Mode Of Acquisition Research Articles

Investigating the Bias in Orthopaedic Patient-reported Outcome Measures by Mode of Administration: A Meta-analysis.

Background:Patient-reported outcome measures (PROMs) are critical and frequently used to assess clinical outcomes to support medical decision-making.Questions/Purpose:The purpose of this meta-analysis was to compare differences in the modes of administration of PROMs within the field of orthopaedics to determine their impact on clinical outcome assessment.Patients and Methods:The PubMed database was used to conduct a review of literature from 1990 to 2018 with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocol. All articles comparing PROMs for orthopaedic procedures were included and classified by the mode of administration. Each specific survey was standardized to a scale of 0 to 100, and a repeated random effectsmodel meta-analysis was conducted to determine the mean effect of each mode of survey.Results:Eighteen studies were initially included in the study, with 10 ultimately used in the meta-analysis that encompassed 2384 separate patient survey encounters. Six of these studies demonstrated a statistically notable difference in PROM scores by mode of administration. The meta-analysis found that the standardized mean effect size for telephone-based surveys on a 100-point scale was 71.7 (SE 5.0) that was significantly higher (P , 0.0001) than survey scores obtained via online/tech based (65.3 [SE 0.70]) or self-administered/paper surveys (61.2 [SE 0.70]).Conclusions:Overall, this study demonstrated that a documented difference exists in PROM quality depending on the mode of administration. PROM scores obtained via telephone (71.7) are 8.9% higher than scores obtained online (65.3, P , 0.0001), and 13.8% higher than scores obtained via self-administered on paper (61.8, P , 0.0001). Few studies have quantified statistically notable differences between PROM scores based solely on the mode of acquisition in orthopaedic

The Application of RFID Technology in the Work Mode of Library Acquisition and Cataloging

<p>In the 21st century, with the continuous development of Radio Frequency Identification (RFID), more and more libraries have begun to apply this technology. Due to the many restrictions of the traditional editing model, RFID technology, with its characteristics, has improved work efficiency and service quality of library acquisition and cataloging work. Therefore, the application of RFID technology in library work has great prospects. The application of RFID technology to the intelligent process of libraries has been promoted.</p><p> </p>

FARM SIZE AND PRODUCTIVITY OF FOOD CROP FARMERS IN ABEOKUTA NORTH LOCAL GOVERNMENT AREA, OGUN STATE, NIGERIA

This study examined farm size and productivity of food crop farmers in Abeokuta North Local Government Area of Ogun State, Nigeria. The study was based on primary data obtained through the use of structured questionnaires. The survey involved a cross section random selection of 112 farming households from the study area. Data were obtained on the socio – economic characteristic of the farming members of the households, mode of land acquisition, parcels of land available for cultivation, total parcels of land cultivated, resources used, cost and outputs of food crops on parcels of land cultivated. The data was analyzed by both descriptive statistics and stochastic frontier model with the level of land fragmentation measured by Simpson index as well as the number of parcel cultivated. It was found that significant evidence exists to show that most farms cultivated in the study area are relatively fragmented which was caused by inheritance mode of land acquisition and this have effect on food crop production. The farm sizes cultivated by farming households have significance effect on output. Hired labour and cost of intermediate materials used have significant effect on the production efficiency of farmers. The finding revealed that most farming households in the study area were found operating relatively on scattered farm land. On the basis of the above findings, it was recommended that Farmers' accessibility to loans should be addressed by government and to establish farm estate, pattern of land holding and also acquisition of more farmland should be addressed for high production efficiency.

Passport: global challenges – local solutions

This article deals with the origin and trajectory of the passport, its multifaceted nature in modern life. Firstly, a passport is a standardizedand written, visualized, and anthropometric, personalized proof of citizenship of its bearer, but not always. Secondly, it is aproof of identification, regardless of the time, place, and mode of acquisition of citizenship of a particular state (in the form of personaldata processing) and control over them by that state. Finally, it is a paper document (actually machine-readable) that gives its bearerrights, responsibilities, and privileges guarantee his/her freedom of movement (unlimited and indefinite entry into and exit from thestate of citizenship) and immunity (from extradition and expulsion).In the time of globalization and omnipresent migration, there is a myriad of modern researches worldwide related to passport,citizenship, person identification, etc. Up to my mind, we can shortlist such authors as Atossa Araxia Abrahamian (cosmopolites andglobal citizen), Leo Benedictus (history of the passport), Claire Benoit (the passport in the context of citizenship), Evelyn Capassakis(passport revocations or denials), Jelena Džankić (the global market for investor citizenship), Yossi Harpaz (dual nationality as a worldwideasset), Martin Lloyd and Craig Robertson (the history of the passport), Mark B Salter (the passport in international relations),Ayelet Shachar (the shifting border of immigration regulation), Peter J Spiro (the past and future of dual citizenship), John C Torpey(the invention of the passport), James Tully (on global citizenship), Patrick Weil (citizenship, passports, and the legal identity of persons).In modern days this most traveled document in the world is a perfect political and legal instrument used by the particular stateto identify its citizens, keep them in the borders, and not let them enjoy the freedom of movement extra territory. In this article, I tracethe history of the passport within the law, international relations, and globalization. A separate piece of information is related to its evolutionduring centuries. It is interesting how passports and their carriers (citizens of a particular state) are handled at international borders?And what are the fundamental functions of the passport in global mobility?In 2020 not only states globally in terms of preservation of national security and identity but also health stop (at least hamper)migration. “This virus (COVID-19) does not have a passport”, declared French President Emmanuel Macron on 12 March 2020 in aprimary television address to the French people. Non-essential travel when you possess not enough worthy passport stops you beyondthe borders of the European Union. You are not allowed to enter unless you acquire dual nationality and obtain a second alternativepassport.

Passport: global challenges – local solutions

This article deals with the origin and trajectory of the passport, its multifaceted nature in modern life. Firstly, a passport is a standardizedand written, visualized, and anthropometric, personalized proof of citizenship of its bearer, but not always. Secondly, it is aproof of identification, regardless of the time, place, and mode of acquisition of citizenship of a particular state (in the form of personaldata processing) and control over them by that state. Finally, it is a paper document (actually machine-readable) that gives its bearerrights, responsibilities, and privileges guarantee his/her freedom of movement (unlimited and indefinite entry into and exit from thestate of citizenship) and immunity (from extradition and expulsion).In the time of globalization and omnipresent migration, there is a myriad of modern researches worldwide related to passport,citizenship, person identification, etc. Up to my mind, we can shortlist such authors as Atossa Araxia Abrahamian (cosmopolites andglobal citizen), Leo Benedictus (history of the passport), Claire Benoit (the passport in the context of citizenship), Evelyn Capassakis(passport revocations or denials), Jelena Džankić (the global market for investor citizenship), Yossi Harpaz (dual nationality as a worldwideasset), Martin Lloyd and Craig Robertson (the history of the passport), Mark B Salter (the passport in international relations),Ayelet Shachar (the shifting border of immigration regulation), Peter J Spiro (the past and future of dual citizenship), John C Torpey(the invention of the passport), James Tully (on global citizenship), Patrick Weil (citizenship, passports, and the legal identity of persons).In modern days this most traveled document in the world is a perfect political and legal instrument used by the particular stateto identify its citizens, keep them in the borders, and not let them enjoy the freedom of movement extra territory. In this article, I tracethe history of the passport within the law, international relations, and globalization. A separate piece of information is related to its evolutionduring centuries. It is interesting how passports and their carriers (citizens of a particular state) are handled at international borders?And what are the fundamental functions of the passport in global mobility?In 2020 not only states globally in terms of preservation of national security and identity but also health stop (at least hamper)migration. “This virus (COVID-19) does not have a passport”, declared French President Emmanuel Macron on 12 March 2020 in aprimary television address to the French people. Non-essential travel when you possess not enough worthy passport stops you beyondthe borders of the European Union. You are not allowed to enter unless you acquire dual nationality and obtain a second alternativepassport.

S0193 Outcomes of Pediatric Hospital and Community-Associated Clostridioides difficile Infection

INTRODUCTION: Incidence of Clostridioides difficile infection (CDI) in pediatric population is increasing, with paucity of data on CDI outcomes in this population, particularly in community-associated cases. METHODS: A population-based cohort study of the pediatric age group (< 18 years) from 2006 to 2017 was conducted using the Rochester Epidemiology Project. CDI was diagnosed with watery diarrhea and a positive stool assay, after exclusion of other causes of diarrhea. CDI was defined as healthcare-associated (HA) if symptoms occurred >48 hours after admission to or < =4 weeks of hospital discharge; community-acquired (CA) if there was no discharge from a hospital in the past 12 weeks; rest were indeterminate. CDI was considered severe if WBC ≥15000/µL or creatinine ≥1.5mg/dL, fulminant if there was ileus, megacolon, ICU admission, colectomy, hypotension or sepsis. Recurrence was defined with recurrent diarrhea within 8 weeks of the last episode, with positive stool assay and interim symptom resolution. Chi-square/Fischer’s exact tests were used for comparison of baseline characteristics and outcomes. P < 0.05 was considered statistically significant. RESULTS: From 2006 to 2017, 157 pediatric patients were identified with median age 3.6 years (range, 0.2–17.9), 54% (85) were female. Overall 12 patients with indeterminate CDI were excluded. Of the remaining patients, majority [67.6% (98)] had CA-CDI. Baseline characteristics of CA and HA CDI are outlined in Table 1; 48.3% (70) patients had antibiotic exposure, more in HA than CA CDI. Overall, 2.1% patients (3) had severe CDI, 9.6% (14) had fulminant CDI; 6.9% (10) required ICU admission. Overall, 8.3% (12) patients needed a change in treatment due to non-response or adverse events. Recurrence occurred in 20.1% (29) patients. Patients with CA-CDI were less likely to have fulminant disease and ICU admission compared to HA-CDI (Table 2). There were no CDI-related deaths. CONCLUSION: Community-acquired infection accounts for a majority of CDI in the pediatric age group, and is associated with better outcomes compared to healthcare-associated CDI.Table 1.: Baseline characteristics by mode of acquisition of CDI* *data presented as n (%) for categorical and median (min-max) for continuous variables) ^risk factor exposure within 90 days prior to CDI is reportedTable 2.: Outcome of CDI by mode of acquisition

Predicting Sexually Transmitted Infections Among HIV+ Adolescents and Young Adults: A Novel Risk Score to Augment Syndromic Management in Eswatini.

Despite poor predictive power, syndromic screening is standard of care for diagnosing sexually transmitted infections (STIs) in low-resource, high HIV-burden settings. Predictive models may augment syndromic screening when diagnostic testing is not universally available for screening high-risk patient populations such as adolescents and young adults living with HIV. Four hundred fifteen adolescents and young adults living with HIV, age 15-24 years, participated from 3 clinical sites in Eswatini, provided urine, sexual and medical history, and completed physical examination. STI cases were defined by a positive Xpert result for Chlamydia trachomatis, Neisseria gonorrhea, or Trichomonas vaginalis. Features predictive of an STI were selected through Least Absolute Shrinkage and Selection Operator (LASSO) with 5-fold cross validation. Various model strategies were compared with parametric area under the Receiver Operator Curve (AUC) estimation and inferences were made with bootstrapped standard errors. Syndromic screening poorly predicted STIs [AUC 0.640 95% Confidence Interval (95% CI): 0.577 to 0.703]. A model considering 5 predictors (age group, sex, any sexual activity, not always using condoms (either self or partner), a partner who was 25 years or older, and horizontal or unknown mode of HIV acquisition) predicted STIs better than syndromic screening [AUC: 0.829 (95% CI: 0.774 to 0.885)] and was improved when the risk score was supplemented with leukocyte esterase (LE) testing [AUC: 0.883 (95% CI: 0.806 to 0.961)]. This simple predictive model, with or without leukocyte esterase testing, could improve STI diagnosis in HIV-positive adolescents and young adults in high burden settings through complementary use with syndromic screening and to guide patient selection for molecular STI diagnostic tests.

Experience of Hepatitis B e Antigen positive and anti-HBeAg positive pregnancy in hepatitis B virus positive women in a Teaching Hospital: Frequency, viral load association and outcome

: Mother to child transmission (MTCT) is the most important mode of acquisition of hepatitis B. MTCT is dependent on HBeAg status and HBV DNA levels. There is lack of information about HBeAg status and HBV DNA levels in HBsAg pregnant women in India.We aimed to determine the frequency of Hepatitis B infection, HBeAg positive status, its association with HBV viral load and compared the differences in clinical and laboratory characteristics between HBeAg positive and negative cohort.: We extracted demographic, laboratory and virological characteristics from case records of pregnant women with HBV seen by department of Obstetrics and Gynaecology and Gastroenterology between January 2011 and December 2018. Patients were stratified into HBeAg positive and negative groups. Descriptive statistics were carried out. : The prevalence of HBsAg positive pregnancy was 0.63% (130/20624 deliveries). Of the 89 patients in whom e antigen results were available, 14 (15.7%) were HBeAg positive and 73 (82%) were HBeAg negative. HBeAg positive women were younger (24y vs 27y), had higher AST (36 vs 18), ALT (56 vs 23) and HBV DNA level (1.3x10 vs 54 IU/ml) levels compared to HBeAg negative women. 12/14 HBeAg positive women received antivirals to prevent MTCT.: Hepatitis B prevalence in our cohort is 0.63%. HBeAg positive status was seen in 15.7% of pregnant women and was associated with high viral load of &amp;#62;10/copies/ml. 82% were HBeAg negative and associated with low viral load. HBeAg can be used as a surrogate marker for viral load and has immunoprophylaxis and treatment implications.

Wearable Sensing Devices for Point of Care Diagnostics.

The growth of smart wearable sensing systems has gained immense importance in the present mode of data acquisition and signaling in pharmaceutical, healthcare, and wellness industries. Presently, application of smart wearables is gaining prominence in several fitness activities, therapeutics, and diagnostic areas. Smart wearable biosensors offer real-time monitoring of physiological metrics and biomarkers that are specific to certain diseases in ambulant condition. This review offers a broad overview of the state-of-the-art progress on smart wearable biosensors focusing on applications in point of care diagnostics. A careful comparison of presently available commercial devices, implementation in clinical trials, and validation also have been highlighted in the present review. This work concludes with challenges and future prospects for scientists and engineers working in the nascent interdisciplinary field.

Histoplasmosis Caused by Histoplasma capsulatum var. duboisii: A Comprehensive Review of Cases From 1993 to 2019.

Histoplasmosis caused by Histoplasma capsulatum var. duboisii (Hcd) is a rare, but probably underestimated, endemic infection described in intertropical Africa. Therefore, the epidemiology of the infection remains unclear, and there is no consensus on therapeutic management. Using a comprehensive search on different Internet databases, we collected case reports of Hcd infection published from 1993 to 2019. Epidemiological and clinical charts and therapeutic strategies were analyzed. We found 94 well-documented cases of Hcd infection, and 30.1% of the patients were under 18 years old. Symptoms occurred in some patients several decades after leaving the endemic area. Cutaneous/subcutaneous lesions, bone infections, and lymphadenopathies, both isolated and combined, were the most frequent presentations. The human immunodeficiency virus (HIV) coinfection rate was at 20.8%, with fever, lymphadenopathies, and an absence of bone infection being the differentiating elements from patients living without HIV. The rate of disseminated forms (60.6% in our review) significantly increased as compared to studies published before 1993, but without correlation with HIV infection. The global mortality rate was at 23.4% by the end of follow-up. The outcome was not correlated with the antifungal drug prescribed, nor with HIV serologic status, but was correlated with the initiation of an antifungal therapy. Hcd histoplasmosis is a severe fungal infection for which the precise mode of acquisition remains to be determined. There is a need for affordable and more specific diagnostic tools. Itraconazole and amphotericin B are the best therapeutic alternatives and should be available in all low-income countries of the endemic area.

Crowdsourcing Data for the Elaboration of Noise Maps: a Methodological Proposal

In recent decades, the awareness that noise pollution caused by traffic, industry and recreational activities constitutes one of the main environmental problems is growing. In order to control the environmental noise, many regulations propose the creation of noise maps according to standard procedures that involves the data acquisition, analysis and elaboration. In this paper, crowdsourcing noise data collection is described. It involves volunteers that can record sound pressure levels thanks to specific applications on their mobile devices, such as the “NoiseCapture” app developed in France by CNRS and IFSTTAR, and upload the measurement, with their GPS location data, on a continuously updated map. This approach mainly contributes to citizens’ greater awareness about noise pollution in an urban area. Beside this mode of data acquisition, the paper focuses on the analysis of the acquired data with the kernel density estimation technique, implemented in a GIS environment. The results allows the elaboration of sound density maps, defined from the spatial and temporal point of view, that can support the appropriate mitigation actions.

Regulation of Combinations: Law and Policy in India

The Competition Act 2002, uses a composite expression ‘Combinations’ which includes within its ambit merger, acquisition of shares, assets, acquiring control of an enterprise. The fundamental rationale for a combination or merger is that the value of the merged entity is expected to be greater than the sum of the independent values of merging entities. Through appropriate mode and level of acquisition it is possible to restrict or eliminate competition. The objective of any competition law is to ensure that persons or enterprises obtaining autonomy through mergers and acquisitions do not impair the structure of competition. In order to promote competition it becomes important to restrict monopolization. However, the Competition Act, 2002 attempts to make a shift from curbing monopolies to curbing practices that have adverse effects on competition both within and outside India. Unlike anti-competitive agreement and abuse of dominant position which are essentially behavioral issues, mergers/combinations are a structural issue affecting competition. Moreover, anti-competitive agreements and abuse of dominant position operate post-facto or while the situation is still prevailing; mergers on the other hand, are to be notified at the pre-merger stage. This is in order to prevent the damage that is anticipated to arise.

Caracterisations biophysique et floristique des parcs agroforestiers a Daniellia oliveri dans la zone Soudano-Sahelienne du Cameroun

Daniellia oliveri agroforestry exist in dry areas and play a big role for local populations. The objective of this work is to contribute to the biophysical characterization and floristic diversity in D. oliveri agroforestry parks in the Sudano-Sahelian zone of Cameroon. For this, an ethnobotanical study followed by an ecological study was carried out. In total, 504 farmers were interviewed in the Benoue and Mayo-Rey divisions. Plots of 144 ha have been established in agroforestry parks (cultivated, fallow). The dendrometric parameters (diameter at breast height of trees, height of trees and diameter of the canopy of individuals) were measured. The results show that inheritance is the most widely shared mode of acquisition. D. oliveri agroforestry parks are at least 30 years old. Parks provide many ecosystem services to local people. The specific richness varies from 59 species in the parks of Benoue to 62 species in the parks of Mayo-Rey. The density varies from 47.72 stems.ha-1 in cultivated parks to 353.43 stems.ha-1 in fallow parks. The Shannon index varies from 1.99 (cultivated parks) to 3.50 (fallow parks) in the Benoue area, while in the Mayo-Rey area, it varies from 2.14 (cultivated parks) to 2.72 (fallow parks). The Fabaceae and Combretaceae are the most important families with 22 and 10 species respectively. The population structure of fallow parks is

Abundance and phenology of macrofungal fruiting bodies in central and northern Japan

To understand how ectomycorrhizal (ECM), wood-decomposing (WDC) and litter-decomposing (LDC) fungi differ in abundance and fruiting season, fruiting-body production was monitored by counting their number and/or measuring their biomass in deciduous broad-leaved and coniferous forests in Ishikawa (central Japan) and Hokkaido (northern Japan). ECM fungi were dominant in forests of both types in Ishikawa and a Larix kaempheri forest in Tomakomai (Hokkaido), whereas WDC fungi were dominant in a deciduous broad-leaved forest in Sapporo (Hokkaido). ECM and WDC fungi usually showed two abundance peaks in Kanazawa (Ishikawa), mid-summer and autumn for ECM fungi and spring or summer and autumn for WDC fungi, whereas LDC fungi usually showed one peak in autumn. In Tomakomai, the abundance peak appeared later in ECM fungi but earlier in LDC and WDC fungi in comparison with Kanazawa. The mode of resource acquisition is assumed as one of factors that affect the seasonal timing of fruiting-body production. On the other hand, highly positive correlations were often observed between precipitation in Jun or Aug and the fruiting-body production in summer and/or autumn in the survey in Kanazawa, suggesting that precipitation could affect the fruiting-body production a few months later. • Ectomycorrhizal fungi (ECM) showed two production peaks in mid-summer and autumn. • Wood-decomposing fungi (WDC) showed two peaks in spring and mid- or late-autumn. • Litter-decomposing fungi (LDC) showed a peak in autumn. • ECM showed more extensive yearly variation in fruiting phenology than WDC. • Precipitation is assumed to affect the fruiting-body production.

Three Separate Clinical Entities of Infective Endocarditis-A Population-Based Study From Southern Finland 2013-2017.

BackgroundHealth care–associated infective endocarditis (HAIE) and intravenous drug use–related IE (IDUIE) have emerged as major groups in infective endocarditis (IE). We studied their role and clinical picture in a population-based survey.MethodsA population-based retrospective study including all adult patients diagnosed with definite or possible IE in Southern Finland in 2013–2017. IE episodes were classified according to the mode of acquisition into 3 groups: community-acquired IE (CAIE), HAIE, and IDUIE.ResultsTotal of 313 episodes arising from 291 patients were included. Incidence of IE was 6.48/100 000 person-years. CAIE accounted for 38%, HAIE 31%, and IDUIE 31% of IE episodes. Patients in the IDUIE group were younger, and they more frequently had right-sided IE (56.7% vs 5.0%; P < .001) and S. aureus as etiology (74.2% vs 17.6%; P < .001) compared with the CAIE group. In-hospital (15.1% vs 9.3%; P = .200) and cumulative 1-year case fatality rates (18.5% vs 17.5%; P = .855) were similar in CAIE and IDUIE. Patients with HAIE had more comorbidities, prosthetic valve involvement (29.9% vs 10.9%; P = .001), enterococcal etiology (20.6% vs 5.9%; P = .002), and higher in-hospital (27.8% vs 15.1%; P = .024) and cumulative 1-year case fatality rates (43.3% vs 18.5%; P < .001) than patients with CAIE. Staphylococcus aureus caused one-fifth of IE episodes in both groups.ConclusionsOur study indicates that in areas where injection drug use is common IDUIE should be regarded as a major risk group for IE, along with HAIE, and not seen as part of CAIE. Three different risk groups, CAIE, HAIE, and IDUIE, with variable characteristics and outcome should be recognized in IE.

Insights into the processes and controls on the absolute abundance and distribution of manganese in Precambrian iron formations

The role of manganese as redox tracer in the context of iron formations (IF) has received renewed attention in recent years. The utility of several redox-sensitive trace metal proxies in IF (e.g., Mo) is based on the premise that simultaneously elevated manganese concentrations in the form of primary Mn(IV) oxides, would have controlled the redox behaviour and stable isotope variations of such elements during primary deposition and diagenesis. Recent research on the mineral fraction-specific geochemistry of Paleoproterozoic IF from South Africa (Griquatown and Kuruman Iron Formations) reports no preserved Mn(IV) oxides and a strong affinity of manganese (>90%) to partition into carbonate minerals as Mn(II). In this study, we exploit further this relationship by examining in detail the mineral-specific abundance and distribution of manganese across the same IF succession, with main emphasis on the Mn-enriched upper 120 m of the Griquatown IF. Dominant carbonate minerals include ankerite, siderite and occasional calcite, with MnO contents across all three minerals ranging from less than 1 to well over 10 wt%. Co-existing ankerite and siderite on the scale of individual thin sections record very similar MnO (and MgO) contents at statistically very low variance. Calcite is only observed as relic phase showing apparent textural evidence for replacement by ankerite and siderite. The calcite is Mg-rich (up to 15 wt% MgO) and contains the highest MnO contents out of the entire dataset obtained. Variability in the MnO content of calcite is also high and anti-correlates strongly with CaO content. Ankerite and siderite co-existing with calcite have similar MnO and MgO concentrations, consistent with conservative transfer during replacement reactions and only net addition of Fe(II) from pore fluids. For one of the calcite-containing samples, all three carbonate minerals were also analysed sequentially for carbon isotopes and yielded very similar δ13C values (−6.7 to −6.0‰). We interpret the above features as indicative of primary calcite being the dominant mode of manganese acquisition in the initial sediment. Diagenetic replacement reactions then homogeneously reworked Mn (along with Mg and Ca) in a largely conservative fashion into diagenetic ankerite and siderite. Our interpretation questions IF models that assume high primary Mn(IV) oxide deposition and its bacterially-mediated diagenetic reconstitution in IF during transient oxygenation events (oxygen “whiffs”); instead, it lends support to emerging ideas for primary water-column processes leading to the formation and precipitation of reduced Fe(+Mn) mineral species as precursors to IF.

The Clinical and Molecular Epidemiology of Noncarbapenemase-Producing Carbapenem-Resistant Enterobacteriaceae: A Case-Case-Control Matched Analysis.

BackgroundRisk factors and outcomes associated with carbapenem-resistant Enterobacteriaceae (CRE) acquisitions are derived primarily from cohorts consisting of carbapenemase-producing (CP) strains. Worldwide epidemiology of non-CP-CRE is evolving, but controlled epidemiological analyses are lacking.MethodsA matched case-case-control investigation was conducted at Shamir (Assaf Harofeh) Medical Center, Israel, on November 2014–December 2016. Noncarbapenemase-producing CRE (as defined by the US Clinical and Laboratory Standards Institute Standards) carriers were matched to patients with non-CRE Enterobacterales and to uninfected controls (1:1:1 ratio). Matched and nonmatched multivariable regression models were constructed to analyze predictors for acquisition and the independent impact of carriage on multiple outcomes, respectively. Representative isolates were whole genome sequenced and analyzed for resistome and phylogeny.ResultsNoncarbapenemase-producing CRE carriers (n = 109) were matched to the 2 comparative groups (overall n = 327). Recent exposure to antibiotics (but not specifically to carbapenems), prior intensive care unit admission, and chronic skin ulcers were all independent predictors for non-CP-CRE acquisition. Acquisitions were almost exclusively associated with asymptomatic carriage (n = 104), and despite strong associations per univariable analyses, none were independently associated with worse outcomes. Genomic analyses of 13 representative isolates revealed polyclonality, confirmed the absence of carbapenemases, but confirmed the coexistence of multiple other genes contributing to carbapenem-resistance phenotype (multiple beta-lactamases and efflux pumps).ConclusionsNoncarbapenemase-producing CRE acquisitions are primarily associated with asymptomatic carriage, specifically among prone populations with extensive recent exposures to antibiotics. The prevalent mode of acquisition is “emergence of resistance” (not “patient-to-patient transmission”), and therefore the role of stewardship interventions in reducing the spread of these therapeutically challenging pathogens should be further explored.

A prospective study of incidence of cervical HPV infection &amp; its association with aetiological factors &amp; cervical cancer in adult women of Jamnagar

Introduction: Etiological link between cervical cancer & HPV is independent of other risk factors but their geographic variations need to be explored. Cervical cancer with profile of Sexually Transmitted Disease has consistent causal connection with persistent cervical HPV infection, so such carrier women are at High risk. Thus, study evaluate risk of HPV infection in women of Jamnagar region by exploring aetiological determinants related to their sexual life. Aim: To explore incidence of cervical HPV infection along with its association with cervical cancer as well with commonly proposed aetiological factors in adult women of Jamnagar Materials and Methods: The study was conducted in 2004 on random 110 women attending Gynecology out patient department of GG Hospital at MPSGMC Jamnagar by taking their cervical smear and administering them questionnaires about their sexual life. HPV infection was diagnosed based on cytopathic effects of HPV, by Microbiological staining techniques. Association of cervical HPV positive status of women in relation to common aetiological factors and carcinoma cervix were analyzed. Results: 10.9% of women exhibited cervical HPV infection out of them 20% belonged to higher age group (50-59 years) followed by 16.6% of young age group (20-29). 15.3% of women with HPV infection were having 6 -10 years of active married life. Accordingly 18.18% HPV infected women were multipara - bearing 3 - 4 children whereas nullipara had no HPV infection. 75% of women with carcinoma cervix were positive for cervical HPV which endorse strong causal connections. Conclusions: Study concludes that cervical HPV is prevalent in 10.9% adult women of Jamnagar region and is significantly attributable to cervical cancer. HPV positive woman have profile of sexually active life of initial years, early age at first coitus or had longer but active married life, so sexual transmission happens to be the predominant mode of HPV acquisition. Similarly, multiparity has aetiol

Automatic Implementation of a Self-Adaption Non-Intrusive Load Monitoring Method Based on the Convolutional Neural Network

Non-intrusive load monitoring (NILM) is an effective way to achieve demand-side measurement and energy efficiency optimization. This paper studies a method of non-intrusive on-line load monitoring under a high-frequency mode of electric data acquisition, which enables the NILM to be automated and in real-time, including the short-term construction of a dynamic signature library and continuous on-line load identification. Firstly, in the short initial operation phase, load separation and category determination are carried out to construct the load waveform library of the monitoring user. Then, the continuous load monitoring phase begins. Based on the data of each user’s signature library, the decomposition waveforms are classified by convolutional neural network models that are constructed to be suitable for each signature library in order to realize load identification. The real-time power consumption status of the load can be obtained continuously. In this paper, the electricity data of actual users are collected and used to perform the experiments, which show that the proposed method can construct the load signature library adaptively for different users. Meanwhile, the classification of the convolutional neural network model based on a library constructed in actual operation ensures the real-time and accuracy of load monitoring.

SARS-CoV-2 Reverse Genetics Reveals a Variable Infection Gradient in the Respiratory Tract

The mode of acquisition and causes for the variable clinical spectrum of coronavirus disease 2019 (COVID-19) remain unknown. We utilized a reverse genetics system to generate a GFP reporter virus to explore severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pathogenesis and a luciferase reporter virus to demonstrate sera collected from SARS and COVID-19 patients exhibited limited cross-CoV neutralization. High-sensitivity RNA in situ mapping revealed the highest angiotensin-converting enzyme 2 (ACE2) expression in the nose with decreasing expression throughout the lower respiratory tract, paralleled by a striking gradient of SARS-CoV-2 infection in proximal (high) versus distal (low) pulmonary epithelial cultures. COVID-19 autopsied lung studies identified focal disease and, congruent with culture data, SARS-CoV-2-infected ciliated and type 2 pneumocyte cells in airway and alveolar regions, respectively. These findings highlight the nasal susceptibility to SARS-CoV-2 with likely subsequent aspiration-mediated virus seeding to the lung in SARS-CoV-2 pathogenesis. These reagents provide a foundation for investigations into virus-host interactions in protective immunity, host susceptibility, and virus pathogenesis.