Arrival of carbapenem-hydrolyzing-oxacillinases in Acinetobacter baumannii in Bosnia and Herzegovina

Multidrug-resistant Acinetobacter baumannii (MDR-AB) is an important threat for critically ill patients. It can infect the respiratory tract, blood, soft tissues, urinary tract and central nervous system. Recently, carbapenem-resistance was observed in A. baumannii clinical isolates from Bosnia and Herzegovina. This prompted us to analyze these isolates with regards to genotypic diversity, antibiotic susceptibility and occurrence of acquired carbapenem resistance genes. Twelve carbapenem-resistant isolates were collected at a University hospital during two different periods of 2011 and 2015-2016: four isolates in 2011 and eight isolates 2015-2016 and compared to determine the dynamic changes in carbapenemase resistance mechanisms and population structure. All twelve isolates were positive for intrinsic blaOXA-51-like, nine for blaOXA-40-like and one for the blaOXA-23-like gene. ISAba1 was found upstream of blaOXA-51 in all and upstream of blaOXA-23-like gene in one isolate. Sequencing of the selected PCR products revealed the presence of OXA-72 β-\ud lactamase (strain 1) and OXA-23 β-lactamase (strain 41). WGS of the selected isolate (AB 5) revealed the presence of blaOXA-72, chromosomal genes blaOXA-69 and blaADC. Moreover, the aac (3)-1a and aadA1 genes encoding aminoglycoside resistance, and sul1encoding sulphonamide resistance were identified. PFGE and rep-PCR revealed two clones containing highly similar isolates positive for OXA-40-like; one from 2011 and the other from 2015- 2016. Implementation of hospital hygiene measures, screening of the patients on admission for carriage of MDR-AB, and the early and accurate detection, with restriction of antibiotic use should be recommended to control the spread of these important hospital pathogenes. To our knowledge, this is the first report of A. baumannii isolates producing carbapenem-hydrolyzing oxacillinases (CHDL) from Bosnia and Herzegovina

Emergence of multidrug-resistant Proteus mirabilis in a long-term care facility in Croatia

BACKGROUND: An increased frequency of Proteus mirabilis isolates resistant to expanded-spectrum cephalosporins was observed recently in a long-term care facility in Zagreb (Godan). The aim of this study was the molecular characterization of resistance mechanisms to new cephalosporins in P. mirabilis isolates from this nursing home. ----- METHODS: Thirty-eight isolates collected from 2013-2015 showing reduced susceptibility to ceftazidime were investigated. Antibiotic susceptibilities were determined by broth microdilution method. Inhibitor-based tests were performed to detect extended-spectrum (ESBLs) and AmpC β-lactamases. AmpC β-lactamases were characterized by polymerase chain reaction (PCR) followed by sequencing of bla ampC genes. Quinolone resistance determinants (qnr genes) were characterized by PCR. Genotyping of the isolates was performed by repetitive element sequence (rep)-PCR and pulsed-field gel electrophoresis (PFGE). ----- RESULTS: Presence of an AmpC β-lactamase was confirmed in all isolates by combined-disk test with phenylboronic acid. All isolates were resistant to amoxicillin alone and combined with clavulanate, cefotaxime, ceftriaxone, cefoxitin, and ciprofloxacin; but susceptible to cefepime, imipenem, and meropenem. PCR followed by sequencing using primers targeting bla ampc genes revealed CMY-16 β-lactamase in all but one strain. Bla cmy-16 was carried by a non-conjugative plasmid which did not belong to any known plasmid-based replicon typing (PBRT) group. Rep-PCR identified one large clone consisting of 15 isolates, three pairs or related isolates, one triplet, and four singletons. PFGE confirmed the clonality of the isolates. ----- CONCLUSIONS: This is the first report of multidrug resistant P. mirabilis in a nursing home in Croatia. Cephalosporin resistance was due to plasmid-mediated AmpC β-lactamase CMY-16

The challenge and response to global tourism in the post-modern era: the commodification, reconfiguration and mutual transformation of Habana Vieja, Cuba

There is a growing literature on the symbolic and cultural meanings of tourism and the ways in which cities are increasingly competing for tourists through the promotion of cultural assets and different forms of spectacle in the `tourist bubble'. To date, research on the role and impact of tourism in cities has largely been confined to those in Western, post-industrial economies. This paper examines the growth of cultural tourism in the central area of Havana, Cuba, and explores the range of unique, devolved, state-owned enterprises that are attempting to use tourism as a funding mechanism to achieve improvements in the social and cultural fabric of the city for the benefit of residents. The paper concludes with an assessment of the implications of this example for our understanding of how the pressures for restructuring and commodification can be moderated at the city level. Copyright 2008 SAGE Publications. All rights reserved. Not for commercial use or unauthorized distribution

Numerical study on load-bearing capabilities of beam-like lattice structures with three different unit cells

The design and analysis of lattice structures manufactured using Additive Manufacturing (AM) technique is a new approach to create lightweight high-strength components. However, it is difficult for engineers to choose the proper unit cell for a certain function structure and loading case. In this paper, three beam-like lattice structures with triangular prism, square prism and hexagonal prism were designed, manufactured by SLM process using AlSi10Mg and tested. The mechanical performances of lattice structures with equal relative density, equal base area and height, and equal length for all unit cells were conducted by Finite Element Analysis (FEA). It was found that effective Young’s modulus is proportional to relative density, but with different affecting levels. When the lattice structures are designed with the same relative density or the same side lengths, the effective Young’s modulus of lattice structure with triangular prism exhibits the maximum value for both cases. When the lattice structures are designed with the same base areas for all unit cells, the effective Young’s modulus of lattice structures with square prism presents the maximum. FEA results also show that the maximum stress of lattice structures with triangular prisms in each comparison is at the lowest level and the stiffness-to-mass ratio remains at the maximum value, showing the overwhelming advantages in terms of mechanical strength. The excellent agreements between numerical results and experimental tests reveal the validity of FEA methods applied. The results in this work provide an explicit guideline to fabricate beam-like lattice structures with the best tensile and bending capabilities

Modeling and simulation of highly porous open cell structures - elasto-plasticity and localization versus disorder and defects

Zellulare Materialien stellen eine besondere Klasse von Werkstoffen dar.Sie treten häufig in der Natur auf (Knochen, Holz, Kork, etc.), finden sich aber auch in vielen technischen Anwendungen wieder (Kerne von Sandwichplatten, Aufprallschutz, Verpackung, usw.).Ihre hervorragenden Eigenschaften wie hohes Energieaufnahmevermögen, gute Formbarkeit und ausgezeichnete Dämmung werden hauptsächlich durch ihre Mikrostruktur bestimmt.Die Möglichkeit, ihre Eigenschaften, d.h. ihre Mikrostruktur, für bestimmte Einsatzgebiete anzupassen, macht sie in hohem Ausmaß für technische Anwendungen interessant.Speziell ermöglicht der Einsatz von Rapid Prototyping Verfahren die Erzeugung zellularer Strukturen mit maßgeschneiderten mechanischen Eigenschaften.Hierfür ist es unumgänglich das mechanische Verhalten von zellularen Strukturen zu verstehen.Die vorliegende Arbeit beschäftigt sich mit der numerischen Simulation des mechanischen Verhaltens von regelmäßigen und unregelmäßigen offenzelligen Strukturen.Dabei liegt das Hauptaugenmerk auf Strukturen die mittels des Rapid Prototyping Verfahrens hergestellt werden können.In Kapitel 2 werden verschiedene Ansätze für die Modellierung von offenzelligen Strukturen mittels der Methode der Finiten Elemente dargestellt.Unter Verwendung von Kontinuumselementen und Balkenelementen, mit und ohne einer Anpassung der Steifigkeit im Bereich der Strukturknoten, werden die Strukturen als unendliche und endliche Medien betrachtet.Es werden die linear elastischen Eigenschaften verschiedener Strukturen ermittelt und ein Vergleich zu experimentellen Ergebnissen gezogen. Unter Berücksichtigung von elastisch-plastischem Verhalten des Grundmaterials, großen Verformungen und Lokalisieren der Deformation werden in Kapitel 3 die Untersuchungen auf das nichtlineare mechanische Verhalten ausgeweitet.Unregelmäßige Strukturen werden durch zufälliges Verschieben der Strukturknoten erzeugt.Der Einfluss dieser strukturellen Unordnung auf die elastische Anisotropie, das nichtlineare mechanische Verhalten, die Verteilung der mechanischen Energie sowie das Lokalisierungsverhalten wird für endliche Strukturen unter einachsiger Kompression untersucht.Kapitel 4 widmet sich der Frage welchen Einfluss die Form und die Größe der Strukturen auf ihr mechanisches Verhalten haben.Es wird das nichtlineare Verhalten und das Lokalisieren von quaderförmigen und zylindrischen Strukturen unter einachsigem Druck verglichen. Aufbauend auf die Erkenntnisse der vorangegangenen Kapitel werden in Kapitel 5 neue offenzellige Strukturen mit vorgegebenen mechanischen Eigenschaften entworfen.Dabei ist das Ziel, Strukturen mit hoher Steifigkeit bei gleichzeitiger geringen elastischen Anisotropie zu entwickeln.Weiters wird das nichtlineare Verhalten der vorgeschlagenen Strukturen unter einachsigem Druck betrachtet und ein Vergleich zu experimentellen Ergebnissen präsentiert.Zum Abschluß werden in Kapitel 6 die Auswirkungen von Defekten in regelmäßigen und unregelmäßigen offenzelligen Strukturen untersucht.Es werden drei verschiedene Klassen von Defekten, die alle die gleiche Anzahl an fehlenden Stäben aufweisen, in zylindrische Strukturen eingebracht und das nichtlineare mechanische Verhalten unter einachsigem Druck verglichen.Cellular materials are a unique class of materials and can be found in nature (bone, wood, cork, etc.) as well as in engineering applications (in the cores of sandwich panels, crash protection, packaging, etc.).Their excellent properties like high energy absorption, good formability, and excellent insulation are mainly determined by their microstructure.The possibility of tailoring their overall properties, i.e. their microstructure, for certain service conditions makes them highly attractive for engineering applications.Especially the introduction of Rapid Prototyping techniques opens the possibility of building cellular structures with predetermined properties.Therefore an understanding of the mechanical behavior of cellular materials is crucial.In the present thesis numerical simulations regarding the mechanical behavior of regular and irregular open cell structures are carried out with the focus on open cell structures fabricated by Rapid Prototyping.In Chapter 2 several approaches regarding the modelling of open cell structures by means of the Finite Element Method are presented.The structures are treated as infinite and finite media, respectively, employing continuum element based models as well as beam element based models with and without an adaption of stiffness in the vicinity of the vertices.The linear elastic properties of various cell architectures are predicted and a comparison to experimental results is shown.In Chapter 3 the investigations are extended to the nonlinear behavior of open cell materials, taking into account elastic-plastic bulk material behavior, large strain theory, and deformation localization.Disordered structures are generated by randomly shifting the vertex positions of regular structures.The influence of structural disorder on the elastic anisotropy, the nonlinear mechanical response, the distribution of the mechanical energy, and the deformation localization is investigated for two different finite structures subjected to uniaxial compression.The influence of the size and the shape of finite cellular structures on their mechanical response is discussed in Chapter 4.The nonlinear response and the deformation localization of cuboidal and cylindrical finite samples subjected to uniaxial compression are compared.Based on the findings of the previous chapters, new open cell structures with predetermined mechanical properties are introduced in Chapter 5.The design goal is high overall stiffness at low elastic anisotropy.Furthermore, their nonlinear properties are discussed and a comparison to experimental results is presented.Finally, the effect of defects on the mechanical behavior of regular and disordered open cell structures is investigated in Chapter 6.Three different types of defects, all representing the same amount of missing struts, are introduced to cylindrical samples with varying lattice orientations and their nonlinear mechanical responses under uniaxial compression is compared.11

Delmar's παιδιατρική νοσηλευτική

Η βιβλιοθήκη διαθέτει αντίτυπο του βιβλίου με ταξινομικό αριθμό: RJ245 .L8915 201

On the History of the Icelandic Pronouns nokkur and nokkuð. An examination of selected manuscripts from the 13th to the 16th century

In his article “Óákv. forn. nokkur, nokkuð” published in Lingua Islandica — Íslenzk tunga in the years 1961­62 Hreinn Benediktsson presents a very thorough study of the Icelandic indefinite pronouns nokkur and nokkuð, especially concerning their earliest development. When in the year 2002 a revised and translated version of this article was published in Hreinn Benediktsson’s collected papers “Linguistic Studies, Historical and Comparative” no new major contributions on the history of these pronouns had appeared. The lack of sufficient data was mentioned by Hreinn Benediktsson already in 1961­62, and in 2002 he still discusses more or less the same problems based on an insufficient amount of data (Hreinn Benediktsson 1961­62:29; 2002:495­96). As a consequence some aspects of the history of the Icelandic pronouns nokkur, nokkuð still deserve further examination. The present work aims at finding answers to the following three questions: 1. What was the nature of the change of the vowel in the first syllable? When did the change from /ö/ to /o/ happen? 2. When do the first indications of u­syncope in trisyllabic forms appear, i.e. when does the stem nokkr­ appear? 3. What was the development of word­final -rr and intervocalic r(r) in these pronouns? To do this, it was necessary to set up a corpus with sufficient data. This data was extracted from nineteen Jónsbók manuscripts from the late thirteenth century until the late sixteenth century

Delmasr's geriatric:nursing care plans

The nursing process serves as a learning tool for readars and as a practice and documentation format for clinicians.xv, 335 hlm.: ilus.; 26 c