Combinatorial discovery of polymers resistant to bacterial attachment

Bacterial attachment and subsequent biofilm formation are key challenges to the long term performance of many medical devices. Here, a high throughput approach coupled with the analysis of surface structure-property relationships using a chemometics approach has been developed to simultaneously investigate the interaction of bacteria with hundreds of polymeric materials on a microarray format. Using this system, a new group of materials comprising ester and hydrophobic moieties are identified that dramatically reduce the attachment of clinically relevant, pathogenic bacteria (Pseudomonas aeruginosa, Staphylococcus aureus and uropathogenic Escherichia coli). Hit materials coated on silicone catheters resulted in up to a 30 fold reduction in coverage compared to a commercial silver embedded catheter, which has been proven to half the incidence of clinically acquired infection. These polymers represent a new class of materials resistant to bacterial attachment that could not have been predicted from the current understanding of bacteria-surface interactions

BHPR research: qualitative1. Complex reasoning determines patients' perception of outcome following foot surgery in rheumatoid arhtritis

Background: Foot surgery is common in patients with RA but research into surgical outcomes is limited and conceptually flawed as current outcome measures lack face validity: to date no one has asked patients what is important to them. This study aimed to determine which factors are important to patients when evaluating the success of foot surgery in RA Methods: Semi structured interviews of RA patients who had undergone foot surgery were conducted and transcribed verbatim. Thematic analysis of interviews was conducted to explore issues that were important to patients. Results: 11 RA patients (9 ♂, mean age 59, dis dur = 22yrs, mean of 3 yrs post op) with mixed experiences of foot surgery were interviewed. Patients interpreted outcome in respect to a multitude of factors, frequently positive change in one aspect contrasted with negative opinions about another. Overall, four major themes emerged. Function: Functional ability & participation in valued activities were very important to patients. Walking ability was a key concern but patients interpreted levels of activity in light of other aspects of their disease, reflecting on change in functional ability more than overall level. Positive feelings of improved mobility were often moderated by negative self perception ("I mean, I still walk like a waddling duck”). Appearance: Appearance was important to almost all patients but perhaps the most complex theme of all. Physical appearance, foot shape, and footwear were closely interlinked, yet patients saw these as distinct separate concepts. Patients need to legitimize these feelings was clear and they frequently entered into a defensive repertoire ("it's not cosmetic surgery; it's something that's more important than that, you know?”). Clinician opinion: Surgeons' post operative evaluation of the procedure was very influential. The impact of this appraisal continued to affect patients' lasting impression irrespective of how the outcome compared to their initial goals ("when he'd done it ... he said that hasn't worked as good as he'd wanted to ... but the pain has gone”). Pain: Whilst pain was important to almost all patients, it appeared to be less important than the other themes. Pain was predominately raised when it influenced other themes, such as function; many still felt the need to legitimize their foot pain in order for health professionals to take it seriously ("in the end I went to my GP because it had happened a few times and I went to an orthopaedic surgeon who was quite dismissive of it, it was like what are you complaining about”). Conclusions: Patients interpret the outcome of foot surgery using a multitude of interrelated factors, particularly functional ability, appearance and surgeons' appraisal of the procedure. While pain was often noted, this appeared less important than other factors in the overall outcome of the surgery. Future research into foot surgery should incorporate the complexity of how patients determine their outcome Disclosure statement: All authors have declared no conflicts of interes

A Multicenter, Randomized, Placebo‐Controlled Trial of Atorvastatin for the Primary Prevention of Cardiovascular Events in Patients With Rheumatoid Arthritis

Objective: Rheumatoid arthritis (RA) is associated with increased cardiovascular event (CVE) risk. The impact of statins in RA is not established. We assessed whether atorvastatin is superior to placebo for the primary prevention of CVEs in RA patients. Methods: A randomized, double‐blind, placebo‐controlled trial was designed to detect a 32% CVE risk reduction based on an estimated 1.6% per annum event rate with 80% power at P 50 years or with a disease duration of >10 years who did not have clinical atherosclerosis, diabetes, or myopathy received atorvastatin 40 mg daily or matching placebo. The primary end point was a composite of cardiovascular death, myocardial infarction, stroke, transient ischemic attack, or any arterial revascularization. Secondary and tertiary end points included plasma lipids and safety. Results: A total of 3,002 patients (mean age 61 years; 74% female) were followed up for a median of 2.51 years (interquartile range [IQR] 1.90, 3.49 years) (7,827 patient‐years). The study was terminated early due to a lower than expected event rate (0.70% per annum). Of the 1,504 patients receiving atorvastatin, 24 (1.6%) experienced a primary end point, compared with 36 (2.4%) of the 1,498 receiving placebo (hazard ratio [HR] 0.66 [95% confidence interval (95% CI) 0.39, 1.11]; P = 0.115 and adjusted HR 0.60 [95% CI 0.32, 1.15]; P = 0.127). At trial end, patients receiving atorvastatin had a mean ± SD low‐density lipoprotein (LDL) cholesterol level 0.77 ± 0.04 mmoles/liter lower than those receiving placebo (P < 0.0001). C‐reactive protein level was also significantly lower in the atorvastatin group than the placebo group (median 2.59 mg/liter [IQR 0.94, 6.08] versus 3.60 mg/liter [IQR 1.47, 7.49]; P < 0.0001). CVE risk reduction per mmole/liter reduction in LDL cholesterol was 42% (95% CI −14%, 70%). The rates of adverse events in the atorvastatin group (n = 298 [19.8%]) and placebo group (n = 292 [19.5%]) were similar. Conclusion: Atorvastatin 40 mg daily is safe and results in a significantly greater reduction of LDL cholesterol level than placebo in patients with RA. The 34% CVE risk reduction is consistent with the Cholesterol Treatment Trialists’ Collaboration meta‐analysis of statin effects in other populations

The historical knowledge within the educational process of the health professional

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Evolución de la red telefónica existente en Guayaquil hacia banda ancha

Consiste en implantar una red pública ATM para la ciudad de Guayaquil. Describe las generalidades y tendencias de una red telefónica, los modelos de interconexión y los planes técnicos fundamentales. Se enfoca la tecnología SDH y la forma de incluir celdas ATM dentro de las tramas STM. Sus principios, estructura, funciones, conmutación, señalización y control del tráfico. Se explica la arquitectura de la RDSI de banda ancha: la red de gestión, red de transporte y red de acceso. Dentro de las tendencias de la red de acceso se trata de analizar el uso de la tecnología ADSL, redes FTTC y HFC; también se da una descripción de conmutadores ATM. La implementación de la red pública de banda ancha ATM de Guayaquil permitirá usar al máximo la infraestructura existente, con la posibilidad de brindar nuevos servicios tanto para el mercado empresarial como para el residencial.GuayaquilIngeniero en Electricidad Especialización Electrónic

Evaluación de la red telefonica existente en Guayaquil hacia banda ancha

CONSISTE EN IMPLANTAR UNA RED PUBLICA ATM PARA LA CIUDAD DE GUAYAQUIL. DESCRIBE LAS GENERALIDADES Y TENDENCIAS DE UNA RED TELEFONICA, LOS MODELOS DE INTERCONEXION Y LOS PLANES TECNICOS FUNDAMENTALES. SE ENFOCA LA TECNOLOGIA SDH Y LA FORMA DE INCLUIR CELDAS ATM DENTRO DE LAS TRAMAS STM. SUS PRINCIPIOS, ESTRUCTURA, FUNCIONES, CONMUTACION, SEÑALIZACION Y CONTROL DEL TRAFICO. SE EXPLICA LA ARQUITECTURA DE LA RDSI DE BANDA ANCHA: LA RED DE GESTION, RED DE TRANSPORTE Y RED DE ACCESO. DENTRO DE LAS TENDENCIAS DE LA RED DE ACCESO SE TRATA DE ANALIZAR EL USO DE LA TECNOLOGIA ADSL, REDES FTTC Y HFC; TAMBIEN SE DA UNA DESCRIPCION DE CONMUTADORES ATM. LA IMPLEMENTACION DE LA RED PUBLICA DE BANDA ANCHA ATM DE GUAYAQUIL PERMITIRA USAR AL MAXIMO LA INFRAESTRUCTURA EXISTENTE, CON LA POSIBILIDAD DE BRINDAR NUEVOS SERVICIOS TANTO PARA EL MERCADO EMPRESARIAL COMO PARA EL RESIDENCIAL