Prevalence and Antibiotic Sensitivity pattern of Bacterial Isolates from Catheterized UTI Patients: A Local Study

Prevalence and multidrug resistance among bacteria in catheter-associated urinary tract infections (CAUTIs) has been on the rise in recent times. Hence, the prevalence rate and antibacterial susceptibility of bacteria in CAUTIs in ICU patients was evaluated. A total of 120 patients admitted to the ICU of Nishtar Hospital, Multan, were recruited for this study. Both gram-positive and gram-negative bacterial isolates were characterized based on biochemical tests including catalase test, oxidase test, indole test, TSI test, citrate test, coagulase test and growth on 6.5% NaCl agar. The prevalence of bacterial species was Escherichia coli (32%), Staphylococcus aureus (26%), Pseudomonas spp. (18%), Proteus spp. (14%) and Enterococcus spp. (2%). A considerable degree of resistance against commonly prescribed antibiotics was observed. Gram negative bacteria showed resistance to ciprofloxacin, piperacillin-tazobactam and amikacin as well as susceptibility to imipenem, tigecycline and polymixin. Gram positive bacteria showed resistance to antibiotics such as piperacillin-tazobactam, ampicillin, gentamicin, oxacillin and ceftazidime suggesting the ineffectiveness of these antibiotics for treating bacterial infections among CAUTI patients and demonstrating the latest trends in antimicrobial drug resistance profile in local population.

Volcanic air pollution and human health: recent advances and future directions

Volcanic air pollution from both explosive and effusive activity can affect large populations as far as thousands of kilometers away from the source, for days to decades or even centuries. Here, we summarize key advances and prospects in the assessment of health hazards, effects, risk, and management. Recent advances include standardized ash assessment methods to characterize the multiple physicochemical characteristics that might influence toxicity; the rise of community-based air quality monitoring networks using low-cost gas and particulate sensors; the development of forecasting methods for ground-level concentrations and associated public advisories; the development of risk and impact assessment methods to explore health consequences of future eruptions; and the development of evidence-based, locally specific measures for health protection. However, it remains problematic that the health effects of many major and sometimes long-duration eruptions near large populations have gone completely unmonitored. Similarly, effects of prolonged degassing on exposed populations have received very little attention relative to explosive eruptions. Furthermore, very few studies have longitudinally followed populations chronically exposed to volcanic emissions; thus, knowledge gaps remain about whether chronic exposures can trigger development of potentially fatal diseases. Instigating such studies will be facilitated by continued co-development of standardized protocols, supporting local study teams and procuring equipment, funding, and ethical permissions. Relationship building between visiting researchers and host country academic, observatory, and agency partners is vital and can, in turn, support the effective communication of health impacts of volcanic air pollution to populations, health practitioners, and emergency managers.

Plastic Microbead Accumulation in our Freshwaters: North American Great Lakes Assessments and Perspective

The authors review recent studies conducted across the Great Lakes of North America to assess the quantity and type of microplastic waste found in these waters, sediments, and beaches. Findings from their own studies are shared, sampling plastic pollution from remote and secluded Nature Reserves in Lake Erie (ON), and the Ottawa River watershed (QC), showing significant accumulation of microbeads. Spherical ‘microbeads’ made of plastics are now ubiquitous in a wide range of personal healthcare and cleansing products, used by the average North American consumer now at upwards of quadrillions per day. Designed to be flushable, these plastic microbeads inevitably end up in municipal wastewater streams, and then to a large extent leak into our freshwater ecosystems. Recent studies throughout the important Great Lakes system of North America have reported microbeads at essentially all locations examined. On the shorelines, in surface waters, throughout water columns, and in sediments of these freshwater systems, microbeads are now ever-present, and are accumulating in significant amounts. Their small and stable shape and composition, and limited pathways to degradation produce a long lifespan, with the capacity to remain in the freshwater environment for potentially hundreds of years. This review collects and compares initial microbead studies between 2013–2021 in the Great Lakes region to provide a snapshot of the current levels and locations, and to serve as a baseline for future tracking to assess progress as the microbead contamination and accumulation problem is addressed. We as well present findings from our own local study of microplastic/bead accumulation downstream of the Great Lakes, in the St. Lawrence and Ottawa rivers near Montreal. Aspects of microbead contamination represent a unique subset of the worldwide microplastic problem, in that much control remains over their life cycle and eventual fate. Consequently, the power to address this microbead problem can rest with polymer chemists and engineers, who, armed with a better understanding of the relevant physical polymer properties of the beads that govern their movement into the aquatic environment, hold the ability to rationally redesign microbead composition and develop removal techniques.

Epidemiology, etiology, and diagnosis of health care acquired pneumonia including ventilator-associated pneumonia in Nepal

Epidemiologic data regarding health care acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP) from Nepal are negligible. We conducted a prospective observational cohort study in the intensive care unit (ICU) of a major tertiary hospital in Nepal between April 2016 and March 2018, to calculate the incidence of VAP, and to describe clinical variables, microbiological etiology, and outcomes. Four hundred and thirty-eight patients were enrolled in the study. Demographic data, medical history, antimicrobial administration record, chest X-ray, biochemical, microbiological and haematological results, acute physiology and chronic health evaluation II score and the sequential organ failure assessment scores were recorded. Categorical variables were expressed as count and percentage and analyzed using the Fisher’s exact test. Continuous variables were expressed as median and interquartile range and analyzed using Kruskal-Wallis rank sum test and the pairwise Wilcoxon rank—sum test. 46.8% (205/438) of the patients required intubation. Pneumonia was common in both intubated (94.14%; 193/205) and non-intubated (52.36%; 122/233) patients. Pneumonia developed among intubated patients in the ICU had longer days of stay in the ICU (median of 10, IQR 5–15, P< 0.001) when compared to non-intubated patients with pneumonia (median of 4, IQR 3–6, P< 0.001). The incidence rate of VAP was 20% (41/205) and incidence density was 16.45 cases per 1,000ventilator days. Mortality was significantly higher in patients with pneumonia requiring intubation (44.6%, 86/193) than patients with pneumonia not requiring intubation (10.7%, 13/122, p<0.001, Fisher’s exact test). Gram negative bacteria such as Klebsiella and Acinetobacter species were the dominant organisms from both VAP and non-VAP categories. Multi-drug resistance was highly prevalent in bacterial isolates associated with VAP (90%; 99/110) and non-VAP categories (81.5%; 106/130). HAP including VAP remains to be the most prevalent hospital-acquired infections (HAIs) at Patan hospital. A local study of etiological agents and outcomes of HAP and VAP are required for setting more appropriate guidelines for management of such diseases.

Peripheral Visions: Design in ephemeral New Zealand print c1880 – 1914

<p>My thesis is an investigation of design in print in New Zealand circa 1880 – 1914, the period in which it is generally accepted graphic design began in the industrial Western nations. The medium of design studied is New Zealand’s most significant printed product, popular everyday ephemera, which is contextualized within local and international print production, technology, and debates concerning design. The research aim is to contribute to new approaches in the proto-discipline of graphic design history, specifically the current debates concerning purpose, scope and methods, by writing a local study that has relevance here and internationally. In this way it joins the growing number of local and national design studies of countries customarily defined as politically, culturally and geographically peripheral. It further explores alternative approaches by using formal analysis as a tool for the interpretation of visual codes and their rhetoric in print to enable the appraisal of local significances and international relationships. The study follows a model of graphic design as visual communication encompassing purpose, production, and reception, to argue the historic significations, activities, and values of local graphic design are of critical import for their role in social and cultural formation at both national and international levels. It argues against traditional binary models of centre to margin design transmission to assert alternative theories of networks, and of the hybridity of forms (particularly in colonial societies). Theories that, like this study, seek to apprehend complexity and more appropriately explain research findings that indicate the spread of design in print is an active circulation of signifying forms in a process of influence, adaptation and exchange. The argument engages five theoretical debates that are further concerned with contemporary issues of history and its methods as they impinge on graphic design history. They are the current issues of historiography and calls for interdisciplinarity; the status and importance of ephemeral print; relationships of graphic design to modernity; concepts of the peripheral and networks; the use of semiotics in interpreting the visual rhetoric of typography and image. This investigation, allowing for problems with the survival and attribution of material, is formed by three case studies that encompass a range of processes, media and products. The first considers typography and letterpress through the linked printing and writings of compositor/printer Robert Coupland Harding; the second charts the career of lithographic designer and illustrator Robert Hawcridge and his use of visual syntax, rhetoric and iconography. The third considers the composite local illustrated magazine the New Zealand Graphic and the role of design in editorial and advertising matter. New knowledge is diverse, establishing crucial facts about design here, its forms, and the importance it was accorded in supposedly slight material. Widespread and unexpected influences and networks of exchange are traced, and the considerable but neglected role of graphic design in social and cultural formation and the early articulations of a national identity are appraised. While of significance for the development of graphic design history, the findings also have relevance for the wider investigations of new history, including transnational, cosmopolitan, technological, and material histories.</p>

Peripheral Visions: Design in ephemeral New Zealand print c1880 – 1914

<p>My thesis is an investigation of design in print in New Zealand circa 1880 – 1914, the period in which it is generally accepted graphic design began in the industrial Western nations. The medium of design studied is New Zealand’s most significant printed product, popular everyday ephemera, which is contextualized within local and international print production, technology, and debates concerning design. The research aim is to contribute to new approaches in the proto-discipline of graphic design history, specifically the current debates concerning purpose, scope and methods, by writing a local study that has relevance here and internationally. In this way it joins the growing number of local and national design studies of countries customarily defined as politically, culturally and geographically peripheral. It further explores alternative approaches by using formal analysis as a tool for the interpretation of visual codes and their rhetoric in print to enable the appraisal of local significances and international relationships. The study follows a model of graphic design as visual communication encompassing purpose, production, and reception, to argue the historic significations, activities, and values of local graphic design are of critical import for their role in social and cultural formation at both national and international levels. It argues against traditional binary models of centre to margin design transmission to assert alternative theories of networks, and of the hybridity of forms (particularly in colonial societies). Theories that, like this study, seek to apprehend complexity and more appropriately explain research findings that indicate the spread of design in print is an active circulation of signifying forms in a process of influence, adaptation and exchange. The argument engages five theoretical debates that are further concerned with contemporary issues of history and its methods as they impinge on graphic design history. They are the current issues of historiography and calls for interdisciplinarity; the status and importance of ephemeral print; relationships of graphic design to modernity; concepts of the peripheral and networks; the use of semiotics in interpreting the visual rhetoric of typography and image. This investigation, allowing for problems with the survival and attribution of material, is formed by three case studies that encompass a range of processes, media and products. The first considers typography and letterpress through the linked printing and writings of compositor/printer Robert Coupland Harding; the second charts the career of lithographic designer and illustrator Robert Hawcridge and his use of visual syntax, rhetoric and iconography. The third considers the composite local illustrated magazine the New Zealand Graphic and the role of design in editorial and advertising matter. New knowledge is diverse, establishing crucial facts about design here, its forms, and the importance it was accorded in supposedly slight material. Widespread and unexpected influences and networks of exchange are traced, and the considerable but neglected role of graphic design in social and cultural formation and the early articulations of a national identity are appraised. While of significance for the development of graphic design history, the findings also have relevance for the wider investigations of new history, including transnational, cosmopolitan, technological, and material histories.</p>

Shetland's Population in the Eighteenth and Early Nineteenth Centuries

This paper investigates Rev Alexander's Webster's demographic methodology in his calculation of the population of Shetland in 1755 and his conclusions, which are problematic. It sets them within a wider review of the population data for Shetland up to the 1831 Government census, the latest for which no detailed information survives. This is a local study limited to one county, but by showing how difficult it is to find reliable evidence at a parochial level, it raises questions with implications for the analysis of population throughout Scotland and elsewhere. This study shows the need to look behind the frequently quoted statistics and question the sources. It is a case study which shows that the complications of attempting to establish the accuracy of data at this detailed level encourage scepticism about national data and the conclusions based on them.

Risk factors of post-anaesthesia care unit delirium in patients undergoing non-cardiac surgery in Singapore

Introduction: Post-anaesthesia care unit (PACU) delirium affects 5%–45% of patients after surgery and is associated with postoperative delirium and increased mortality. Up to 40% of PACU delirium is preventable but it remains under-recognised due to a lack of awareness for its diagnosis. Nursing Delirium Screening Scale (Nu-DESC) has been validated in diagnosing PACU delirium but is not routine locally. This study aim was to use the Nu-DESC to establish the incidence and risk factors of PACU delirium in patients undergoing non-cardiac surgery in the surgical population. Methods: With IRB approval and informed consent, we conducted an audit of eligible patients undergoing major surgery in three major public hospitals in Singapore over one week. Patients were assessed for delirium 30–60 minutes following their arrival in the PACU using the Nu-DESC with a score of ≥ 2 as indicative of delirium. Results: A total of 478 patients were assessed. The overall incidence rate of PACU delirium was 18/478 (3.8%) and 9/146 (6.2%) in patients over 65 years old. PACU delirium was more common in females, patients with malignancy and those who underwent longer operations. Logistic Regression analysis showed that the use of BIS (p < 0.001) and the presence of malignancy (p<0.001) were significantly associated with a higher incidence of PACU delirium. Conclusion: In this first local study, the incidence of PACU delirium was 3.8%, with the incidence increasing to 6.2% in those older than 65 years old. Understanding these risk factors will form the basis for which protocols can be established to optimise resource management and prevent long term morbidities and mortality of PACU delirium.

Early mobilisation following fragility hip fracture surgery: current trends and association with dicharge outcomes in a local tertiary hospital

Introduction: Postoperative day 1 (POD1) mobilisation is a key clinical indicator for the fragility hip fracture surgery population. This study aimed to evaluate the current trends of POD1 mobilisation at our institution; and to review the relationships between early mobilisation and outcomes of early functional recovery, length of stay (LOS) and discharge destination. Methods: In this preliminary observational study, data pertaining to demographics, pre-morbid function, health status, injury and surgical factors, POD1 mobilisation status and clinical outcomes of interest were retrieved from eligible patients. Patients who attained POD1 ambulation formed the “Early Ambulation (EA)” Group while the remaining patients formed the “Delayed Ambulation (DA)” group. Data were analysed for any significant difference between the groups. Results: 115 patients were included in the analysis. The rate of patients achieving at least sitting out of bed on POD1 was 80.0% (92 patients) which was comparable with data available from international hip fracture audit databases. 55 patients (47.8%) formed the EA group and 60 patients (52.5%) formed the DA group. EA group was approximately nine times more likely to achieve independence in ambulation at discharge compared to the DA group (adjusted odds ratio 9.20; 95% Confidence Interval 1.50-56.45; p = 0.016). There were observed trends of shorter LOS and more proportion of home discharge in the EA group compared to DA group (p > 0.05). Conclusion: This is the first local study to offer benchmark of the POD1 mobilisation status for this population. Patients who attained POD1 ambulation had better early functional recovery.