GPU Computing Taxonomy

Over the past few years, a number of efforts have been made to obtain benefits from graphic processing unit (GPU) devices by using them in parallel computing. The main advantage of GPU computing is that it provides cheap parallel processing environments for those who need to solve single program multiple data (SPMD) problems. In this chapter, a GPU computing taxonomy is proposed for classifying GPU computing into four different classes depending on different strategies of combining CPUs and GPUs

BALANITES KERNEL OIL FOR THE TREATMENT OF DERMATOPHYTES: A CLINICAL TRIAL

In a previous in vitro study, we have shown that the kernel oil of fruits of the tree Balanites aegyptiaca referred to as Balanites kernel oil ((BKO) is active against dermatophytes (i.e. superficial mycosis, ringworms, tineas (T. captitis, T. cercinata and T. pedis). We report here our clinical trials with BKO. Trials were performed on patients presenting at Wad Medani Dermatology Teaching Hospital as well as primary school children in Elsoreeba Town (5 km south of Wad Medani). Not all patients followed treatment till completely cured. Patients treated with BKO (half of the total) achieved complete cure in 3-5 weeks, on average, while those treated with the standard antifungal drug Miconazole (half of the total patients) did the same in the longer period of 3-8 weeks. Photographs showing progress of response to BKO treatments are included. BKO has great potential for development as a commercial drug for the treatment of dermatophytes

Assessing information and communication technology in surgical training, Sudan as example

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Antimicrobial activity of 7,3ʹ,4ʹ-trihydroxyflavonol isolated from Acacia nilotica var. ad stringens

Acacia species (Mimosaceae) is widely distributed in tropical and subtropical countries and has a variety of ethnomedicinal uses. There is inadequate laboratory investigation to identify bioactive compounds and therapeutic effect of Acacia nilotica var. ad stringens. This research has been conducted to extract, isolate and identify major compounds from heartwood of Acacia nilotica var. ad stringens and to test them against representative bacteria. Powdered air-dried heartwood of A. nilotica var. ad stringens has been extracted with methanol/water, 4:1 and the extract has been then purified using chromatographic techniques (column and paper chromatography). A pure flavonoid compound has been isolated and the structure has been elucidated based on extensive spectroscopic analysis procedures (IR, UV, 1H NMR, and mass spectrometery). The isolated compound has then been evaluated for antimicrobial potential against Gram-negative (Escherichia coli and Pseudomonas aeruginosa) and Gram-positive bacteria (Bacillus subtilis, Bacillus cereus, and Staphylococcus aureus) using cup-plate agar diffusion method. The spectroscopic analysis of the isolated compound has led to its identification as 7,3ʹ,4ʹ-trihydroxyflavonol. The compound shows varying antimicrobial responses with high potency against Gram-negative human pathogens. The Gram-positive bacteria which are inhibited are Bacillus cereus, Corynebacterium sp., Enterococcus faecalis, Staphylococcus aureus , and Streptococcus agalactiae. The Gram-negative bacteria are Acinetobacterbaumannii , Acinetobacter sp. , Escherichia coli, Pseudomonas aeruginosa and yeasts are Candida albicans and Cryptococcus neoformans. The present study has demonstrated that 7,3ʹ,4ʹ-trihydroxyflavonol is an effective antimicrobial compound. If applied in suitable pharmaceutical formulations it could be valuable for treating various bacterial infections or introduced as adjunct treatment along with standard agents.

Antimicrobial activity of 7,3ʹ,4ʹ-trihydroxyflavonol isolated from Acacia nilotica var. ad stringens

1117-1120Acacia species (Mimosaceae) is widely distributed in tropical and subtropical countries and has a variety of ethnomedicinal uses. There is inadequate laboratory investigation to identify bioactive compounds and therapeutic effect of Acacia nilotica var. ad stringens. This research has been conducted to extract, isolate and identify major compounds from heartwood of Acacia nilotica var. ad stringens and to test them against representative bacteria. Powdered air-dried heartwood of A.nilotica var. ad stringens has been extracted with methanol/water, 4:1 and the extract has been then purified usingchromatographic techniques (column and paper chromatography). A pure flavonoid compound has been isolated and thestructure has been elucidated based on extensive spectroscopic analysis procedures (IR, UV, 1H NMR, and mass spectrometery). The isolated compound has then been evaluated for antimicrobial potential against Gram-negative (Escherichia coli and Pseudomonas aeruginosa) and Gram-positive bacteria (Bacillus subtilis, Bacillus cereus, and Staphylococcus aureus) using cup-plate agar diffusion method. The spectroscopic analysis of the isolated compound has led to its identification as 7,3ʹ,4ʹ-trihydroxyflavonol. The compound shows varying antimicrobial responses with high potency against Gram-negative human pathogens. The Gram-positive bacteria which are inhibited are Bacillus cereus, Corynebacterium sp., Enterococcus faecalis, Staphylococcus aureus , and Streptococcus agalactiae. The Gram-negative bacteria are Acinetobacterbaumannii , Acinetobacter sp. , Escherichia coli, Pseudomonas aeruginosa and yeasts are Candida albicans and Cryptococcus neoformans. The present study has demonstrated that 7,3ʹ,4ʹ-trihydroxyflavonol is an effective antimicrobial compound. If applied in suitable pharmaceutical formulations it could be valuable for treating various bacterial infections or introduced as adjunct treatment along with standard agents

Progress and experiences of implementing an integrated disease surveillance and response system in Somalia; 2016–2023

IntroductionIn 2021, a regional strategy for integrated disease surveillance was adopted by member states of the World Health Organization Eastern Mediterranean Region. But before then, member states including Somalia had made progress in integration of their disease surveillance systems. We report on the progress and experiences of implementing an integrated disease surveillance and response system in Somalia between 2016 and 2023.MethodsWe reviewed 20 operational documents and identified key integrated disease surveillance and response system (IDSRS) actions/processes implemented between 2016 and 2023. We verified these through an anonymized online survey. The survey respondents also assessed Somalia’s IDSRS implementation progress using a standard IDS monitoring framework Finally, we interviewed 8 key informants to explore factors to which the current IDSRS implementation progress is attributed.ResultsBetween 2016 and 2023, 7 key IDSRS actions/processes were implemented including: establishment of high-level commitment; development of a 3-year operational plan; development of a coordination mechanism; configuring the District Health Information Software to support implementation among others. IDSRS implementation progress ranged from 15% for financing to 78% for tools. Reasons for the progress were summarized under 6 thematic areas; understanding frustrations with the current surveillance system; the opportunity occasioned by COVID-19; mainstreaming IDSRS in strategic documents; establishment of an oversight mechanism; staggering implementation of key activities over a reasonable length of time and being flexible about pre-determined timelines.DiscussionFrom 2016 to 2023, Somalia registered significant progress towards implementation of IDSRS. The 15 years of EWARN implementation in Somalia (since 2008) provided a strong foundation for IDSRS implementation. If implemented comprehensively, IDSRS will accelerate country progress toward establishment of IHR core capacities. Sustainable funding is the major challenge towards IDSRS implementation in Somalia. Government and its partners need to exploit feasible options for sustainable investment in integrated disease surveillance and response

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Burnout among surgeons before and during the SARS-CoV-2 pandemic: an international survey

Background: SARS-CoV-2 pandemic has had many significant impacts within the surgical realm, and surgeons have been obligated to reconsider almost every aspect of daily clinical practice. Methods: This is a cross-sectional study reported in compliance with the CHERRIES guidelines and conducted through an online platform from June 14th to July 15th, 2020. The primary outcome was the burden of burnout during the pandemic indicated by the validated Shirom-Melamed Burnout Measure. Results: Nine hundred fifty-four surgeons completed the survey. The median length of practice was 10 years; 78.2% included were male with a median age of 37 years old, 39.5% were consultants, 68.9% were general surgeons, and 55.7% were affiliated with an academic institution. Overall, there was a significant increase in the mean burnout score during the pandemic; longer years of practice and older age were significantly associated with less burnout. There were significant reductions in the median number of outpatient visits, operated cases, on-call hours, emergency visits, and research work, so, 48.2% of respondents felt that the training resources were insufficient. The majority (81.3%) of respondents reported that their hospitals were included in the management of COVID-19, 66.5% felt their roles had been minimized; 41% were asked to assist in non-surgical medical practices, and 37.6% of respondents were included in COVID-19 management. Conclusions: There was a significant burnout among trainees. Almost all aspects of clinical and research activities were affected with a significant reduction in the volume of research, outpatient clinic visits, surgical procedures, on-call hours, and emergency cases hindering the training. Trial registration: The study was registered on clicaltrials.gov "NCT04433286" on 16/06/2020

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely