Ciprofloxacin pharmacokinetics after oral and intravenous administration in (morbidly) obese and non-obese individuals: a prospective clinical study

Background and Objective Ciprofloxacin is a fluoroquinolone used for empirical and targeted therapy of a wide range of infections. Despite the increase in obesity prevalence, only very limited guidance is available on whether the ciprofloxacin dose needs to be adjusted when administered orally or intravenously in (morbidly) obese individuals. Our aim was to evaluate the influence of (morbid) obesity on ciprofloxacin pharmacokinetics after both oral and intravenous administration, to ultimately guide dosing in this population. Methods (Morbidly) obese individuals undergoing bariatric surgery received ciprofloxacin either orally (500 mg; n = 10) or intravenously (400 mg; n = 10), while non-obese participants received semi-simultaneous oral dosing of 500 mg followed by intravenous dosing of 400 mg 3 h later (n = 8). All participants underwent rich sampling (11-17 samples) for 12 h after administration. Non-linear mixed-effects modelling and simulations were performed to evaluate ciprofloxacin exposure in plasma. Prior data from the literature were subsequently included in the model to explore exposure in soft tissue in obese and non-obese patients. Results Overall, 28 participants with body weights ranging from 57 to 212 kg were recruited. No significant influence of body weight on bioavailability, clearance or volume of distribution was identified (all p > 0.01). Soft tissue concentrations were predicted to be lower in obese individuals despite similar plasma concentrations compared with non-obese individuals. Conclusion Based on plasma pharmacokinetics, we found no evidence of the influence of obesity on ciprofloxacin pharmacokinetic parameters; therefore, ciprofloxacin dosages do not need to be increased routinely in obese individuals. In the treatment of infections in tissue where impaired ciprofloxacin penetration is anticipated, higher dosages may be required.Pharmacolog

Adhesion formation after surgery for locally advanced colonic cancer in the COLOPEC trial

This study investigated the impact of laparoscopic or open resection of locally advanced colonic cancer on the incidence and severity of adhesions evaluated by laparoscopy at 18 months, primarily intended to evaluate peritoneal recurrence. Open surgery was identified as an independent risk factor for adhesions, but not intraperitoneal chemotherapy.</p

GO4genome: A Prokaryotic Phylogeny Based on Genome Organization

Determining the phylogeny of closely related prokaryotes may fail in an analysis of rRNA or a small set of sequences. Whole-genome phylogeny utilizes the maximally available sample space. For a precise determination of genome similarity, two aspects have to be considered when developing an algorithm of whole-genome phylogeny: (1) gene order conservation is a more precise signal than gene content; and (2) when using sequence similarity, failures in identifying orthologues or the in situ replacement of genes via horizontal gene transfer may give misleading results. GO4genome is a new paradigm, which is based on a detailed analysis of gene function and the location of the respective genes. For characterization of genes, the algorithm uses gene ontology enabling a comparison of function independent of evolutionary relationship. After the identification of locally optimal series of gene functions, their length distribution is utilized to compute a phylogenetic distance. The outcome is a classification of genomes based on metabolic capabilities and their organization. Thus, the impact of effects on genome organization that are not covered by methods of molecular phylogeny can be studied. Genomes of strains belonging to Escherichia coli, Shigella, Streptococcus, Methanosarcina, and Yersinia were analyzed. Differences from the findings of classical methods are discussed

Pro-actief stressmanagement houdt medewerker gezond

Stress is vaak het gevolg van problemen in de besturing en inrichting van de organisatie. In dit artikel wordt een door TNO Arbeid ontwikkeld werkstressinstrument beschreven (Tripod Sigma) dat managers in staat stelt werkstress in hun eigen onderdeel te beheersen. Het instrument is zo opgezet dat de resultaten laten zien hoe de problemen die werkstess veroorzaken ook een bedreiging vormen voor het primaire proces. Managers zien hierdoor duidelijk wat er voor hen te winnen is en kunnen pro-actief de bestaande problemen oplossen en toekomstige problemen voorkomen. P&O'ers helpen zonodig bij het invoeren van de verbeteringen die de managers initiëren

Tripod sigma: results of a pro-active work stress-survey

Work related stress is an important causes of disability and absenteeism. TNO Work and Employment has developed an instrument, called Tripod Sigma, that identifies risks to work stress and provides tools for remedying these risks. The Tripod Sigma model is developed analogous to the Tripod philosophy which Shell has initiated to identify and proactively control safety risks. This model is used to measure latent failures in the working environment that can cause human error. The main philosophy behind Tripodis that human error can most effectively be controlled by controlling the working environment and the organisation of work. Work stress, like human error, is something that occurs on the level of the individual. Research shows that causes which contribute to work related stress can also be traced back to conditions of the working environment of employees. The project described in this paper has the aim to develop an instrument for analysis of risks for work related stress ‘all the way back’ to the level of management decisions. An instrument that not only identifies risks, but also provides directions for management to reduce or prevent risks

Feasibility of a worker-directed web-based intervention for employees with depressive symptoms

Depressive disorders are highly prevalent in the working population and lead to excessive costs. Online interventions have shown to be effective treatments for depression but are not often applied in the work setting, despite the importance of work related aspects in the development and perpetuation of depression. We developed a worker-directed web-based intervention for employees with depressive symptoms named Happy@Work. A process evaluation was conducted alongside a randomized controlled trial to assess the feasibility of the intervention and to explore barriers and facilitators for further implementation of the intervention. Employees from different companies in the Netherlands who experienced elevated depressive symptoms and were not on sick leave were eligible to take part in this study. Happy@Work contains six lessons and every lesson has several assignments. When completed, a coach provides feedback to assignments via the website. Process measures investigated were: reach, dose delivered, dose received, and fidelity. Recruitment methods and participant satisfaction with the intervention were described and analyzed as well. Data was collected at baseline and 8 weeks later via online questionnaires and data registrations on the website. The implementation score of the intervention was sufficient, but reach of the target population was low. The dose delivered was high, with 93.1% of participants who used the intervention components that were offered to them. However, adherence to the intervention was low; the dose received was 57.8%. The fidelity of the implementation of the intervention was satisfactory. Recruitment of companies and participants was difficult. Participants were satisfied with the different aspects of the intervention, especially with the feedback from the coach. The results of this process evaluation showed that the intervention was conducted according to protocol and seems feasible for further implementation. Potential barriers to further implementation of the intervention include the reach of the target population, intervention adherence and the quality of the feedback. Based on the results of the effectiveness of the intervention, we do not recommend further implementation of the intervention in its current form

Use of intervention mapping for occupational risk prevention and health promotion: A systematic review of literature

Aim: Intervention mapping (IM) is a method to systematically design interventions that is applied regularly within the public health domain. This study investigates whether IM is effectively used within the occupational safety and health domain as well. Specifically, this study explores the relation between the fidelity regarding the use of the IM protocol for intervention develop-ment, the implementation process and the effectiveness of the occupational risk prevention and health promotion interventions. Methods: A systematic review was conducted including articles on development, implementation, and effects of occupational risk prevention and health promotion interventions that were developed according to the IM-protocol. By means of a checklist, two authors reviewed the articles and rated them on several indicators regarding the fidelity of the IM-protocol, the implementation process, and the intervention effect. Results: A literature search resulted in a total of 12 interventions as described in 38 articles. The fidelity to the IM-protocol was relatively low for participation throughout the development process and implementation planning. No relationship was found between fidelity of the IM-protocol and the intervention effect. A theory-based approach (as one of the core elements of IM) appears to be positively related to a successful implementation process. Conclusion: Results of the review suggest that organizing a participative approach and implementation planning is difficult in practice. In addition, results imply that conducting matrices of change objectives as part of the intervention development, although challenging and time-consuming, may ultimately pay off, resulting in a tailored intervention that matches the target group