Geographical variation in antimicrobial use and multiresistant pathogens in Brazilian intensive care units: a nationwide study

Introduction: Geographical analyses of antibiotic use identify regions with the highest consumption and help design policies for strategic patient groups.Methodology: We conducted a cross-sectional study based on official data available in July 2022 from Brazilian Health Surveillance Agency (Anvisa). Antibiotics are reported as a defined daily dose (DDD) per 1,000 patient-days, and central line-associated bloodstream infection (CLABSI) is defined according to Anvisa criteria. We also considered multi-drug resistant (MDR) as the critical pathogens the World Health Organization listed. We measured antimicrobial use and CLABSI trends per ICU bed using the compound annual growth rate (CAGR). Results: we evaluated the regional variation in CLABSI by multidrug-resistant pathogens and the antimicrobial use in 1,836 hospital intensive care units (ICUs). In 2020, the leader in use in intensive care units (ICUs) in the North was piperacillin/tazobactam (DDD = 929.7) in the Northeast. Midwest and South were meropenem (DDD = 809.4 and DDD = 688.1, respectively), and Southeast was ceftriaxone (DDD = 751.1). The North has reduced polymyxin use (91.1%), and ciprofloxacin increased (439%) in the South. There was an increase in CLABSI by carbapenem-resistant Pseudomonas aeruginosa in the North region (CAGR = 120.5%). Otherwise, CLABSI by vancomycin-resistant Enterococcus faecium (VRE) increased in all regions except the North (CAGR =-62.2%), while that carbapenem-resistant Acinetobacter baumannii increased in the Midwest (CAGR = 27.3%). Conclusions: we found heterogeneity in antimicrobial use patterns and CLABSI etiology among Brazilian ICUs. Although Gram-negative bacilli were the primary responsible agent, we observed a notable increase trend of CLABSI by VRE

Contextuality and Noncommutative Geometry in Quantum Mechanics

Observable properties of a classical physical system can be modelled deterministically as functions from the space of pure states to outcome values; dually, states can be modelled as functions from the algebra of observables to outcome values. The probabilistic predictions of quantum physics are contextual in that they preclude this classical assumption of reality: noncommuting observables, which are not assumed to be jointly measurable, cannot be consistently ascribed deterministic values even if one enriches the description of a quantum state. Here, we consider the geometrically dual objects of noncommutative operator algebras of observables as being generalisations of classical (deterministic) state spaces to the quantum setting and argue that these generalised state spaces represent the objects of study of noncommutative operator geometry. By adapting the spectral presheaf of Hamilton–Isham–Butterfield, a formulation of quantum state space that collates contextual data, we reconstruct tools of noncommutative geometry in an explicitly geometric fashion. In this way, we bridge the foundations of quantum mechanics with the foundations of noncommutative geometry à la Connes et al. To each unital C*- algebra A we associate a geometric object—a diagram of topological spaces collating quotient spaces of the noncommutative space underlying A —that performs the role of a generalised Gel'fand spectrum. We show how any functor F from compact Hausdorff spaces to a suitable target category C can be applied directly to these geometric objects to automatically yield an extension F~ acting on all unital C*-algebras. This procedure is used to give a novel formulation of the operator K0-functor via a finitary variant K~f of the extension K~ of the topological K-functor. We then delineate a C*-algebraic conjecture that the extension of the functor that assigns to a topological space its lattice of open sets assigns to a unital C*-algebra the Zariski topological lattice of its primitive ideal spectrum, i.e. its lattice of closed two-sided ideals. We prove the von Neumann algebraic analogue of this conjecture

The novel 5-lipoxygenase inhibitor ABT-761 attenuates cerebral vasospasm in a rabbit model of subarachnoid hemorrhage

OBJECTIVE: Eicosanoids have been implicated in the pathogenesis of cerebral vasospasm after subarachnoid hemorrhage (SAH). Leukotrienes, 5-hydroxyperoxyeicosatetraenoic acid, and 5-hydroxyeicosatetraenoic acid are part of this group of substances, resulting from the 5-lipoxygenase activity on arachidonic acid metabolism. This study examined the effects of ABT-761, a new 5-lipoxygenase inhibitor, on cerebral vasospasm in an in vivo rabbit model of SAH. METHODS: A total of 48 rabbits were assigned to one of six groups: SAH + placebo (n = 8), SAH + ABT-761 20 mg/kg (n = 8), SAH + ABT-761 30 mg/kg (n = 8), control + placebo (n = 8), control + ABT-761 20 mg/kg (n = 8), and control + ABT-761 30 mg/kg (n = 8). Drug administration was initiated 30 minutes after induction of SAH and repeated 24 hours later. The animals were killed 48 hours after SAH, using the perfusion-fixation method. The cross sectional areas of basilar artery histological sections were measured by an investigator blinded to the treatment groups of the individual samples. RESULTS: In placebo-treated animals, the average luminal cross sectional area of the basilar artery was reduced by 68% after SAH as compared with controls (P < 0.0001). After SAH, the vasospastic response was attenuated in animals treated with 20 or 30 mg/kg representing a 28 or 35% reduction, respectively (P = 0.0011 and P = 0.0038). CONCLUSION: The results demonstrated that ABT-761 is effective in attenuating experimental cerebral vasospasm, indicating that this new drug represents a potential therapeutic agent for the treatment of vasospasm after SAH

Quantifying Robotic Swarm Coverage

In the field of swarm robotics, the design and implementation of spatial density control laws has received much attention, with less emphasis being placed on performance evaluation. This work fills that gap by introducing an error metric that provides a quantitative measure of coverage for use with any control scheme. The proposed error metric is continuously sensitive to changes in the swarm distribution, unlike commonly used discretization methods. We analyze the theoretical and computational properties of the error metric and propose two benchmarks to which error metric values can be compared. The first uses the realizable extrema of the error metric to compute the relative error of an observed swarm distribution. We also show that the error metric extrema can be used to help choose the swarm size and effective radius of each robot required to achieve a desired level of coverage. The second benchmark compares the observed distribution of error metric values to the probability density function of the error metric when robot positions are randomly sampled from the target distribution. We demonstrate the utility of this benchmark in assessing the performance of stochastic control algorithms. We prove that the error metric obeys a central limit theorem, develop a streamlined method for performing computations, and place the standard statistical tests used here on a firm theoretical footing. We provide rigorous theoretical development, computational methodologies, numerical examples, and MATLAB code for both benchmarks.Comment: To appear in Springer series Lecture Notes in Electrical Engineering (LNEE). This book contribution is an extension of our ICINCO 2018 conference paper arXiv:1806.02488. 27 pages, 8 figures, 2 table

3D models of pelvic floor muscles developed by manual segmentation to FEM

The female pelvic floor is an understudied region of the body from the biomechanical perspective. MRI has been used in the diagnostic evaluation of the pelvic floor dysfunctions. Static images show their morphology while dynamic images show the functional changes that occur on straining and contraction of the pelvic floor. In the present work, MR images contribute to generate 3D solids of pelvic floor muscles through manual segmentation. To study the biomechanical behavior of pelvic floor muscles the Finite Element Method (FEM) would be applied to these 3D solids, contributing to analyze this complex musculature structure. The purpose of this study was to reconstruct tridimensional pelvic floor muscle by manual segmentation and apply FEM. The manual segmentation was made within commercial software. MR images were acquired from the subject supine position, using a 3.0 T system. Field view of the exam was 25×25 cm, 2 mm thick with no gap. The images were acquired in DICOM format, and later converted jpeg format. Twenty consecutive images obtained in the axial plane for each woman were used to construct a 3D model from each of the 8 women. From this 3D reconstruction made through splines in each image, changes in the pubovisceral muscle (a part from the pelvic floor muscles) from the pubis to coccyx were edited. All the pubovisceral muscles edited were exported in step format to the FE analyses software ABAQUS. Finite element meshes were generated for each woman pubovisceral muscle. According to literature soft tissues properties, FE analyses were established to better understand pelvic floor muscles biomechanics. Manual segmentation of the pelvic floor muscles tissues generated very realistic completely different volumetric solids for each woman. It is a very sluggish technique and the nonlinear shape of the pelvic floor makes difficult the utilization of other automatic segmentation

Effects of person-centered care approaches to dementia care on staff: a systematic review

YesPerson-centered care (PCC) has been the subject of several intervention studies, reporting positive effects on people with dementia. However, its impact on staff’s outcomes remains unclear. The purpose of this systematic review was to assess the impact of PCC approaches on stress, burnout and job satisfaction of staff caring for people with dementia in care homes. The databases PubMed, Web of Knowledge, Scopus and EBSCO and reference lists from relevant publications, were searched between December 2012 and March 2013. The review was limited to experimental and quasi-experimental studies, published in English and involving direct care workers (DCWs). Seven studies were included, addressing different PCC approaches: dementia care mapping (n=1); stimulation-oriented approaches (n=2); emotion-oriented approaches (n=2) and behavioral-oriented approaches (n=2). Five studies reported benefits on DCWs, suggesting a tendency towards the effectiveness of PCC on staff. However, methodological weaknesses and heterogeneity among studies make it difficult to draw firm conclusions.Portuguese Foundation for Science and Technolog

Odorant Receptor from the Southern House Mosquito Narrowly Tuned to the Oviposition Attractant Skatole

Oviposition attractants are environmental cues that allow Culex gravid female mosquitoes to locate suitable sites for egg-laying and, therefore, may be exploited for environmentally friendly strategies for controlling mosquito populations. Naturally occurring skatole has been identified as an oviposition attractant for the Southern House mosquito, Culex quinquefasciatus. Previously, we identified in Cx. quinquefasciatus female antennae an olfactory receptor neuron (ORN) highly sensitive to skatole and an odorant-binding protein involved in the detection of this semiochemical. Here, we describe the characterization of an odorant receptor (OR), CquiOR10, which is narrowly tuned to skatole when expressed in the Xenopus oocyte system. Odorant-induced response profiles generated by heterologously expressed CquiOR10 suggest that this OR is expressed in the mosquito ORN sensitive to skatole. However, geranylacetone, which stimulates the antennal ORN, was not detected by CquiOR10-expressing oocytes, thus raising interesting questions about reception of oviposition attractants in mosquitoes

Desire for a child among women living with HIV/AIDS in northeast Brazil

In Brazil, an increasing proportion of new HIV infections and AIDS cases involve women of reproductive age. To describe the reproductive desire of women with HIV/AIDS and to identify factors associated with the desire for motherhood, a cross-sectional study was carried out in the referral hospital for infectious diseases in Ceara State, northeast Brazil. In total, 229 women were included in data analysis. Median age was 32 years (interquartile range, 26-37), and 63% had a monthly family income of less than 210 USD. Forty-nine percent were using a contraceptive method, and 37% wished to undergo tubal ligation. Sixty-four percent of the latter women were motivated by the fear of having an HIV-positive child. Forty percent of the participants wanted to have a child. In the multivariate regression analysis, variables independently associated with women's desire to have a child were: younger age ( in years, odds ration [OR] = 0.94; 95% confidence interval [CI]: 0.90-0.98), number of children (OR = 0.73; 95% CI: 0.57-0.96), and partner's desire for a child (OR = 3.35; 95% CI: 1.75-6.39). Having a partner who did not know about the woman's positive serostatus was negatively associated with the woman's desire for a child (OR = 0.17; 95% CI: 0.04-0.69). No variable related to clinical status was significantly associated with the outcome variable. Our data showed that many unsterilized HIV-positive women in northeast Brazil, at whatever stage of illness, have a desire for children. We recommend that nondirective counseling, consisting of helping women evaluate their own feelings, goals and needs with respect to reproductive options be provided.21426126

T-Cell Memory Responses Elicited by Yellow Fever Vaccine are Targeted to Overlapping Epitopes Containing Multiple HLA-I and -II Binding Motifs

The yellow fever vaccines (YF-17D-204 and 17DD) are considered to be among the safest vaccines and the presence of neutralizing antibodies is correlated with protection, although other immune effector mechanisms are known to be involved. T-cell responses are known to play an important role modulating antibody production and the killing of infected cells. However, little is known about the repertoire of T-cell responses elicited by the YF-17DD vaccine in humans. In this report, a library of 653 partially overlapping 15-mer peptides covering the envelope (Env) and nonstructural (NS) proteins 1 to 5 of the vaccine was utilized to perform a comprehensive analysis of the virus-specific CD4+ and CD8+ T-cell responses. The T-cell responses were screened ex-vivo by IFN-γ ELISPOT assays using blood samples from 220 YF-17DD vaccinees collected two months to four years after immunization. Each peptide was tested in 75 to 208 separate individuals of the cohort. The screening identified sixteen immunodominant antigens that elicited activation of circulating memory T-cells in 10% to 33% of the individuals. Biochemical in-vitro binding assays and immunogenetic and immunogenicity studies indicated that each of the sixteen immunogenic 15-mer peptides contained two or more partially overlapping epitopes that could bind with high affinity to molecules of different HLAs. The prevalence of the immunogenicity of a peptide in the cohort was correlated with the diversity of HLA-II alleles that they could bind. These findings suggest that overlapping of HLA binding motifs within a peptide enhances its T-cell immunogenicity and the prevalence of the response in the population. In summary, the results suggests that in addition to factors of the innate immunity, "promiscuous" T-cell antigens might contribute to the high efficacy of the yellow fever vaccines. © 2013 de Melo et al