Antibiotic Sensitivity in Post Cesarean Surgical Site Infection at a Tertiary Care Centre in Eastern Nepal

Introduction: Post cesarean surgical site infection (SSI) is one of the common complications diagnosed in 2.5%-16% of the cases and is associated with significant increase in maternal morbidity, hospital stay, costs, and psychological stress to the new parents. This study was designed to study the incidence of SSI and the antimicrobial resistance pattern in our hospital. Methods: This was a prospective observational study conducted from July 2015 to December 2015, in which all patients who were admitted with post cesarean SSI or developed SSI during their stay were included.  Wound specimens were collected and susceptibility testing was carried out using disc diffusion technique. Results: The incidence of post cesarean SSI was 6.07% (47/774). Out of the 47 patients who had SSI, 35 (74.75%) had positive swab culture. The most important organism isolated was Staphylococcus aureus (82.85%) out of which 17 (58.62%) were MRSA strain. The resistance of Staphylococcus to penicillin was 84.6% whereas amikacin was found to be highly sensitive (>96%). Among the MRSA strain, resistance to ciprofloxacin, which is the currently used drug for prophylaxis, was 94%. Resistance to penicillins, cephalosporins, and clavulanate was also high. Resistance to vancomycin was also high (53%). Amikacin and chloramphenicol were found to be highly sensitive  (94% and 90% respectively) in the MRSA group. Conclusion: MRSA is the leading cause of post cesarean SSI and is a matter of great concern. Amikacin and chloramphenicol were found to be highly sensitive in this group but unlike other studies, resistance of vancomycin was showing an increasing trend

How the Human Brain Goes Virtual: Distinct Cortical Regions of the Person-Processing Network Are Involved in Self-Identification with Virtual Agents

Millions of people worldwide engage in online role-playing with their avatar, a virtual agent that represents the self. Previous behavioral studies have indicated that many gamers identify more strongly with their avatar than with their biological self. Through their avatar, gamers develop social networks and learn new social-cognitive skills. The cognitive neurosciences have yet to identify the neural processes that underlie self-identification with these virtual agents. We applied functional neuroimaging to 22 long-term online gamers and 21 nongaming controls, while they rated personality traits of self, avatar, and familiar others. Strikingly, neuroimaging data revealed greater avatar-referential cortical activity in the left inferior parietal lobe, a region associated with self-identification from a third-person perspective. The magnitude of this brain activity correlated positively with the propensity to incorporate external body enhancements into one's bodily identity. Avatar-referencing furthermore recruited greater activity in the rostral anterior cingulate gyrus, suggesting relatively greater emotional self-involvement with one's avatar. Post-scanning behavioral data revealed superior recognition memory for avatar relative to others. Interestingly, memory for avatar positively covaried with play duration. These findings significantly advance our knowledge about the brain's plasticity to self-identify with virtual agents and the human cognitive-affective potential to live and learn in virtual worlds

Arthritis Activity and Work Limitation in Behavioral Risk Factor Surveillance System 2011-2013 Data

This study used 2011-2013 Behavioral Risk Factor Surveillance System data to provide a cross-sectional evaluation of the relationship between the exposure arthritis attributable joint pain and two outcomes: arthritis attributable activity limitation and arthritis attributable work limitation. Co-variates representing the domains: sociodemographic factors, health status factors and health behaviors were included in the analysis to assess how their inclusion affected the relationship between main exposure and each of the outcomes. Arthritis attributable joint pain was evaluated as both a dichotomous variable (yes/no joint pain) and a categorical variable (no joint pain, mild-moderate joint pain, and severe joint pain). For each relationship evaluated, arthritis attributable joint pain was a significant risk factor for arthritis attributable activity limitation and arthritis attributable work limitation in both the crude and fully adjusted models. Fully adjusted odds ratios for the relationship between arthritis attributable joint pain and arthritis attributable activity limitation were, for dichotomous joint pain: 9.2 (8.3, 10.1), for categorical joint pain: mild-moderate 6.1 (5.5, 6.7), severe 24.9 (22.4, 27.6). Fully adjusted odds ratios for the relationship between arthritis attributable joint pain and arthritis attributable work limitation were, for dichotomous joint pain: 7.0 (5.9, 8.4), for categorical joint pain: mild-moderate 4.3 (3.6, 5.1), severe 17.1 (14.4, 20.4). Other statistically significant modifiable risk factors identified were self-reported health status and physical activity, though their odds ratios were smaller, ranging from 2.5-3.7 and 1.1-1.4 respectively. Future work in this area could focus on the relative contribution of co-variates with regard to the relationship between the main exposure and the outcomes, as well as identifying other factors which may affect these relationships

The Accuracy of New Wheelchair Users’ Predictions about their Future Wheelchair Use

DOI: 10.1097/PHM.0b013e3182555e4c - NIH Public Access - Author manuscriptObjective—This study examined the accuracy of new wheelchair user predictions about their future wheelchair use. Design—Prospective cohort study of 84 community dwelling veterans provided a new manual wheelchair. Results—The association between predicted and actual wheelchair use was strong at 3-months (phi coefficient = .56), with 90% of those who anticipated using the wheelchair at 3-months still using it (i.e., positive predictive value 0.96) and 60% of those who anticipated not using it indeed no longer using the wheelchair (i.e., negative predictive value 0.60, overall accuracy 0.92). Predictive Accuracy diminished over time, with overall accuracy declining from 0.92 at 3-months to 0.66 at 6-months. At all time points, and for all types of use, patients better predicted use as opposed to disuse, with correspondingly higher positive than negative predictive values. Accuracy of prediction of usage in specific indoor and outdoor locations varied according to location. Conclusions—This study demonstrates the importance of better understanding the potential mismatch between the anticipated and actual patterns of wheelchair use. The findings suggest that users can be relied upon to accurately predict their basic wheelchair-related needs in the short term. Further exploration is needed to identify characteristics that will aid users and their providers in more accurately predicting mobility needs for the long-term

Self-identification and empathy modulate error-related brain activity during the observation of penalty shots between friend and foe

The ability to detect and process errors made by others plays an important role is many social contexts. The capacity to process errors is typically found to rely on sites in the medial frontal cortex. However, it remains to be determined whether responses at these sites are driven primarily by action errors themselves or by the affective consequences normally associated with their commission. Using an experimental paradigm that disentangles action errors and the valence of their affective consequences, we demonstrate that sites in the medial frontal cortex (MFC), including the ventral anterior cingulate cortex (vACC) and pre-supplementary motor area (pre-SMA), respond to action errors independent of the valence of their consequences. The strength of this response was negatively correlated with the empathic concern subscale of the Interpersonal Reactivity Index. We also demonstrate a main effect of self-identification by showing that errors committed by friends and foes elicited significantly different BOLD responses in a separate region of the middle anterior cingulate cortex (mACC). These results suggest that the way we look at others plays a critical role in determining patterns of brain activation during error observation. These findings may have important implications for general theories of error processing

How the human brain goes virtual: Distinct cortical regions of the person-processing network are involved in self-identification with virtual agents

Contains fulltext : 102600.pdf (publisher's version ) (Open Access)Millions of people worldwide engage in online role-playing with their avatar, a virtual agent that represents the self. Previous behavioral studies have indicated that many gamers identify more strongly with their avatar than with their biological self. Through their avatar, gamers develop social networks and learn new social-cognitive skills. The cognitive neurosciences have yet to identify the neural processes that underlie self-identification with these virtual agents. We applied functional neuroimaging to 22 long-term online gamers and 21 nongaming controls, while they rated personality traits of self, avatar, and familiar others. Strikingly, neuroimaging data revealed greater avatar-referential cortical activity in the left inferior parietal lobe, a region associated with self-identification from a third-person perspective. The magnitude of this brain activity correlated positively with the propensity to incorporate external body enhancements into one's bodily identity. Avatar-referencing furthermore recruited greater activity in the rostral anterior cingulate gyrus, suggesting relatively greater emotional self-involvement with one's avatar. Post-scanning behavioral data revealed superior recognition memory for avatar relative to others. Interestingly, memory for avatar positively covaried with play duration. These findings significantly advance our knowledge about the brain's plasticity to self-identify with virtual agents and the human cognitive-affective potential to live and learn in virtual worlds.9 p

Gelcasting of Ceramic Bodies

Net-shape and near-net-shape forming techniques have long been appealing in the production of ceramic materials. The high hardness and low toughness of ceramics make post-densification machining both costly and time-consuming, providing strong incentive for the development and optimization of net-shape techniques. The oldest of these forming techniques is slip casting. However, extrusion of cylindrical shapes, tape casting of laminates, and gelcasting, freeze casting, and injection molding of complex shapes have received considerable attention. Selective laser sintering, where shapes are determined via a computer-controlled localized heating profile, and robocasting, where material from a syringe or fine extruder is deposited in robotically controlled patterns, have garnered more recent interest. Each of these techniques relies on the suspension of a ceramic powder in a liquid vehicle or binder system for the forming stage of the operation. The shaped component is solidified through drying, cooling, or gelling. Once residual liquid is evaporated and binders are burned out, traditional densification methods, such as sintering, are employed. Treated here is gelcasting, one of the more promising forming methods for complex-shaped ceramic and powdered metal components. This method was patented by Janney and Omatete in the early 1990s and was explored in detail by them and their coworkers at Oak Ridge National Laboratory. In their originally conceived method, a low-viscosity slurry is produced by mixing a ceramic powder into an aqueous-based monomer solution, while Venkataswamy et al. used monomers that required organic solvents. The slurries have characteristically high solids loadings, often greater than 50 vol %, but have sufficiently low viscosity to flow easily. Through the addition of a chemical initiator and, in some cases, a catalyst, polymerization commences, at which point the slurry should be cast. The chemically cross-linked network that is formed through polymerization renders the ceramic powder particles immobile. The filled gel conforming to the shape of the mold is rigid enough to be removed for further processing. The high water content makes a controlled drying process critical to prevent warping and cracking. Low binder concentrations (generally <5 wt %) can be removed quickly and the body sintered. Sintering to full density is promoted by the high solids loading that can be achieved in gel-casting slurries. Gelcasting should not be confused with sol-gel processing. In gelcasting, ceramic (or precursor) powders are suspended in a monomer or polymer solution to form slurries for casting. The monomer/polymer solution gels without reacting with the suspended powder, in essence locking the particles in place; the same gel would form in the absence of any ceramic. In sol-gel processing, ceramic precursors are integral to the gel formation process (through hydrolysis, polycondensation, etc.) Metal alkoxides, hydroxides, and the like form the backbone of the gel network and are converted to ceramic in later processing steps. In this chapter, we first describe the categories of gel-casting systems and the chemistry of gelation in each type. Following this is a description of the processing steps from gel preparation to densification. An account of the variety of structural classes that are afforded by gelcasting is then presented. In addition to the processing of conventional bulk ceramics, gelcasting of textured ceramics, porous bodies, and laminates is described. Finally, gel-casting challenges and opportunities are highlighted