222 research outputs found
Prospective Survey of AntibioticUtilization in Pediatric Hospitalized Patients to IdentifyTargets for Improvement of Prescription
Abstract. : Background: : The rise in the use of antibiotics has resulted in increasing health care costs and the emergence of resistant bacteria. Little is known about the general misuse of antibiotics in hospitalized children. We evaluated the utilization of antibiotics in a pediatric teaching hospital aiming to identify targets for improvement of prescription. Patients and Methods: : Clinical, radiological, laboratory and treatment data of patients hospitalized in a pediatric medical and a pediatric surgery ward were prospectively collected during a 6-week period. A subsequent review of the collected data by a pediatric infectious diseases specialist, taking into consideration existing in-house treatment guidelines, was carried out. Results: : A total of 125 (36%) of 349 patients was prescribed 246 antibiotics. The median length of hospital stay for children prescribed antibiotics was 5 days (range, 2-30 days) and for those not prescribed 3 days (1-32 days; p < 0.001). Of 154 patients in the medical ward, 64 (42%) received antibiotics, compared to 61 (31%) of 195 patients in the surgical ward (p < 0.05). Empirical prescriptions were more frequent than prophylactic ones, which were more frequent than therapeutic prescriptions (136 [55%] vs 94 [38%] vs 16 [7%]; p < 0.001). Overall, 85% of the prescriptions were considered justified. The rates of inappropriate prescriptions were similar in the medical and surgical ward, and higher for therapeutic (19%) or prophylactic treatment (18%) than for empirical treatment (12%). Higher inappropriate prescription rates were noted for macrolides than for co-trimoxazole and β-lactams (50% vs 18% and 15%, respectively; p < 0.05). Conclusion: : Efforts need to be undertaken towards continuous education of medical staff on judicious antibiotic use, as well as ensuring compliance with existing guidelines. Improvement in the availability of rapid diagnostic methods to discern viral from bacterial infections may help reduce the numbers of empiric therapies in favor of pathogen-targeted therapeutic treatment
Enhancing Market Readiness for nZEB Implementation
ABSTRACT: Despite transposing the 2010/31/EU Directive's requirements creates legal responsibilities at the national level, the nearly Zero energy building (nZEB) principle does not appear to be widely adopted just yet in many nations. Previous studies have shown that the most significant barriers include determining the cost-effective ideal integration of the technologies appropriate for nZEB and the skills constraints faced by the construction industry. In order to meet the challenge of an efficient nZEB implementation, existing certification courses and training programs are still insufficient and inadequate, and hiring experienced specialists for building retrofit and new construction is not common practice. The traditionally conservative real estate industry is nevertheless hesitant to adopt the new building standards and practices, notably in the residential sector, despite a significant movement towards nZEB and extensive energy renovation. In this specific situation, this paper provides a preliminary analysis of the European project nZEB Ready Enhancing Market Readiness for nZEB Implementation, which aims to address the issue of the effective implementation of the nZEB and make use of new possibilities to act at the market level in order to boost the market's readiness for a successful implementation of the nZEB and to encourage demand for energy-related skills among construction workers and specialists in the countries involved and beyond.info:eu-repo/semantics/publishedVersio
Into Thick(er) Air? Oxygen Availability at Humansâ Physiological Frontier on Mount Everest
Global audiences are captivated by climbers pushing themselves to the limits in the hypoxic environment of Mount Everest. However, air pressure sets oxygen abundance, meaning it varies with the weather and climate warming. This presents safety issues for mountaineers, but also an opportunity for public engagement around climate change. Here we blend new observations from Everest with ERA5 reanalysis (1979- 2019) and climate model results to address both perspectives. We find that plausible warming could generate subtle but physiologically relevant changes in summit oxygen availability, including an almost 5% increase in annual minimum VO 2 max for 2°C warming since pre-industrial. In the current climate we find evidence of swings in pressure sufficient to change Everestâs apparent elevation by almost 750 m. Winter pressures can also plunge lower than previously reported, highlighting the importance of air pressure forecasts for the safety of those trying to push the physiological frontier on Mt. Everest
A catalog of microbial genes from the bovine rumen unveils a specialized and diverse biomass-degrading environment
Background
The rumen microbiota provides essential services to its host and, through its role in ruminant production, contributes to human nutrition and food security. A thorough knowledge of the genetic potential of rumen microbes will provide opportunities for improving the sustainability of ruminant production systems. The availability of gene reference catalogs from gut microbiomes has advanced the understanding of the role of the microbiota in health and disease in humans and other mammals. In this work, we established a catalog of reference prokaryote genes from the bovine rumen.
Results
Using deep metagenome sequencing we identified 13,825,880 non-redundant prokaryote genes from the bovine rumen. Compared to human, pig, and mouse gut metagenome catalogs, the rumen is larger and richer in functions and microbial species associated with the degradation of plant cell wall material and production of methane. Genes encoding enzymes catalyzing the breakdown of plant polysaccharides showed a particularly high richness that is otherwise impossible to infer from available genomes or shallow metagenomics sequencing. The catalog expands the dataset of carbohydrate-degrading enzymes described in the rumen. Using an independent dataset from a group of 77 cattle fed 4 common dietary regimes, we found that only <0.1% of genes were shared by all animals, which contrast with a large overlap for functions, i.e., 63% for KEGG functions. Different diets induced differences in the relative abundance rather than the presence or absence of genes, which explains the great adaptability of cattle to rapidly adjust to dietary changes.
Conclusions
These data bring new insights into functions, carbohydrate-degrading enzymes, and microbes of the rumen to complement the available information on microbial genomes. The catalog is a significant biological resource enabling deeper understanding of phenotypes and biological processes and will be expanded as new data are made available.info:eu-repo/semantics/publishedVersio
Phenotypic Consequences of Copy Number Variation: Insights from Smith-Magenis and Potocki-Lupski Syndrome Mouse Models
The characterization of mice with different number of copies of the same genomic segment shows that structural changes influence the phenotypic outcome independently of gene dosage
"Don't try to teach me, I got nothing to learn": Management students' perceptions of business ethics teaching
[EN] Interest is growing towards including business ethics in university curricula, aiming at improving ethical behaviour of future managers. Extant literature has investigated the impact of ethics education on different ethics-related students' cognitive and/or behavioural outcomes, considering variables related to training programmes and students' demographic aspects. Accordingly, we aim at assessing students' understanding of business ethics issues, by focusing on the differences in students' perceptions depending on gender, age, work experience, and ethics courses taken. Testing our hypotheses on a sample of 307 management students at a Polish university, and controlling for social desirability bias, we obtained mixed and partially surprising results. We found significant differences in students' understanding of business ethics depending on their gender and age (female and older students showed more ethical inclinations), but not depending on having taken ethics courses-actually perceptions of such courses worsened after taking them. Besides, work experience was not a significant variable. Moreover, course exposure intensiveness (i.e., number of ethics courses completed), and time passed since completion of the latest course, did not confirm hypothesized effects on most of the dependent (sub)variables. These findings stimulate further questions and challenges for future research (e.g., around course design and methodology, and social/cultural/contextual issues).Tormo-CarbĂł, G.; Oltra, V.; Klimkiewicz, K.; SeguĂ-Mas, E. (2019). "Don't try to teach me, I got nothing to learn": Management students' perceptions of business ethics teaching. 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Deficient histone H3 propionylation by BRPF1-KAT6 complexes in neurodevelopmental disorders and cancer
Lysine acetyltransferase 6A (KAT6A) and its paralog KAT6B form stoichiometric complexes with bromodomain- and PHD finger-containing protein 1 (BRPF1) for acetylation of histone H3 at lysine 23 (H3K23). We report that these complexes also catalyze H3K23 propionylation in vitro and in vivo. Immunofluorescence microscopy and ATAC-See revealed the association of this modification with active chromatin. Brpf1 deletion obliterates the acylation in mouse embryos and fibroblasts. Moreover, we identify BRPF1 variants in 12 previously unidentified cases of syndromic intellectual disability and demonstrate that these cases and known BRPF1 variants impair H3K23 propionylation. Cardiac anomalies are present in a subset of the cases. H3K23 acylation is also impaired by cancer-derived somatic BRPF1 mutations. Valproate, vorinostat, propionate and butyrate promote H3K23 acylation. These results reveal the dual functionality of BRPF1-KAT6 complexes, shed light on mechanisms underlying related developmental disorders and various cancers, and suggest mutation-based therapy for medical conditions with deficient histone acylation
Uncommon genetic syndromes and narrative production - Case Studies with Williams, Smith-Magenis and Prader- Willi Syndromes
This study compares narrative production among three syndromes with
genetic microdeletions: Williams syndrome (WS), Smith-Magenis syndrome
(SMS), and Prader-Willi syndrome (PWS), characterized by intellectual
disabilities and relatively spared language abilities. Our objective is to study
the quality of narrative production in the context of a common intellectual
disability. To elicit a narrative production, the task Frog! Where Are You was
used. Then, structure, process, and content of the narrative process were
analysed in the three genetic disorders:WS (n52), SMS (n52), and PWS (n52).
Data show evidence of an overall low narrative quality in these syndromes,
despite a high variability within different measures of narrative production.
Results support the hypothesis that narrative is a highly complex cognitive
process and that, in a context of intellectual disability, there is no evidence of
particular âhypernarrativityâ in these syndromes.This research was supported by the grants FEDER â
Clinical spectrum of SIX3-associated mutations in holoprosencephaly: correlation between genotype, phenotype and function
BACKGROUND: Holoprosencephaly (HPE) is the most common structural malformation of the human forebrain. There are several important HPE mutational target genes, including the transcription factor SIX3, which encodes an early regulator of Shh, Wnt, Bmp and Nodal signalling expressed in the developing forebrain and eyes of all vertebrates. OBJECTIVE: To characterise genetic and clinical findings in patients with SIX3 mutations. METHODS: Patients with HPE and their family members were tested for mutations in HPE-associated genes and the genetic and clinical findings, including those for additional cases found in the literature, were analysed. The results were correlated with a mutation-specific functional assay in zebrafish. RESULTS: In a cohort of patients (n = 800) with HPE, SIX3 mutations were found in 4.7% of probands and additional cases were found through testing of relatives. In total, 138 cases of HPE were identified, 59 of whom had not previously been clinically presented. Mutations in SIX3 result in more severe HPE than in other cases of non-chromosomal, non-syndromic HPE. An over-representation of severe HPE was found in patients whose mutations confer greater loss of function, as measured by the functional zebrafish assay. The gender ratio in this combined set of patients was 1.5:1 (F:M) and maternal inheritance was almost twice as common as paternal. About 14% of SIX3 mutations in probands occur de novo. There is a wide intrafamilial clinical range of features and classical penetrance is estimated to be at least 62%. CONCLUSIONS: Our data suggest that SIX3 mutations result in relatively severe HPE and that there is a genotype-phenotype correlation, as shown by functional studies using animal models
Use of procalcitonin for the diagnosis of pneumonia in patients presenting with a chief complaint of dyspnoea: results from the BACH (Biomarkers in Acute Heart Failure) trial
Biomarkers have proven their ability in the evaluation of cardiopulmonary diseases.We investigated the utility of concentrations
of the biomarker procalcitonin (PCT) alone and with clinical variables for the diagnosis of pneumonia in
patients presenting to emergency departments (EDs) with a chief complaint of shortness of breath.
The BACH trial was a prospective, international, study of 1641 patients presenting to EDs with dyspnoea. Blood
samples were analysed for PCT and other biomarkers. Relevant clinical data were also captured. Patient outcomes
were assessed at 90 days. The diagnosis of pneumonia was made using strictly validated guidelines. A model using
PCT was more accurate [area under the curve (AUC) 72.3%] than any other individual clinical variable for the diagnosis
of pneumonia in all patients, in those with obstructive lung disease, and in those with acute heart failure (AHF).
Combining physician estimates of the probability of pneumonia with PCT values increased the accuracy to .86% for
the diagnosis of pneumonia in all patients. Patients with a diagnosis of AHF and an elevated PCT concentration
(.0.21 ng/mL) had a worse outcome if not treated with antibiotics (P Âź 0.046), while patients with low PCT
values (,0.05 ng/mL) had a better outcome if they did not receive antibiotic therapy (P Âź 0.049).
Procalcitonin may aid in the diagnosis of pneumonia, particularly in cases with high diagnostic uncertainty. Importantly,
PCT may aid in the decision to administer antibiotic therapy to patients presenting with AHF in which clinical uncertainty
exists regarding a superimposed bacterial infection
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