Screening for multi-drug-resistant Gram-negative bacteria: what is effective and justifiable?

Effectiveness is a key criterion in assessing the justification of antibiotic resistance interventions. Depending on an intervention's effectiveness, burdens and costs will be more or less justified, which is especially important for large scale population-level interventions with high running costs and pronounced risks to individuals in terms of wellbeing, integrity and autonomy. In this paper, we assess the case of routine hospital screening for multi-drug-resistant Gram-negative bacteria (MDRGN) from this perspective. Utilizing a comparison to screening programs for Methicillin-Resistant Staphylococcus aureus (MRSA) we argue that current screening programmes for MDRGN in low endemic settings should be reconsidered, as its effectiveness is in doubt, while general downsides to screening programs remain. To accomplish justifiable antibiotic stewardship, MDRGN screening should not be viewed as a separate measure, but rather as part of a comprehensive approach. The program should be redesigned to focus on those at risk of developing symptomatic infections with MDRGN rather than merely detecting those colonised

Regulation and splicing of scavenger receptor class B type I in human macrophages and atherosclerotic plaques

BACKGROUND: The protective role of high-density lipoprotein (HDL) in the cardiovascular system is related to its role in the reverse transport of cholesterol from the arterial wall to the liver for subsequent excretion via the bile. Scavenger receptor class B type I (SR-BI) binds HDL and mediates selective uptake of cholesterol ester and cellular efflux of cholesterol to HDL. The role of SR-BI in atherosclerosis has been well established in murine models but it remains unclear whether SR-BI plays an equally important role in atherosclerosis in humans. The aim of this study was to investigate the expression of SR-BI and its isoforms in human macrophages and atherosclerotic plaques. METHODS: The effect of hypoxia and minimally modified low-density lipoprotein (mmLDL), two proatherogenic stimuli, on SR-BI expression was studied in human monocyte-derived macrophages from healthy subjects using real-time PCR. In addition, SR-BI expression was determined in macrophages obtained from subjects with atherosclerosis (n = 15) and healthy controls (n = 15). Expression of SR-BI isoforms was characterized in human atherosclerotic plaques and macrophages using RT-PCR and DNA sequencing. RESULTS: SR-BI expression was decreased in macrophages after hypoxia (p < 0.005). In contrast, SR-BI expression was increased by exposure to mmLDL (p < 0.05). There was no difference in SR-BI expression in macrophages from patients with atherosclerosis compared to controls. In both groups, SR-BI expression was increased by exposure to mmLDL (p < 0.05). Transcripts corresponding to SR-BI and SR-BII were detected in macrophages. In addition, a third isoform, referred to as SR-BIII, was discovered. All three isoforms were also expressed in human atherosclerotic plaque. Compared to the other isoforms, the novel SR-BIII isoform was predicted to have a unique intracellular C-terminal domain containing 53 amino acids. CONCLUSION: We conclude that SR-BI is regulated by proatherogenic stimuli in humans. However, we found no differences between subjects with atherosclerosis and healthy controls. This indicates that altered SR-BI expression is not a common cause of atherosclerosis. In addition, we identified SR-BIII as a novel isoform expressed in human macrophages and in human atherosclerotic plaques

Host plant range of a fruit fly community (Diptera: Tephritidae): Does fruit composition influence larval performance?

Background: Phytophagous insects differ in their degree of specialisation on host plants, and range from strictly monophagous species that can develop on only one host plant to extremely polyphagous species that can develop on hundreds of plant species in many families. Nutritional compounds in host fruits affect several larval traits that may be related to adult fitness. In this study, we determined the relationship between fruit nutrient composition and the degree of host specialisation of seven of the eight tephritid species present in La Réunion; these species are known to have very different host ranges in natura. In the laboratory, larval survival, larval developmental time, and pupal weight were assessed on 22 fruit species occurring in La Réunion. In addition, data on fruit nutritional composition were obtained from existing databases. Results: For each tephritid, the three larval traits were significantly affected by fruit species and the effects of fruits on larval traits differed among tephritids. As expected, the polyphagous species Bactrocera zonata, Ceratitis catoirii, C. rosa, and C. capitata were able to survive on a larger range of fruits than the oligophagous species Zeugodacus cucurbitae, Dacus demmerezi, and Neoceratitis cyanescens. Pupal weight was positively correlated with larval survival and was negatively correlated with developmental time for polyphagous species. Canonical correspondence analysis of the relationship between fruit nutrient composition and tephritid survival showed that polyphagous species survived better than oligophagous ones in fruits containing higher concentrations of carbohydrate, fibre, and lipid. Conclusion: Nutrient composition of host fruit at least partly explains the suitability of host fruits for larvae. Completed with female preferences experiments these results will increase our understanding of factors affecting tephritid host range. (Résumé d'auteur

International Consensus Statement on Rhinology and Allergy: Rhinosinusitis

Background: The 5 years since the publication of the first International Consensus Statement on Allergy and Rhinology: Rhinosinusitis (ICAR‐RS) has witnessed foundational progress in our understanding and treatment of rhinologic disease. These advances are reflected within the more than 40 new topics covered within the ICAR‐RS‐2021 as well as updates to the original 140 topics. This executive summary consolidates the evidence‐based findings of the document. Methods: ICAR‐RS presents over 180 topics in the forms of evidence‐based reviews with recommendations (EBRRs), evidence‐based reviews, and literature reviews. The highest grade structured recommendations of the EBRR sections are summarized in this executive summary. Results: ICAR‐RS‐2021 covers 22 topics regarding the medical management of RS, which are grade A/B and are presented in the executive summary. Additionally, 4 topics regarding the surgical management of RS are grade A/B and are presented in the executive summary. Finally, a comprehensive evidence‐based management algorithm is provided. Conclusion: This ICAR‐RS‐2021 executive summary provides a compilation of the evidence‐based recommendations for medical and surgical treatment of the most common forms of RS

Lack of aggregation of ischemic stroke subtypes within affected sibling pairs

ABSTRAK Rahmat,  Angga  Nur.  2014.  Pengembangan  Trainer  Sistem  Recloser  Berbasis Smart  Relay  Untuk  Menunjang  Matakuliah  Sistem  Distribusi  Dan Transmisi Di Jurusan Teknik Elektro Universitas Negeri Malang. Skripsi, Jurusan  Teknik  Elektro,  Fakultas  Teknik,  Universitas  Negeri  Malang. Pembimbing: (1) Yuni Rahmawati, S.T., M.T., (2) Sujito, S.T., M.T. Kata Kunci: Sistem Recloser, trainer, smart relay   Recloser  atau  Penutup  Balik  Otomatis  merupakan  salah  satu  peralatan proteksi pada jaringan distribusi tenaga listrik. Recloser peralatan yang berfungsi membuka  jaringan  ketika  terjadi  hubung  singkat  atau  arus  lebih  kemudian menutup balik secara otomatis ketika gangguan tersebut hilang dengan sendirinya. selain  itu  sebagai  pengaman  seksi  sehingga  dapat melokalisir/membatasi  daerah yang terganggu. Mata kuliah Sistem Distribusi dan Transmisi  Jurusan Teknik Universitas Negeri Malang merupakan mata  kuliah  yang  disajikan  untuk  program  keahlian Elektro  (Arus  Kuat). Media  pembelajaran  yang membantu  proses  pembelajaran mata kuliah  ini  sangat  terbatas. Keterbatasan  ini dikarenakan peralatan distribusi tidak mungkin  dihadirkan  secara  nyata  ketika  proses  pembelajaran.  berdasarkan observasi  dan  wawancara  kepada  dosen  pengampu  yang  telah  dilakukan  maka diperlukan  media  pembelajaran  yang  hampir  menyerupai  peralatan  distribusi tenaga listrik tersebut. Di Jurusan Teknik Elektro terdapat Trainer sistem recloser berbasis PLC, namun kondisi trainer tersebut sedang rusak, selain itu pengawatan trainer masih rumit dan pengontrolannya  terbatas, sehingga mahasiswa kesulitan dalam memahami  prinsip  kerja  recloser. Trainer  sistem  recloser  berbasis  smart relay  digunakan  sebagai  alternatif media  pembelajaran  yang mampu mengatasi kekurangan  media  pembelajaran  sebelumnya.  Smart  relay  merupakan  sebuah peralatan  elektronik  yang mampu menggantikan  fungsi  relay  konvensional  dan bisa  diberikan  instruksi  atau  program.  Trainer  sistem  recloser  berbasis  smart relay  ini, memiliki  kelebihan,  antara  lain:  pengawatan mudah  dan  pengontrolan lebih banyak.   Model  pengembangan  yang  digunakan  adalah  model  pengembangan Sugiyono  yang  dikombinasikan  dengan metode  Borg  dan  Gall.  Pemilihan  pada model pengembangan tersebut dikarenakan keruntutan dalam setiap tahapnya dan terdapat  beberapa  revisi  yang  justru  berguna  untuk membuat  produk  yang  lebih baik daripada sebelumnya. Tahap model pengembangan yang dilaksanakan, yaitu: (1) Potensi dan Masalah; (2) Pengumpulan Data; (3) Desain Produk; (4) Validasi Desain; (5) Revisi Desain; (6) Produksi; (7) Ujicoba Perseorangan; (8) Revisi; (9) Ujicoba Kelompok Kecil;  (10) Revisi;  (11) Ujicoba Lapangan;  (12) Revisi;  (13) Laporan; dan (14) Produksi Masal.    Berdasarkan  pelaksanaan  metode  penelitian  dan  pengembangan  maka diperoleh  data  hasil    dari  ahli  media  sebesar  95%,  ahli  materi  sebesar  91%, ujicoba kelompok kecil  sebesar 92%, dan ujicoba kelompok besar  sebesar 88%. Dapat  disimpulkan  bahwa  trainer  sistem  recloser  berbasis  smart  relay  telah memenuhi kriteria valid dan layak digunakan sebagai media pembelajaran