Small world effect in an epidemiological model

A model for the spread of an infection is analyzed for different population structures. The interactions within the population are described by small world networks, ranging from ordered lattices to random graphs. For the more ordered systems, there is a fluctuating endemic state of low infection. At a finite value of the disorder of the network, we find a transition to self-sustained oscillations in the size of the infected subpopulation

A pharmacodynamic analysis of resistance trends in pathogens from patients with infection in intensive care units in the United States between 1993 and 2004

<p>Abstract</p> <p>Background</p> <p>Increasing nosocomial pathogen resistance to available antimicrobial agents is of growing concern. While higher MICs can diminish antimicrobial effectiveness, dose adjustments often mitigate this effect. This study's objective was to ascertain whether MICs among major pathogens in the ICU to several commonly used agents have increased enough to significantly impact their ability to achieve bactericidal effect.</p> <p>Methods</p> <p>Cefepime, ceftriaxone, imipenem and piperacillin-tazobactam MICs were determined with 74,394 Gram-negative bacilli obtained from ICU patients with various infections in the US between 1993 and 2004. Results were grouped into four 3-year periods. The predicted cumulative fraction of response (CFR) was estimated based on patient-derived pharmacokinetic values and Monte Carlo simulation. Trends in CFR over the four study periods were assessed using the Cochran-Armitage test. The primary analysis included all organisms combined; <it>Pseudomonas aeruginosa </it>and <it>Acinetobacter </it>species were also evaluated individually.</p> <p>Results</p> <p>In the primary analysis, imipenem 500 mg q6h showed CFRs from 87% to 90% across all four study periods, with a trend toward slightly improved bactericidal target attainment (p < 0.01). CFRs for cefepime 2 g q12h and piperacillin-tazobactam 4.5 g q6h both declined by 2% (p < 0.01 and p < 0.05, respectively), reflecting upward shifts in the underlying MIC distributions. Ceftriaxone had <52% CFR for all regimens in all periods, with no significant trend. Against <it>P. aeruginosa</it>, significant declines in CFR were seen for (range, p-value): imipenem 1 g q8h (82%–79%, p < 0.01), cefepime 1 g q12h (70%–67%, p < 0.01), cefepime 2 g q12h (84%–82%, p < 0.05), piperacillin-tazobactam 3.375 g q6h (76%–73%, p < 0.01), piperacillin-tazobactam 4.5 g q8h (71%–68%, p < 0.01), and piperacillin-tazobactam 4.5 g q6h (80%–77%, p < .01). Against <it>Acinetobacter </it>spp., all regimens of imipenem, cefepime and piperacillin-tazobactam showed significant declines in CFR over time (p < 0.01).</p> <p>Conclusion</p> <p>Our observations suggest that as a result of increasing antimicrobial resistance among ICU pathogens in the US, drug effectiveness, assessed as a function of individual agents' ability to attain pharmacodynamic targets, has declined, especially with <it>P. aeruginosa </it>and <it>Acinetobacter </it>spp. Cefepime 2 g q8h and imipenem were the most potent agents against these species, respectively. More aggressive dosing of all of the agents characterized could preserve their clinical utility, but this must be balanced with safety and tolerability issues by the physician.</p

Effects of Transport Memory and Nonlinear Damping in a Generalized Fisher's Equation

Memory effects in transport require, for their incorporation into reaction diffusion investigations, a generalization of traditional equations. The well-known Fisher's equation, which combines diffusion with a logistic nonlinearity, is generalized to include memory effects and traveling wave solutions of the equation are found. Comparison is made with alternate generalization procedures.Comment: 6 pages, 4 figures, RevTeX

Improving rigid fiberoptic intubation: a comparison of the Bonfils Intubating Fiberscope™ with a novel modification

<p>Abstract</p> <p>Background</p> <p>The Bonfils intubating fiberscope has a limited upward tip angle of 40° and requires retromolar entry into the hypopharynx. These factors may make its use less desirable when managing the difficult airway because most anesthesia providers are well versed in midline oral intubation rather than the lateral retromolar approach. The <it>Center for Advanced Technology and Telemedicine </it>at the University of Nebraska Medical Center has developed a novel fiberscope with a more anterior 60° curve to allow for easier midline insertion and intubation. The objective of this work was to evaluate the novel fiberscope, in comparison to the Bonfils intubating fiberscope, in terms of use and function in difficult airway intubation.</p> <p>Methods</p> <p>Twenty-two anesthesia providers participated in simulated intubations of a difficult airway mannequin to compare the Bonfils intubating fiberscope with the novel curved Boedeker intubating fiberscope. The intubations were assessed based upon the following variables: recorded Cormack Lehane airway scores, requests for cricoid pressure, time to intubation, number of intubation attempts and success or failure of the procedure.</p> <p>Results</p> <p>Participants using the Bonfils fiberscope recorded an average Cormack Lehane (CL) airway score of 1.67 ± 1.02 (median = 1); with the novel fiberscope, the recorded average airway grade improved to 1.18 ± 0.50 (median = 1). The difference in airway scores was not statistically significant (p = 0.34; Fishers Exact Test comparing CL grades 1&2 vs. 3&4). There was, however, a statistically significant difference in intubation success rates between the two devices. With the Bonfils fiberscope, 68% (15/22) of participants were successful in intubation compared to a 100% success rate in intubation with the novel fiberscope (22/22) (p = 0.008). After the intubation trial, the majority of participants (95%) indicated a preference for the novel fiberscope (n = 20).</p> <p>Conclusions</p> <p>With this data, we can infer that the novel fiberscope curvature appears to improve or maintain the quality of an intubation attempt (airway score, cricoid pressure requirement, intubation time, number of attempts, placement success). The data indicate that the novel fiberscope offers a superior intubation experience to currently available best practices. The instrument was well received and would be welcomed by most study participants should the device become clinically available in the future.</p

Lifecourse socioeconomic status and type 2 diabetes: the role of chronic inflammation in the English Longitudinal Study of Ageing

We examined the association between lifecourse socioeconomic status (SES) and the risk of type 2 diabetes at older ages, ascertaining the extent to which adult lifestyle factors and systemic inflammation explain this relationship. Data were drawn from the English Longitudinal Study of Ageing (ELSA) which, established in 2002, is a representative cohort study of ?50-year olds individuals living in England. SES indicators were paternal social class, participants? education, participants? wealth, and a lifecourse socioeconomic index. Inflammatory markers (C-reactive protein and fibrinogen) and lifestyle factors were measured repeatedly; diabetes incidence (new cases) was monitored over 7.5 years of follow-up. Of the 6218 individuals free from diabetes at baseline (44% women, mean aged 66 years), 423 developed diabetes during follow-up. Relative to the most advantaged people, those in the lowest lifecourse SES group experienced more than double the risk of diabetes (hazard ratio 2.59; 95% Confidence Interval (CI)?=?1.81?3.71). Lifestyle factors explained 52% (95%CI:30?85) and inflammatory markers 22% (95%CI:13?37) of this gradient. Similar results were apparent with the separate SES indicators. In a general population sample, socioeconomic inequalities in the risk of type 2 diabetes extend to older ages and appear to partially originate from socioeconomic variations in modifiable factors which include lifestyle and inflammation

Combined use of bacteriophage K and a novel bacteriophage to reduce Staphylococcus aureus biofilm formation

Biofilms are major causes of impairment of wound healing and patient morbidity. One of the most common and aggressive wound pathogens is Staphylococcus aureus, displaying a large repertoire of virulence factors and commonly reduced susceptibility to antibiotics, such as the spread of methicillin-resistant S. aureus (MRSA). Bacteriophages are obligate parasites of bacteria. They multiply intracellularly and lyse their bacterial host, releasing their progeny. We isolated a novel phage, DRA88, which has a broad host range among S. aureus bacteria. Morphologically, the phage belongs to the Myoviridae family and comprises a large double-stranded DNA (dsDNA) genome of 141,907 bp. DRA88 was mixed with phage K to produce a high-titer mixture that showed strong lytic activity against a wide range of S. aureus isolates, including representatives of the major international MRSA clones and coagulase-negative Staphylococcus. Its efficacy was assessed both in planktonic cultures and when treating established biofilms produced by three different biofilm-producing S. aureus isolates. A significant reduction of biofilm biomass over 48 h of treatment was recorded in all cases. The phage mixture may form the basis of an effective treatment for infections caused by S. aureus biofilms

A marine biogenic source of atmospheric ice nucleating particles

The amount of ice present in clouds can affect cloud lifetime, precipitation and radiative properties1,2. The formation of ice in clouds is facilitated by the presence of airborne ice nucleating particles1,2. Sea spray is one of the major global sources of atmospheric particles, but it is unclear to what extent these particles are capable of nucleating ice3-11. Sea spray aerosol contains large amounts of organic material that is ejected into the atmosphere during bubble bursting at the organically enriched sea-air interface or sea surface microlayer12-19. Here we show that organic material in the sea surface microlayer nucleates ice under conditions relevant for mixed-phase cloud and high-altitude ice cloud formation. The ice nucleating material is likely biogenic and less than ~0.2 μm in size. We find that exudates separated from cells of the marine diatom T. Pseudonana nucleate ice and propose that organic material associated with phytoplankton cell exudates is a likely candidate for the observed ice nucleating ability of the microlayer samples. Global model simulations of marine organic aerosol in combination with our measurements suggest that marine organic material may be an important source of ice nucleating particles in remote marine environments such as the Southern Ocean, North Pacific and North Atlantic

Deepwater Horizon oil spill exposure and child health: a longitudinal analysis

The BP Deepwater Horizon oil spill (DHOS) created widespread concern about threats to health among residents of the Louisiana Gulf Coast. This study uses data from the Resilient Children, Youth, and Communities study—a longitudinal cohort survey of households with children in DHOS-affected areas of South Louisiana—to consider the effect of DHOS exposure on health trajectories of children, an especially vulnerable population subgroup. Results from latent linear growth curve models show that family DHOS exposure via physical contact and job/income loss both negatively influenced initial child health. However, the effects of physical exposure dissipated over time while the effects of job/income loss persisted. This pattern holds for both general child health and the number of recent physical health problems children had experienced. These findings help to bridge the literature on disaster impacts and resilience/vulnerability, with the literature on socioeconomic status as a fundamental cause of health outcomes over the life course

Weak-Lensing Mass Measurements of Five Galaxy Clusters in the South Pole Telescope Survey Using Magellan/Megacam

We use weak gravitational lensing to measure the masses of five galaxy clusters selected from the South Pole Telescope (SPT) survey, with the primary goal of comparing these with the SPT Sunyaev--Zel'dovich (SZ) and X-ray based mass estimates. The clusters span redshifts 0.28 < z < 0.43 and have masses M_500 > 2 x 10^14 h^-1 M_sun, and three of the five clusters were discovered by the SPT survey. We observed the clusters in the g'r'i' passbands with the Megacam imager on the Magellan Clay 6.5m telescope. We measure a mean ratio of weak lensing (WL) aperture masses to inferred aperture masses from the SZ data, both within an aperture of R_500,SZ derived from the SZ mass, of 1.04 +/- 0.18. We measure a mean ratio of spherical WL masses evaluated at R_500,SZ to spherical SZ masses of 1.07 +/- 0.18, and a mean ratio of spherical WL masses evaluated at R_500,WL to spherical SZ masses of 1.10 +/- 0.24. We explore potential sources of systematic error in the mass comparisons and conclude that all are subdominant to the statistical uncertainty, with dominant terms being cluster concentration uncertainty and N-body simulation calibration bias. Expanding the sample of SPT clusters with WL observations has the potential to significantly improve the SPT cluster mass calibration and the resulting cosmological constraints from the SPT cluster survey. These are the first WL detections using Megacam on the Magellan Clay telescope.Comment: Main body: 18 pages, 7 figures, 6 tables. Appendix: 6 pages, 10 figures. Accepted by ApJ. New version incorporates changes from accepted articl