119 research outputs found

    Clinical spectrum of severe community acquired infections in patients under General Medicine requiring admission to medical intensive care unit and medical high dependency unit in a tertiary care hospital in South India

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    BACKGROUND : Community acquired infections are a common problem in the intensive care units across the world as well as in India contributing to severe morbidity and mortality. However, there is paucity of data from Indian centres on commonest infections and the associated risk factors for mortality and morbidity. This study was undertaken to study community acquired infections and their outcomes with risk factors for mortality and morbidity. AIMS AND OBJECTIVES : To determine the etiological and clinical spectrum of severe community acquired infections requiring ICU care, their admission correlates and determine factors influencing outcomes. METHODS : 107 patients were included retrospectively and 28 were included prospectively and their course was followed throughout hospital stay. Data collected included demographic variables, APACHE score and laboratory parameters. The primary outcome studied was death and secondary outcomes were nosocomial complications. RESULTS : The three commonest infections in the study were scrub typhus (55.6%), acute pyelonephritis (14.8%) and community acquired pneumonia (CAP) (8.9%). Commonest etiological agent causing bacteremia was E.coli (66.7%) out of which ESBL were 54.5%, followed by S. pneumoniae 12%. Febrile illness with eschar, leucocytosis, and transaminitis characterised scrub typhus. Febrile illness with dysuria, flank pain and isolation of typical organism characterised acute pyelonephritis. Fever with respiratory symptoms and radiological features of consolidation characterised CAP. The commonest co-morbidity was diabetes (46.7%). Shock requiring vasoactive agents was an independent factor for mortality in scrub typhus and acute pyelonephritis. The overall mortality rate in the study population was 29.5%. A higher APACHE score on admission correlated with poor outcome. CONCLUSION : Community acquired infections are a common cause of admission to the ICU and are associated with a higher rate of mortality. Scrub typhus, acute pyelonephritis and CAP are the commonest infections in the ICU

    Lake Ontario Coastal Initiative Action Agenda

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    The mission of the Lake Ontario Coastal Initiative (LOCI), encompassing all New York State North Coast stakeholders from the Niagara River to the St. Lawrence River, is to enlist and retain broad public commitment for remediation, restoration, protection, conservation and sustainable use of the coastal region. This mission will be accomplished by securing funds and resources to achieve scientific understanding, educate citizens, and implement locally supported priorities, programs and projects as identified through this Initiative

    Developing a Rapid Assessment Program for Student Success in Clinical Education

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    Successful management of the struggling student in the clinic relies heavily on the early identification of clinical performance deficits. CIs who directly observe student performance, actions and behaviors should aim for early and precise identification of difficulties, which should lead to initial discussions with the student. If the student\u27s struggles require involvement from the educational institution, the CI should promptly contact and collaborate with the DCE. Early communication with the DCE is beneficial, as they can provide support for CIs overwhelmed by the difficulties that accompany working with a challenging student. The DCE provides guidance on determining the depth of deficiencies, the student’s needs, and options for remediation. The Rapid Student Assessment and Review (R-STAR) Program was designed to facilitate a thorough and timely review of students’ Clinical Performance Instruments (CPIs)through partnership with expert clinical education faculty. With the increasing number of students in programs and the competing demands on Clinical Instructors (CIs), the successful management of the struggling student in the clinic relies heavily on the early identification of clinical performance deficits. Judicious review of CPI ratings and narratives is essential to identify discrepancies between the scores given and narrative comments. The R-STAR Program utilizes clinical partners who were carefully selected and specifically trained to review and provide feedback to students and CIs, while identifying those individuals with issues requiring the DCE to prioritize and address. This session describes how to develop an efficient and effective program that may be implemented to help facilitate the timely management of student assessments in clinical education to enhance success

    Does What Goes up Also Come Down? Using a Recruitment Model to Balance Alewife Nutrient Import and Export

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    Migrating adult Alewives Alosa pseudoharengus are a source of marine-derived nutrients on the East Coast of North America, importing nitrogen and phosphorus into freshwater habitats. Juvenile migrants subsequently transport freshwater-derived nutrients into the ocean. We developed a deterministic model to explore the theoretical nutrient dynamics of Alewife migrations at differing spawner abundances. Net nutrient balance was calculated relative to these abundances along the spawner–recruit curve. The ecological consequences of these subsidies in a particular watershed depend on the magnitude of adult escapement relative to the habitat\u27s carrying capacity for juveniles. At low escapement levels and assuming complete habitat access, the number of recruits produced per spawner was high and juvenile nutrient export dominated. At high escapement levels, fewer recruits were produced per spawner because recruitment is density dependent. As a result, adult nutrient import dominated. At varying levels of freshwater productivity and fisheries mortality for upstream spawners, this trend remained the same while the magnitude of the endpoints changed. Productivity level was the major determinant of export, while fisheries mortality had the strongest effect on adult import. The dynamics of this nutrient trade-off are important for managers to consider as a recovering population will likely shift from net export to net import as escapement increases. This transition will be sensitive to both harvest rates and to fish passage efficacy at dams and other barriers

    Cytotoxicity and Cell Viability Assessment of Biomaterials

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    Biocompatibility testing is essential for medical devices and pharmaceutical agents, regardless of their mechanical, physical, and chemical properties. These tests assess cytotoxic effects and acute systemic toxicity to ensure safety and effectiveness before clinical use. Cell viability, indicating the number of healthy cells in a sample, is determined through various assays that measure live-to-dead cell ratios. Cytotoxicity measures a substance’s potential for cell damage or death, and is evaluated through numerous assay methods based on different cell functions. Ensuring biocompatibility is crucial for the successful integration of medical devices and pharmaceuticals into clinical practice. As part of the evaluation process, researchers utilize a range of cell viability assays and cytotoxicity tests to assess the potential impact of these products on living cells. The results of these tests inform the optimization of cell culture conditions and drug candidates, as well as guide the development of safer, more effective medical devices. By thoroughly examining the interactions between devices, drugs, and biological systems, researchers aim to minimize the risk of adverse reactions and improve patient outcomes
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