Microbiological pathogen analysis in native versus periprosthetic joint infections: a retrospective study

Background The presence or absence of an implant has a major impact on the type of joint infection therapy. Thus, the aim of this study was the examination of potential differences in the spectrum of pathogens in patients with periprosthetic joint infections (PJI) as compared to patients with native joint infections (NJI). Methods In this retrospective study, we evaluated culture-positive synovial fluid samples of 192 consecutive patients obtained from January 2018 to January 2020 in a tertiary care university hospital. For metrically distributed parameters, Mann–Whitney U was used for comparison between groups. In case of nominal data, crosstabs and Chi-squared tests were implemented. Results Overall, 132 patients suffered from periprosthetic joint infections and 60 patients had infections of native joints. The most commonly isolated bacteria were coagulase-negative Staphylococci (CNS, 28%), followed by Staphylococcus aureus (S. aureus, 26.7%), and other bacteria, such as Streptococci (26.3%). We observed a significant dependence between the types of bacteria and the presence of a joint replacement (p < 0.05). Accordingly, detections of CNS occurred 2.5-fold more frequently in prosthetic as compared to native joint infections (33.9% vs. 13.4% p < 0.05). In contrast, S. aureus was observed 3.2-fold more often in NJIs as compared to PJIs (52.2% vs. 16.4%, p < 0.05). Conclusion The pathogen spectra of periprosthetic and native joint infections differ considerably. However, CNS and S. aureus are the predominant microorganisms in both, PJIs and NJIs, which may guide antimicrobial therapy until microbiologic specification of the causative pathogen.

UTILIZATION RATE OF DENTAL SERVICES IN THE ERA OF NATIONAL HEALTH INSURANCE IN PRATAMA CLINIC, CITY OF JEPARA

ABSTRACTBackground: The utilization rate is the use of dental and oral health which can be calculated using the number of National Healthcare Security (BPJS) patients per month compared to the number of BPJS participants multiplied by 100%Method: This study was an observational study used cross sectiona design and nominal data scale that produced quantitative data which was carried out by analysing the Pcare data started from March-August 2019 in eight primary clinics of Jepara City and District. Before conducted the study, Ethics Review No.098 / b.1-KEPK / SA-FKG / VII / 2019 was done.Result: The results of the utilization rate study based on the visit rates, Armina Pratama Clinic was 1.585%, Multisari II Pratama Clinic was 0.665%, Sentra Husada Pratama Clinic was 0.68%, Jepara General Pratama Clinic was 2.329%, Yasmin Medika Pratama Clinic was 2.173%, Hanis Pratama Clinic was 0.752%, Az-Zahra pratama clinic 2.945%, and Armina Denta pratama clinic was 1.885%.Conclusion: In conclusion, the utilization rate based on pratama clinic visits in the city and the regency of Jepara was still in the low to the ideal category. Meanwhile, the utilization rate based on the referral numbers of pratama clinic in the city and the regency of Jepara was far from the standard value

Assessing Nephrotoxicity Associated With Different Vancomycin Dosing Modalities in Obese Patients at a Community Hospital

Background: Vancomycin requires therapeutic drug monitoring (TDM) based on its pharmacokinetic properties, and guidelines have shifted to analyzing area under the curve over 24 hours (AUC24) rather than trough concentrations due to nephrotoxicity concerns and correlation to efficacy. Obesity is an established risk factor for vancomycin-induced nephrotoxicity due to increased drug exposure based on dosing calculations and volume of distribution estimation. The aim of this study is to assess the relationship between AUC-based versus trough-based dosing and nephrotoxicity among obese patients receiving vancomycin. Methods: This research project was conducted as a retrospective, observational, single-centered study which included obese adults who received at least 48 hours of vancomycin. The electronic medical record provided data for patients with vancomycin pharmacokinetic consults either evaluated with trough-only or AUC-based dosing. The primary objective was to compare the development of nephrotoxicity after vancomycin initiation, while secondary objectives included vancomycin loading dose exposure, total daily dose of vancomycin, and whether target TDM was attained. Nominal data were evaluated utilizing the chi-square test and continuous data using the independent samples t-test or Mann-Whitney test. The a priori level of significance was .05. Data analysis was performed using Microsoft Excel and SAS statistical software. Results: Two hundred fifty-four patients were included in the primary analysis. Four patients in the AUC cohort (6.3%) developed nephrotoxicity compared to 32 (17.4%) in the trough cohort ( P = .035). Both cohorts received a median of 4 days of therapy; however, the median loading dose per actual body weight in the AUC cohort was 20 mg/kg as compared to 16 mg/kg in the trough cohort. Of the 130 patients with available TDM in the trough cohort, 97 (74.6%) did not meet target attainment as compared to 15 of the 57 in the AUC cohort (26.3%) ( P < .001). Conclusions: AUC dosing was associated with a statistically significant reduction in AKI occurrence despite overall higher loading dose exposure as compared to the trough cohort. Though maintenance dose exposure was similar between both cohorts, patients in the AUC cohort maintained therapeutic concentrations at a higher percentage than the trough cohort.

Oxidative Stress Level in Patients with Subarachnoid Hemorrhage

Background One of the antioxidant mechanisms is the dynamic balance between thiol and disulfide, which, in subarachnoid hemorrhage and other chronic diseases, is disrupted in favor of the latter. The two most commonly used oxidative stress (OS) biochemical markers are the oxidative stress index (OSI) value, which indicates the total oxidant status (TOS) and total antioxidant status (TAS) balance, and the thiol–disulfide (TDS) value, which indicates the total thiol (TT) and native thiol (NT) balance. High OS levels require further investigations. We aimed to investigate the OS level in aneurysmal SAH (aSAH) patients. methods In this clinical prospective study, blood samples were collected from 50 consecutively treated patients with aSAH and 50 volunteers. Serum TOS, TAS, TT, and NT levels were measured using Erel's method via a spectrophotometer. The Glasgow Coma Scale (GCS) scores, Fisher grades, length of hospital stay (LOS), and the Glasgow Outcome Scale (GOS) scores were recorded. Consequently, the OSI and TDS values were calculated in all participants. Results A statistically significant difference was observed in the TAS, TOS, OSI, and TDS values between the aSAH patients and the controls. The TT and NT values were significantly lower in aSAH patients than in the controls. A correlation was identified between the OSI values and the GCS scores. Although a correlation was observed between the TDS values and the LOS, no correlation was found between the OSI and the TDS values. Conclusion The OSI and TDS, which are OS indicators, might serve as the additional objective nominal data to evaluate the treatment efficacy and follow-up for SAH patients. Moreover, decreasing the OSI values and increasing the TT values can be used as improvement indicators in the treated aSAH patients. If we can reduce the OS at the early stage of SAH, it could improve the prognosis by reducing both the morbidity and mortality rates. Further randomized investigations are required to prove the findings in this prospective study.

Evaluation of the Thermal Comfort and Energy Demand in a Building with Rammed Earth Walls in Spain: Influence of the Use of In Situ Measured Thermal Conductivity and Estimated Values

This paper describes the influence of thermal parameters—conductivity, transmittance, and thermal mass—in the estimation of comfort and energy demand of a building with rammed earth walls, and consequently, the compliance with standards. It is known that nominal design data does not match in situ measured values, especially in traditionally constructed buildings. We have therefore monitored a room in a building with rammed earth walls, designed a computerised model, and compared four different alternatives where we have changed the value for the thermal conductivity (in situ vs. estimated) and the consideration of thermal mass. When we then analyse the compliance with the Spanish energy saving code, using measured values would result in lower differences with the standards’ limits and even comply with the global thermal transmittance (K-value) requirement. This would mean a more realistic approach to the restoration of traditional buildings leading to the use of thinner and more suitable insulation and retrofitting systems, encouraging the use of rammed earth in new buildings, and therefore reducing the carbon footprint due to materials used in construction. Results show that the building model that uses in situ values and considers thermal mass (S1) is closer to reality when assessing thermal comfort. Finally, using nominal data would result in requiring 43% more energy in the selected winter period and 102% more energy in the selected summer period to keep the same comfort conditions as in the alternative where measured values are used.

Study on LT Accuracy Improvement by Calibration Based on Network Measurements

Laser trackers (LT) are widely used to calibrate other machines. Nevertheless, very little is known about calibrating an LT. There are some standards that allow us to evaluate the LT performance. However, they require specialized equipment. A calibration procedure to improve the LT accuracy in an easy and fast way is presented in this paper. This method is based on network measurements where a set of reflectors were measured from different LT positions in a working environment. The methodology proposed deal with the lack of nominal data of the reflector mesh. A measurement scenario was defined, based on error parameter dependence on distances and angles, thus, obtaining those positions more sensitive to errors. The influence of the incidence angle of the laser beam on the reflector was characterized, revealing that its contribution to the LT measurement error can be up to 13 µm. Error kinematic parameters were identified to provide the optimum value of an objective function, where the reflector mesh nominal data were unknown. The calibration procedure was validated with nominal data, by measuring a set of reflectors located on a coordinate measuring machine. The findings of this study suggested that the LT accuracy can be improved up to 25%. Moreover, the method can be carried out by the LT user without requiring specialized equipment.

Projection-Based Local and Global Lipschitz Moduli of the Optimal Value in Linear Programming

In this paper, we use a geometrical approach to sharpen a lower bound given in [5] for the Lipschitz modulus of the optimal value of (finite) linear programs under tilt perturbations of the objective function. The key geometrical idea comes from orthogonally projecting general balls on linear subspaces. Our new lower bound provides a computable expression for the exact modulus (as far as it only depends on the nominal data) in two important cases: when the feasible set has extreme points and when we deal with the Euclidean norm. In these two cases, we are able to compute or estimate the global Lipschitz modulus of the optimal value function in different perturbations frameworks.

A Multiscale Clustering Approach for Non-IID Nominal Data

Multiscale brings great benefits for people to observe objects or problems from different perspectives. Multiscale clustering has been widely studied in various disciplines. However, most of the research studies are only for the numerical dataset, which is a lack of research on the clustering of nominal dataset, especially the data are nonindependent and identically distributed (Non-IID). Aiming at the current research situation, this paper proposes a multiscale clustering framework based on Non-IID nominal data. Firstly, the benchmark-scale dataset is clustered based on coupled metric similarity measure. Secondly, it is proposed to transform the clustering results from benchmark scale to target scale that the two algorithms are named upscaling based on single chain and downscaling based on Lanczos kernel, respectively. Finally, experiments are performed using five public datasets and one real dataset of the Hebei province of China. The results showed that the method can provide us not only competitive performance but also reduce computational cost.

A Data Representation Model for Personalized Medicine

Personalized medicine exploits the patient data, for example, genetic compositions, and key biomarkers. During the data mining process, the key challenges are the information loss, the data types heterogeneity and the time series representation. In this paper, a novel data representation model for personalized medicine is proposed in light of these challenges. The proposed model will account for the structured, temporal and non-temporal data and their types, namely, numeric, nominal, date, and Boolean. After the "Date and Boolean" data transformation, the nominal data are treated by dispersion while several clustering techniques are deployed to control the numeric data distribution. Ultimately, the transformation process results in three homogeneous representations with these representations having only two dimensions to ease the exploration of the represented dataset. Compared to the Symbolic Aggregate Approximation technique, the proposed model preserves the time-series information, conserves as much data as possible and offers multiple simple representations to be explored.

Lung function and breathing patterns in hospitalised COVID-19 survivors: a review of post-COVID-19 Clinics

Introduction There is relatively little published on the effects of COVID-19 on respiratory physiology, particularly breathing patterns. We sought to determine if there were lasting detrimental effect following hospital discharge and if these related to the severity of COVID-19. Methods We reviewed lung function and breathing patterns in COVID-19 survivors > 3 months after discharge, comparing patients who had been admitted to the intensive therapy unit (ITU) (n = 47) to those who just received ward treatments (n = 45). Lung function included spirometry and gas transfer and breathing patterns were measured with structured light plethysmography. Continuous data were compared with an independent t-test or Mann Whitney-U test (depending on distribution) and nominal data were compared using a Fisher’s exact test (for 2 categories in 2 groups) or a chi-squared test (for > 2 categories in 2 groups). A p-value of < 0.05 was taken to be statistically significant. Results We found evidence of pulmonary restriction (reduced vital capacity and/or alveolar volume) in 65.4% of all patients. 36.1% of all patients has a reduced transfer factor (TLCO) but the majority of these (78.1%) had a preserved/increased transfer coefficient (KCO), suggesting an extrapulmonary cause. There were no major differences between ITU and ward lung function, although KCO alone was higher in the ITU patients (p = 0.03). This could be explained partly by obesity, respiratory muscle fatigue, localised microvascular changes, or haemosiderosis from lung damage. Abnormal breathing patterns were observed in 18.8% of subjects, although no consistent pattern of breathing pattern abnormalities was evident. Conclusions An “extrapulmonary restrictive” like pattern appears to be a common phenomenon in previously admitted COVID-19 survivors. Whilst the cause of this is not clear, the effects seem to be similar on patients whether or not they received mechanical ventilation or had ward based respiratory support/supplemental oxygen.