<i>Candida albicans</i> fungaemia following traumatic urethral catheterisation in a paraplegic patient with diabetes mellitus and candiduria treated by caspofungin

A 58-year-old paraplegic male, with long-term indwelling urethral catheter, developed catheter block. The catheter was changed, but blood-stained urine was drained intermittently. A long segment of the catheter was seen lying outside his penis, which indicated that the balloon of Foley catheter had been inflated in urethra. The misplaced catheter was removed and a new catheter was inserted correctly. Gentamicin 160 mg was given intravenously; meropenem 1 gram every eight hours was prescribed; antifungals were not given. Twenty hours later, this patient developed distension of abdomen, tachycardia, and hypotension; he was not arousable. Computed tomography of abdomen revealed inflamed uroepithelium of right renal pelvis and ureter, 4 mm lower ureteric calculus with gas in right ureter proximally, and vesical calculus containing gas in its matrix. Urine and blood culture yielded &lt;i&gt;Candida albicans&lt;/i&gt;. Identical sensitivity pattern of both isolates suggested that the source of the bloodstream infection was most likely urine. Both isolates formed consistently high levels of biofilm formation in vitro as assessed using a biofilm biomass stain, and high levels of resistance to voriconazole were observed. Both amphotericin B and caspofungin showed good activity against the biofilms. HbA1c was 111 mmol/mol. This patient was prescribed human soluble insulin and caspofungin 70 mg followed by 50 mg daily intravenously. He recovered fully from candidemia

Coronary computed tomography angiography: an overview of clinical applications

High diagnostic accuracy has been achieved with coronary CT angiography using 64- and more slice CT scanners, and in selected patients, coronary CT angiography is considered a reliable alternative to invasive coronary angiography. Coronary CT angiography is able to detect variable densities in the coronary atherosclerotic plaques and demonstrate the corresponding intraluminal changes due to presence of plaques, thus providing prognostic value of disease extent. Despite the tremendous contributions of coronary CT angiography to cardiac imaging, coronary CT angiography suffered from high radiation dose, which has raised serious concerns in the literature. The aim of this review is to provide an overview of the clinical applications of coronary CT angiography in coronary artery disease with focus on diagnostic and predictive value of coronary CT angiography; technical developments of cardiac CT imaging and different approaches for radiation dose reduction

Seminoma of Testis Masquerading as Orchitis in an Adult with Paraplegia: Proposed Measures to Avoid Delay in Diagnosing Testicular Tumours in Spinal Cord Injury Patients

Orchitis is common in adult male spinal cord injury (SCI) patients and, therefore, both health professionals and SCI patients themselves tend to attribute testicular swelling to orchitis, with a consequent potential delay in the diagnosis of testicular tumours. A 37-year-old man with paraplegia developed swelling of the right testis. With a presumptive diagnosis of acute bacterial orchitis, he was prescribed ciprofloxacin while awaiting an ultrasound scan. Ultrasound examination of the testis 4 weeks later showed a moderate hydrocele, enlargement and altered echogenicity of both the epididymis and testis, and features of mass-like lesions within the substance of the testis. As these changes might merely have represented a partly treated infection, a follow-up scan was carried out 2 weeks later, which revealed a lobulated mass of mixed echogenicity within the testis and a focal area of increased echogenicity indicative of calcification. A radical orchidectomy performed 19 days later revealed a seminoma. To prevent delay in the diagnosis of testicular tumours in SCI patients, we propose the following measures: (1) patients who develop swelling of the testis should consult a physician as soon as possible for clinical examination; blind antibiotic therapy should be avoided if possible; (2) if clinical examination reveals a hard swelling of the testis and the typical features of acute urinary infection are absent, an ultrasound scan of the scrotum should be performed as soon as possible; (3) in patients with equivocal ultrasound findings, ultrasound-guided, fine-needle aspiration cytology may allow an early diagnosis of testicular malignancy; (4) education of SCI patients and their caregivers is needed to implement these recommendations

Effect of width and temperature of a vertical parallel plate channel on the transition of the developing thermal boundary layer

Numerical simulations are performed to study the transition of the development of the thermal boundary layer of air along an isothermal heated plate in a large channel which is bounded by an adiabatic plate. In particular, the aim is to investigate the effects of the channel width (b) on the transition of the flow under various plate temperatures. Three different RANS based turbulent k–ε models namely standard, RNG and Realizable with an enhanced wall function are employed in the simulations. The channel width was varied from 0.04 m to 0.45 m and the numerical results of the maximum values of the flow velocity, turbulent kinetic energy were recorded along the vertical axis to examine the critical distance of the developing flow. The results show that the transition delays when the width is increased from 0.04 m to 0.08 m and particularly, the critical distance at b = 0.08 m reaches its maximum with the Grashof number of 2.8 × 1010. However, the critical distance drops when b is increased further from 0.08 m to 0.45 m, indicating an early transition of the flow. The transition remains unaffected by the adiabatic plate when b is greater than 0.45 m. Comparisons of selected numerical results are made with available experimental data of turbulent flow and a satisfied agreement is received

R&D Management Trends in the United States, India and China

This study researches the Management of Research and Development (R&amp;D) in the emerging economies of India and China and compares theirs with R&amp;D in the United States (US). The purpose of this research is to forecast the future of R&amp;D in these three countries. Because R&amp;D is changing rapidly, particularly in China, understanding where they will be in the future is of interest to the scientific, academic, government and business segments of each country. Our research consisted of gathering industry standard measures of R&amp;D from 1996 through 2009. These measures are as follows: R&amp;D spending as a percentage of GDP (total government, industry and universities), researchers per million inhabitants, number of patents granted each year, number publications each year and total number of graduates in all programs in thousands. We gathered and logged the metrics for each year from 1996 through 2009 and used the historical data to forecast future positioning of R&amp;D in these countries. An overview of each country is provided in the introductory portion of this paper. This provides the context for the historical performance of R&amp;D and for expected future performance of R&amp;D in the US, India and China

Simple Local Computation Algorithms for the General Lovasz Local Lemma

We consider the task of designing Local Computation Algorithms (LCA) for applications of the Lov\'{a}sz Local Lemma (LLL). LCA is a class of sublinear algorithms proposed by Rubinfeld et al.~\cite{Ronitt} that have received a lot of attention in recent years. The LLL is an existential, sufficient condition for a collection of sets to have non-empty intersection (in applications, often, each set comprises all objects having a certain property). The ground-breaking algorithm of Moser and Tardos~\cite{MT} made the LLL fully constructive, following earlier results by Beck~\cite{beck_lll} and Alon~\cite{alon_lll} giving algorithms under significantly stronger LLL-like conditions. LCAs under those stronger conditions were given in~\cite{Ronitt}, where it was asked if the Moser-Tardos algorithm can be used to design LCAs under the standard LLL condition. The main contribution of this paper is to answer this question affirmatively. In fact, our techniques yield LCAs for settings beyond the standard LLL condition

A study of the efficacy of flashing lights to increase the salience of alcohol-gel dispensers for improving hand hygiene compliance

BackgroundMany interventions have been implemented to improve hand hygiene compliance, each with varying effects and monetary costs. Although some previous studies have addressed the issue of conspicuousness, we found only 1 study that considered improving hand hygiene by using flashing lights.MethodOur attention theory–based hypothesis tested whether a simple red light flashing at 2-3 Hz affixed to the alcohol gel dispensers, within the main hospital entrance, would increase hand hygiene compliance over the baseline rate. Baseline and intervention observations were completed over five 60-minute periods (Monday-Friday) from 7:30 to 8:30 AM using a covert observation method.ResultsBaseline hand hygiene compliance was 12.4%. Our intervention increased compliance to 23.5% during cold weather and 27.1% during warm weather. Overall, our pooled compliance rate increased to 25.3% (P < .0001).ConclusionsA simple, inexpensive flashing red light affixed to alcohol gel dispensers was sufficiently salient to approximately double overall hand hygiene compliance within the main hospital entrance. We hypothesize that our intervention drew attention to the dispensers, which then reminded employees and visitors alike to wash their hands. Compliance was worse during cold days, presumably related to more individuals wearing gloves

An analysis of likes and dislikes for history and geography of 3360 sixth grade children

Thesis (Ed.M.)--Boston Universit