Temocillin in the treatment of Burkholderia cepacia infection in cystic fibrosis

AbstractBackgroundInfections due to Burkholderia cepacia complex (Bcc) strains increase morbidity and mortality in cystic fibrosis (CF). Some transplant centres reject Bcc infected patients. We reviewed the results in patients treated with i.v temocillin.MethodsTwenty-three patients who received 38 courses of temocillin (1988–1998) were identified from the CF database at Royal Brompton Hospital. In three patients' data were inadequate; therefore analysis was done in 20. Outcome was measured as improvement, deterioration or no change (compared to admission) in the following categories: clinical (temperature, dyspnoea, sputum volume, chest pain), physiological (FEV1, FVC, oxygen saturation) and inflammatory markers (WBC, ESR, CRP). Patients who improved in two categories were classified as having improved. Antibiotic sensitivities and outcome were recorded.ResultsIn 18 of 32 courses (56.25%) improvement occurred. The organism (Bcc) in eight patients' sputum became resistant (three died). The antibiotics was changed in five patients with Bcc strains sensitive to temocillin because of no improvement and one patient due to allergy (rash). The average time to the next i.v antibiotic was 41 days. Eight patients died (in three the Bcc strain was resistant to temocillin). Fourteen patients with Bcc were transplanted and eight patients survived. Another patient who developed Bcc infection post-operatively, failing to respond to temocillin.ConclusionsThese results suggest the potential benefit of i.v temocillin in CF patients with Bcc for exacerbations and at the time of transplantation

Algebraic time-decay for the bipolar quantum hydrodynamic model

The initial value problem is considered in the present paper for bipolar quantum hydrodynamic model for semiconductors (QHD) in $\mathbb{R}^3$. We prove that the unique strong solution exists globally in time and tends to the asymptotical state with an algebraic rate as $t\to+\infty$. And, we show that the global solution of linearized bipolar QHD system decays in time at an algebraic decay rate from both above and below. This means in general, we can not get exponential time-decay rate for bipolar QHD system, which is different from the case of unipolar QHD model (where global solutions tend to the equilibrium state at an exponential time-decay rate) and is mainly caused by the nonlinear coupling and cancelation between two carriers. Moreover, it is also shown that the nonlinear dispersion does not affect the long time asymptotic behavior, which by product gives rise to the algebraic time-decay rate of the solution of the bipolar hydrodynamical model in the semiclassical limit.Comment: 23 page

Designing movement into automotive seating - does it improve comfort?

Comfort is important for a good driving experience and automotive seat technology is an important enabler of this. Movement through frequent changes in posture is beneficial for reducing fixed postures. This paper reports on a laboratory study to investigate a novel automotive seat movement concept aiming to delay the onset of driving-related musculoskeletal fatigue and improve feelings of comfort and wellbeing, making the driver feel refreshed and ultimately improving driver performance. The research involved comparison of three seat conditions while driving - no seat movement, fore-aft movement, cushion and backrest angle movement. The movement was designed to be at a fixed speed, slow, smooth and only slightly perceptible while driving. A sample of 10 participants was recruited to take part in a 60 minute drive for each condition-single blind, repeated measures, balanced order and sessions at a similar time of day. Discomfort and wellbeing questionnaires, driver Seat Fidgets and Movements (SFMs), posture capture and a de-brief were used as data collection methods. Results indicate that the two seat movement concepts were positively received. Statistically significant differences were found at minute 60 for buttock area discomfort, with less reported discomfort for the two movement conditions. As expected, overall discomfort ratings and SFMs frequency increased with time spent driving for all trials. Posture scores verified that driver posture was within comfortable ranges and as expected fairly static while driving

Design and Validation of a Bifunctional Ligand Display System for Receptor Targeting

AbstractHere we developed a bacteriophage display particle designed to serve as a bifunctional entity that can target tumors while delivering an agent. We engineered a chimera phage vector containing a pIII-displayed αv integrins-targeting moiety and a pVIII-displayed streptavidin binding adaptor moiety. By using the chimeric phage particle, targeting of αv integrins on cells in culture and tumor-related blood vessels was shown through different applications, including luminescent quantum dots localization, surface plasmon resonance-based binding detection, and an in vivo tumor model. The strategy validated here will accelerate the discovery and characterization of receptor-ligand binding events in high throughput, and cell-specific delivery of diagnostics or therapeutics to organs of choice without the need for chemical conjugation

Clinical importance of cystic fibrosis-related diabetes

AbstractThe prevalence of cystic fibrosis-related diabetes (CFRD) and glucose intolerance (IGT) has risen dramatically over the past 20 years as survival has increased for people with cystic fibrosis (CF). Diabetes is primarily caused by pancreatic damage, which reduces insulin secretion, but glucose tolerance is also modified by factors that alter insulin resistance, such as intercurrent illness and infection. CFRD not only causes the symptoms and micro and macrovascular complications seen in type 1 and type 2 diabetes in the general population, but also is associated with accelerated pulmonary decline and increased mortality. Pulmonary effects are seen some years before the diagnosis of CFRD, implying that impaired glucose tolerance may be detrimental.Current practice is to screen for changes in glucose tolerance by regular measurement of fasting blood glucose, by oral glucose tolerance test or a combination of these approaches with symptom review and measurement of HbA1C. Treatment is clearly indicated for those with CFRD and fasting hyperglycaemia to control symptoms and reduce complications. As nutrition is critical in people with CF to maintain body mass and lung function, blood glucose should be controlled in CFRD by adjusting insulin doses to the requirements of adequate food intake and not by calorie restriction. It is less clear whether blood glucose control will have clinical benefits in the management of patients with CFRD without fasting hyperglycaemia or with impaired glucose tolerance and further studies are required to establish the best treatment for this patient group

A woman with cystic fibrosis, severe hypoxaemia, an atrial thrombus and a patent foramen ovale: a case report

<p>Abstract</p> <p>Introduction</p> <p>Cystic fibrosis is usually associated with chronic pulmonary sepsis and frequent infective exacerbations. We report a very unusual cause of severe hypoxaemia in a woman with cystic fibrosis caused by thrombus formation in the right atrium.</p> <p>Case presentation</p> <p>A 21-year-old Caucasian woman with cystic fibrosis and a totally implantable venous access device presented with severe hypoxaemia. This was initially treated with antibiotics but her oxygen levels did not improve significantly. Subsequently, a transient ischaemic attack occurred. Further investigations, including a contrast echocardiogram and a cardiac magnetic resonance scan, revealed the presence of a large right atrial thrombus and right-to-left intracardiac shunt through a patent foramen ovale.</p> <p>Conclusion</p> <p>This case highlights the need to consider a right-to-left shunt in chronic respiratory diseases when hypoxaemia is out of proportion to the degree of lung function impairment. Totally implantable venous access devices should always be considered as a source of thrombus formation.</p

Stress and exclusion: principles and tools for inclusive design

The Journey Stress Calculator is one of the tools that Loughborough University is developing as part of the Accessibility and User Needs in Transport for Sustainable Urban Environments (AUNT-SUE) project. The ambitious aim of this tool is to model the psychological stress that 100 people would experience during any public transport journey. Assessing whole journey accessibility in this way has been born out of a fresh perspective on the causes of social exclusion. This paper provides an introduction to psychological stress theory and proposes two key principles. The exclusion transaction explains how individual instances of exclusion occur, whilst stressor elimination is the mechanism that reduces exclusion. The potential benefits of understanding exclusion in this way are discussed and it is suggested that the aim of inclusive design should be the elimination of stressors that associated with products and systems. Practical implementation of this approach would rely on the availability of techniques that can be easily integrated into design and policy making processes. The Journey Stress Calculator is one example of how this may be achieved, but simpler and more generally applicable tools are also proposed

ACMECS Bioenergy 2015. Three Years of Effort Towards a Regional Bioenergy Network

Global change, including climate change, societal dynamics, economic challenges, environmental protection and the need to improve livelihoods and to reduce poverty have led to a situation where national solutions must be embedded in regional strategies. The ACMECS countries Lao PDR, Cambodia, Myanmar, Thailand and Vietnam have a long tradition in collaboration across borders. Despite the cultural heterogeneity and different status of development, it can be a great advantage to address global challenges together. Biomass is seen as a promising resource for energy and industrial raw materials, but the challenge is that biomass production requires land and increased production can cause conflicts and environmental degradation. The increased demand for biomass in the recent years, coupled with the fact that the balance between domestic, regional and foreign demand for biomass is changing, requires careful attention. As a consequence of these developments, the Kasetsart Agricultural and Agro-Industrial Product Improvement Institute (KAPI) of the Kasetsart University, Thailand initiated a process to establish a regional bioenergy network. International experts, including members of the IUFRO Task Force "Sustainable Forest Biomass Network (SFBN)", have acknowledged the significant progress made over the last few years. This report is jointly published with the IUFRO Occasional Paper series, Vol. 31 (http://www.iufro.org/publications/series/occasional-papers/article/2016/04/20/occasional-paper-31-acmecs-bioenergy-2015-three-years-of-efforts-towards-a-regional-bioenergy-n/

A toilet system based on hydrothermal carbonization

We are developing a toilet system that converts faecal material to an aqueous suspension of carbonised material that is safe to handle, and readily separated from the remaining liquid. It will also extract useful salts from the liquid. The system is aim to be the new generation universally appealing toilet and it will be of particular and urgent interest to areas where no (or very crude) sanitation exists. The system is designed to be self-sufficient in terms of energy input and to scale for a number of users in the range a few tens to a thousand or more. In parallel with our engineering development we are designing the system to provide users with a positive and comfortable experience. Hydrothermal carbonisation (HTC) has received attention recently as a way to convert biomass - including sewerage - into coal like material. It involves heating the start material in water at high temperatures and pressures. Depending on the conditions used the process can produce hydrocarbon gases or liquids or coal like particles. Most HTC work involving sewerage treatment is currently aimed at replacing established large-scale treatment plants i.e. for places with well-developed sewerage services. Our system, using HTC, is aimed at bringing the process at a decentralized household ( including combination of households) level so that the new generation toilet become accessible to all and particularly to those areas where none currently exists. Using HTC for toilets on continuous basis for such a small scale is the key innovation of our proposed system. We will describe our work to characterise the energetics of the HTC process in order to optimise the process in terms of total energy input and how we have used this information to develop a continuous system based on a plug flow reactor. The material produced by the system can be easily separated from the remaining liquid and used to generate heat and power (via a generator including solar) in order to maintain the process. The solids are safe to handle, and look, feel and smell much like coffee grounds. In situations where electrical (or renewable energy like solar) power is available the solid material can be used either as a fuel for heating and cooking, as a soil conditioner and possibly for carbon capture. We will discuss the possibility of including other waste material (food, sanitary waste etc.) into the system. In order to minimize the amount of water required to flush material away from the toilet bowl and to help maintain high sanitary standards we have been investigating anti-fouling coatings for the system. We will describe the results of studies of a nano-coating based on a responsive polymer that significantly enhances the rate at which water flushes away material that adheres to the toilet surface

Airway glucose concentrations and effect on growth of respiratory pathogens in cystic fibrosis

AbstractBackgroundPulmonary decline accelerates in cystic fibrosis-related diabetes (CFRD) proportional to severity of glucose intolerance, but mechanisms are unclear. In people without CF, airway glucose (AG) concentrations are elevated when blood glucose (BG)≥8 mmol L−1 (airway threshold), and are associated with acquisition of respiratory infection.MethodsTo determine the relationship between BG and AG, 40 CF patients underwent paired BG and AG (nasal) measurements. Daily time with BG>airway threshold was compared in 10 CFRD, 10 CF patients with normal glucose tolerance (CF-NGT) and 10 healthy volunteers by continuous BG monitoring. The effect of glucose at airway concentrations on bacterial growth was determined in vitro by optical densitometry.ResultsAG was present more frequently (85%-vs.-19%, p<0.0001) and at higher concentrations (0.5–3 mmol L−1-vs.-0.5–1 mmol L−1, p<0.0001) when BG was ≥8 mmol L−1-vs.-<8 mmol L−1. Daily time with BG≥8 mmol L−1 was CFRD (49±25%), CF-NGT (6±5%), healthy volunteers (1±3%), p<0.0001. Staphylococcus aureus growth increased at ≥0.5 mmol L−1 (p=0.006) and Pseudomonas aeruginosa growth above 1–4 mmol L−1 glucose (p=0.039).ConclusionsBG≥8 mmol L−1 predicted elevated AG concentrations in CF, at least in nasal secretions. CFRD patients spent ∼ 50% day with BG>airway threshold, implying persistently elevated AG concentrations. Further studies are required to determine whether elevated airway glucose concentrations contribute to accelerated pulmonary decline in CFRD