Optimizing antibiotic therapy-the Aberdeen experience

ObjectiveTo study the quality and continuity of treatment in the Acute Medicines Assessment Unit (AMAU) with regard to empirical prescription of antibiotics, mode of administration, adherence to ward antibiotic policy, as well as collection, awareness and utilization of microbiological investigations.MethodsA prospective study over a 3-month period at the AMAU, Aberdeen Royal Infirmary (ARI), a teaching hospital in north-eastern Scotland, was performed. The study included all patients started on empirical antibiotics on admission to the AMAU and followed up until their discharge.ResultsOf 1303 patients admitted, 221 (17%) were started on empirical antibiotics. This was in accordance with hospital antibiotic policy in 52% of cases. Appropriate specimens were taken from 77% of patients. Culture results showed that 29% (n = 65) of the patients had clinically significant growth of organisms. Of the 65 patients with clinically significant culture results, 49% (n = 32) were on an inappropriate empirical regimen. In 55%, the medication was not changed to a more appropriate antibiotic. In 72% of the patients with a negative culture, the culture report had no obvious effect on the duration or type of antibiotic being administered. Intravenous antibiotics were used in 60% of patients.ConclusionThis study demonstrates a significant overuse of antibiotics, especially intravenous forms, despite a paucity of positive sepsis parameters and chest X-ray findings in these patients The duration of treatment could be shortened and an early switch policy introduced if culture results and sepsis profiles were taken into consideration, as there was a large number of unproven infections. Suggestions are made about how these improvements in prescribing could be made within the current administrative set-up of AMAUs

Effect of Process Variables on Electrochemical Micromachining of Titanium Alloy (Ti-3Al-2.5V)

Electro-chemical Machining (ECM) is mainly used for shaping, deburring, milling and finishing operations in various precision industries and its use in micron level machining is called Electro-Chemical Micro Machining (EMM). EMM and ECM are receiving considerable attention from high-tech industries. It is because it allows to manufacture structures of complex shapes, it has high precision and accuracy, it is simpler and eco-friendly manufacturing technique and it can be used for different conducting materials. Different industry working with water which is saline, needs heat exchanger for the process. Titanium Alloy (Ti-3Al-2.5V) due to its high corrosion resistance under saline conditions is preferred by these industries. This present work is mainly concentrated on identifying the Material Removal rate (MRR) of Titanium Alloy (Ti-3Al-2.5V) workpiece by varying the process parameters like voltage, electrolyte concentration and duty cycle on electro-chemical micro machining

Genetic structure of a small closed population of the New Zealand white rabbit through pedigree analyses

[EN] The genetic structure of a small population of New Zealand White rabbits maintained at the Sheep Breeding and Research Station, Sandynallah, The Nilgiris, India, was evaluated through pedigree analyses. Data on pedigree information (n=2503) for 18 yr (1995-2012) were used for the study. Pedigree analysis and the estimates of population genetic parameters based on the gene origin probabilities were performed. The analysis revealed that the mean values of generation interval, coefficients of inbreeding and equivalent inbreeding were 1.49 yr, 13.23 and 17.59%, respectively. The proportion of population inbred was 100%. The estimated mean values of average relatedness and individual increase in inbreeding were 22.73 and 3.00%, respectively. The percentage increase in inbreeding over generations was 1.94, 3.06 and 3.98 estimated through maximum generations, equivalent generations and complete generations, respectively. The number of ancestors contributing the majority of 50% genes (fa50) to the gene pool of reference population was only 4, which might have led to reduction in genetic variability and increased the amount of inbreeding. The extent of genetic bottleneck assessed by calculating the effective number of founders (fe) and the effective number of ancestors (fa), as expressed by the fe/fa ratio was 1.1, which is indicative of the absence of stringent bottlenecks. Up to 5th generation, 71.29% pedigree was complete, reflecting the well maintained pedigree records. The maximum known generations were 15, with an average of 7.9, and the average equivalent generations traced were 5.6, indicating a fairly good depth in pedigree. The realized effective population size was 14.93, which is very critical, and with the increasing trend of inbreeding the situation has been assessed as likely to become worse in future. The proportion of animals with the genetic conservation index (GCI) greater than 9 was 39.10%, which can be used as a scale to use such animals with higher GCI to maintain balanced contribution from the founders. From the study, it was evident that the herd was completely inbred, with a very high inbreeding coefficient, and the effective population size was critical. Recommendations were made to reduce the probability of deleterious effects of inbreeding and to improve genetic variability in the herd. The present study can help in carrying out similar studies to meet the demand for animal protein in developing countries.The authors acknowledge the support provided by Tamil Nadu Veterinary and Animal Sciences University (TANUVAS) for successful completion of the study.Sakthivel, M.; Balasubramanyam, D.; Kumarasamy, P.; Raja, A.; Anilkumar, R.; Gopi, H.; Devaki, A. (2018). Genetic structure of a small closed population of the New Zealand white rabbit through pedigree analyses. 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Direct correlation between the circadian sleep-wakefulness rhythm and time estimation in humans under social and temporal isolation

Several bodily functions in humans vary on a 24 h pattern and most of these variations persist with a circadian period of ca 25 h when subjects are studied under conditions of social and temporal isolation. We report in this paper that the estimates of short time intervals (TE) of 2 h are strongly coupled to the circadian rhythm in sleepwakefulness. There is a linear correlation between the number of hours humans stay awake (α) and their estimation of 2 h intervals. The coupling of TE to α appears to obtain only under conditions of physical well-being

Switching to second-line antiretroviral therapy in resource-limited settings: comparison of programmes with and without viral load monitoring.

In high-income countries, viral load is routinely measured to detect failure of antiretroviral therapy (ART) and guide switching to second-line ART. Viral load monitoring is not generally available in resource-limited settings. We examined switching from nonnucleoside reverse transcriptase inhibitor (NNRTI)-based first-line regimens to protease inhibitor-based regimens in Africa, South America and Asia

Potable Water Identification with Machine Learning: An Exploration of Water Quality Parameters

In this research, we aim to determine the water potability using three machine learning classification algorithms: decision tree, gradient boosting and bagging classifier. These algorithms were trained and tested on a dataset of water quality measurements. The outcomes of the experiment showed that the gradient boosting algorithm achieved the highest F1-score of 0.78 among all the algorithms. This indicates that the gradient boosting algorithm was most effective in correctly identifying both the safe and contaminated water samples. The results of this study demonstrate that gradient boosting is a promising approach for determining water potability and can be used as a reliable method for water quality assessment

Simulation of a Diesel Engine with Variable Geometry Turbocharger and Parametric Study of Variable Vane Position on Engine Performance

Modelling of a turbocharger is of interest to the engine designer as the work developed by the turbine can be used to drive a compressor coupled to it. This positively influences charge air density and engine power to weight ratio. Variable geometry turbocharger (VGT) additionally has a controllable nozzle ring which is normally electro-pneumatically actuated. This additional degree of freedom offers efficient matching of the effective turbine area for a wide range of engine mass flow rates. Closing of the nozzle ring (vanes tangential to rotor) result in more turbine work and deliver higher boost pressure but it also increases the back pressure on the engine induced by reduced turbine effective area. This adversely affects the net engine torque as the pumping work required increases. Hence, the optimum vane position for a given engine operating point is to be found through simulations or experimentation. A thermodynamic simulation model of a 2.2l 4 cylinder diesel engine was developed for investigation of different control strategies. Model features map based performance prediction of the VGT. Performance of the engine was simulated for steady state operation and validated with experimentation. The results of the parametric study of VGT’s vane position on the engine performance are discussed

Male infertility: no evidence of involvement of androgen receptor gene among Indian men

Spermatogenesis is collaboratively controlled by testosterone and follicle stimulating hormone. Testosterone and its immediate metabolite dihydrotestosterone affect their roles through the androgen receptor (AR). Mutations in the AR gene have been shown to cause partial to complete androgen insensitivity or infertility in otherwise normal males. The dependence of germ cells upon Sertoli and Leydig cells for their differentiation into sperms and deletion studies of the AR gene in animal models indicate a direct or indirect role of the AR gene in spermatogenesis. Although a few studies worldwide have reported AR mutations in male infertility, no similar study has been conducted on Indian populations. Therefore, we undertook this study to look at the contribution of AR mutations in male infertility among Indian men. We have sequenced the complete coding region of the AR gene in a total of 399 infertile samples, comprising 277 azoospermic, 100 oligozoospermic, and 22 oligoteratozoospermic samples. A total of 100 healthy males with proven fertility and the same ethnicity as the experimental group served as controls. Sequence analysis revealed no mutation in any of these samples. Our study suggests that mutations in the AR gene are less likely to cause azoospermia and oligozoospermia; however, it was difficult to rule out its effect in oligoteratozoospermia, as the sample size was small

New Delhi Metallo-β-Lactamase in Klebsiella pneumoniae and Escherichia coli, Canada

Multidrug-resistant Klebsiella pneumoniae and Escherichia coli isolates harboring New Delhi metallo-β-lactamase (NDM-1) were isolated from a patient who had returned to Canada from India. The NDM-1 gene was found on closely related incompatibility group A/C type plasmids. The occurrence of NDM-1 in North America is a major public health concern