deposits

Geological and Geothermal Investigation of the Lower Wind River Valley, Southwestern Washington Cascade Range

The Wind River Valley, on the west slope of the Cascade Range, is a northwest-trending drainage that joins the Columbia River near Carson, Washington. The region has been heavily dissected by fluvial and glacial erosion. Ridges have sharp crests and deep subsidiary valleys typical of a mature topography, with a total relief of as much as 900 m. The region is vegetated by fir and hemlock, as well as dense, brushy ground-cover and undergrowth. The lower 8 km of the valley is privately owned and moderately populated. The upper reaches lies within the Gifford Pinchot National Forest, and include several campgrounds and day parks, the Carson National Fish Hatchery, and the Wind River Ranger Station and Wind River Nursery of the US Forest Service. Logging activity is light due to the rugged terrain, and consequently, most valley slopes are not accessible by vehicle. The realization that a potential for significant geothermal resources exists in the Wind River area was brought about by earlier exploration activities. Geologic mapping and interpretation was needed to facilitate further exploration of the resource by providing a knowledge of possible geologic controls on the geothermal system. This report presents the detailed geology of the lower Wind River valley with emphasis on those factors that bear significantly on development of a geothermal resource

Geochemical Analyses, Age Dates, and Flow-Volume Estimates for Quaternary Volcanic Rocks, Southern Cascade Mountains, Washington

Data collected over the last three years as part of a continuing study of the Quaternary volcanic rocks of the southern Cascade Mountains are presented. Whole-rock chemical analyses, selected trace element geochemistry, volume approximations, specific gravity determinations, and locations are provided for most of the 103 samples collected, and 21 radiometric age dates are included. In addition, partial information, including names and flow-volumes, are presented for 98 additional samples, collected for related studies. The study extends from the Columbia River north to the Cowlitz River and Goat Rocks Wilderness area, and from the Klickitat River west to the Puget-Willamette Trough. The volcanic rocks are all younger than 3 million years and consist primarily of tholeiitic and high-alumina basalts and basaltic-andesites erupted from numerous shield volcanoes and cinder cones. A few analyses of more silicic rocks, including hornblende and/or pyroxene andesites and dacites characteristic of the stratovolcanoes of the region, are also presented. However, systematic sampling of the stratovolcanoes in the study area, Mount Adams and Mount St. Helens, was not conducted. A map of the areal extent of Quaternary volcanic units and sample locations is included. It has been based on the 1:125,000 reconnaissance geologic map of the southern Cascade Range by Hammond (1980)

The 1980-1982 Geothermal Resource Assessment Program in Washington

Since 1978, the Division of Geology and Earth Resources of the Washington Department of Natural Resources has participated in the U.S. Department of Energy's (USDOE) State-Coupled Geothermal Resource Program. Federal and state funds have been used to investigate and evaluate the potential for geothermal resources, on both a reconnaissance and area-specific level. Preliminary results and progress reports for the period up through mid-1980 have already been released as a Division Open File Report (Korosec, Schuster, and others, 1981). Preliminary results and progress summaries of work carried out from mid-1980 through the end of 1982 are presented in this report. Only one other summary report dealing with geothermal resource investigations in the state has been published. An Information Circular released by the Division (Schuster and others, 1978) compiled the geology, geochemistry, and heat flow drilling results from a project in the Indian Heaven area in the south Cascades. The previous progress report for the geothermal program (Korosec, Schuster, and others, 1981) included information on temperature gradients measured throughout the state, heat flow drilling in the southern Cascades, gravity surveys for the southern Cascades, thermal and mineral spring investigations, geologic mapping for the White Pass-Tumac Mountain area, and area specific studies for the Camas area of Clark County and Mount St. Helens. This work, along with some additional studies, led to the compilation of the Geothermal Resources of Washington map (Korosec, Kaler, and others, 1981). The map is principally a nontechnical presentation based on all available geothermal information, presented as data points, tables, and text on a map with a scale of 1:500,000