Rapid Identification and Antimicrobial Susceptibility of Gram Negative Bacteria Detected in Positive Blood Culture Bottles

Background Blood stream infection (BSI) is one of the most serious situations in infectious disease .Accurate and timely identification of the causative agent and determination of its antimicrobial susceptibility profile are essential for guiding targeted and effective antimicrobial treatment. Current methods involve culturing of blood in a liquid medium and subsequently subculturing of signal positive bottles on solid media in order to obtain isolated colonies that can be further used in identification and susceptibility testing of the isolates. The standard method requires additional 48-72hours following the appearance of a positive signal in order to provide a reliable patient report. On the other hand, rapid identification of the causative agent and determination of its susceptibility profile by direct inoculation of the biochemical test media with the blood-broth mixtures from signal positive bottles and performing primary susceptibility testing might help reducing the time needed for provision of results compared to the standard isolated-colony based method and hence would help the rapid initiation of effective and targeted antimicrobial therapy and reduce the bacteremia-related morbidity and mortality. Objective The aim of the present study was to determine the accuracy and precision of the non-standard methods (direct identification and susceptibility testing using the blood/broth mixture) by comparing its results to those of the standard isolate-based identification and susceptibility testing methods. Material and method The study included 52 signal blood culture bottles yielding gram negative isolates. Bottles were selected amongst blood culture bottles submitted to the Main Microbiology laboratory, Ain Shams University hospital, for culture and antimicrobial susceptibility testing during the period between May 2018 and October 2018. a portion of the blood-broth mixture was aspirated from positive blood culture bottles, after being well mixed, and was subcultured onto agar media for the isolation of the causative agent and subsequently determination of its antimicrobial susceptibility profile was performed. Another part of the aspirated blood-broth mixture was diluted with sterile saline, its turbidity was adjusted against a 0.5McFarland standard and was used to inoculate directly the biochemical test media panel used for the identification of gram negative organisms as well as to perform direct (primary) antimicrobial susceptibility. Results The present study revealed there was 100% categorical agreement between the results of the direct biochemical inoculation method and those of the standard isolate-based inoculation method regarding the identification of the causative agent. The results of the direct biochemical identification method were also consistent giving rise to a 100% withinrun precision categorical agreement and a 100% between-run precision categorical agreement. The overall categorical agreement between the results of the standard isolate-based AST method and the results of the direct (primary susceptibility) AST method was 96.3% for the signal blood culture media. The major error rate was 0.5% whereas the minor error rate was 3.3% . Consistent results were also obtained for the AST done directly from the signal blood culture bottles since the between-run and within-run precision categorical agreement were 96.3% and 98.6%, respectively. Conclusion the overall performance of the AST done directly from positive blood culture bottles fulfilled the acceptable performance criteria specified in the Cumitech 31A so the direct method can be used for the earlier determination of AST and identification of Gram negative bacteria and thus to reduce the time for early initiation of appropriate antibiotic

Sistem Pendukung Keputusan Team Survei Terbaik Pada SNI (Serikat Nelayan Indonesia) Menggunakan Metode SMART (Studi Kasus: Sekretariat SNI, Medan)

Surveys are usually confused with the term observation in the everyday sense, surveys are also the main way to collect primary data if secondary data are deemed incomplete to answer a question, if the secondary data is complete enough and the hypothesis can be tested with secondary data then Direct primary data collection using the survey method is no longer necessary, a survey is looking for detailed factual information that is currently symptomatic and identifying problems or to justify conditions and ongoing activities to find out what people are doing which is the target of research in solving problems, as material for planning and making decisions in the future. SMART (Simple Multi - Attribute Rating Technique) is a multi-criteria decision-making method developed by Edward in 1977.This multi-criteria decision-making technique is based on the theory that each alternative consists of a number of criteria that have values and each criterion has a weight describes how important it is compared to other criteria. This weighting is used to assess each alternative in order to obtain the best alternative. SMART uses a linear additive model to predict the value of each alternative. SMART is a flexible decision making method.

Direct Primary Care: A Successful Financial Model for the Clinical Practice of Lifestyle Medicine

Primary care has been shown to significantly decrease the overall cost of a population’s health care while improving the quality of each person’s well-being. Lifestyle medicine (LM) is ideally positioned to be delivered via primary care and has been shown to improve short- and long-term health outcomes of patients and populations. Direct primary care (DPC) represents a viable alternative to the fee-for-service reimbursement model. It has been shown to be economically and financially sustainable. Furthermore, it has the potential to fulfill the Quadruple Aim of health care in the United States. LM practiced in a DPC model has the potential to transform health care delivery. This article will discuss the need for health care systems change, provide an overview of the DPC model, demonstrate a basic understanding of the benefits, and review the steps needed to de-risk the investment of time, money, and resources for our future DPC providers.

Perilaku UMKM Terhadap Pelaksanaan Pemungutan Pajak UMKM Dengan Menggunakan Self Assessment System

- The implementation of MSME tax collection with the Self Assessment System is a tax collection system by calculating, paying and reporting by yourself by giving confidence to taxpayers based on applicable laws and regulations. This study aims to 1) determine the implementation of the implementation of the self-assessment system in Makasar District, East Jakarta; 2) analyzing the understanding of the taxation knowledge of the UMKM taxpayers, 3) analyzing the implementation of the MSME taxpayer obligations 4) analyzing the tax awareness of taxpayers' sensitivity. This type of research is qualitative descriptive by means of direct primary data collection through interviews with 10 taxpayer informants of MSME actors. The results of his research indicate that the implementation of the self-assessment system has not been going well and more intensive assistance is needed. This is due to the lack of public awareness of taxation and lack of understanding of taxation knowledge. There are 4 informants who run the self-assessment system, 2 of which are assisted by tax consultant services and 6 other informants have not implemented the self assetment system properly

Direct Primary Care: Family Physician Perceptions of a Growing Model

Purpose Direct Primary Care (DPC) is a relatively new primary care practice model in which patients receive unlimited access to a defined set of primary care services in exchange for a monthly practice-specific membership fee. DPC is a bottom-up physician-driven approach that contrasts to typical top-down insurer-centric health care delivery reform efforts. The degree to which physicians are aware of this practice model and whether they believe it addresses two key challenges facing primary care, access and administrative burden, are unclear. Methods An online survey distributed in July 2017 gauged family physicians' awareness of DPC and views about the model. Results Most respondents (85%) had heard of DPC and eight percent practiced in a DPC model at the time of the survey. In general, respondents reported that DPC can offer positive outcomes through lower administrative burden for physicians, improved doctor-patient relationships, and better access. Respondents also suggested DPC may result in improved patient health outcomes and lower overall healthcare spending. Respondents' concerns included inappropriateness of the model for vulnerable populations and physician shortages. Survey responses differed depending on whether the respondent practiced in a DPC model; DPC physicians had a more favorable view of the model and were focused on benefits to patients rather than benefits to physicians. Conclusions While some perceive challenges of DPC, others think that this model may benefit both patients and physicians.

Лакунарні компоненти у фразеології українського ареального континууму

Lacunary Components in the Phraseology of the Ukrainian Areal ContinuumThis article deals with the peculiarities of the concept lacuna from the per­spective of theoretical considerations. Based on theoretical studies of lacunar­ity, the author discusses issues related to the phenomenon of linguistic and cultural lacunae, including their sources and types. She also presents the main features of linguistic lacunae and their classifications, and analyses factors which have an impact on the emergence of lacunary phraseological units and their functioning. The study outlines the criteria of lacunarity and a method for identifying phraseological lacunae. It also considers the status of the lacuna and its functioning in areal phraseology, and examines the possibility of applying the theory of lacunarity to the areal phraseological system of the Ukrainian continuum. The study is focused on etymological analysis of phraseological lacunae and their origins. Lacunae are known to constitute a semantic vacuum which functions in the modes of language, speech and speech behaviour. As demonstrated, overcoming the problems of linguistic continuum requires the knowledge not only of the direct (primary) meaning of words and phrases, but also of their place and functions in a given sociocultural community where they are used, and where dialect is the actual means of communication. The article also identifies the main dimensions of the phraseological system in focus: the themes of the meanings of phraseological units, the nature of their figurative basis, and the way these two aspects are interrelated. Komponent lakunarny we frazeologii ukraińskiego kontinuum arealnego W artykule omówiono specyfikę pojęcia lakuna (luka) z punktu widzenia podejmowanych na jego temat rozważań teoretycznych. W oparciu o prace teo­retyczne poświęcone lakunarności autorka omawia rozmaite aspekty zjawiska luk językowych i kulturowych, ich źródła i typy. Artykuł uwzględnia główne cechy i istniejące klasyfikacje luk językowych, a także poddaje analizie czynniki wpływające na pojawianie się i funkcjonowanie luk frazeologicznych. Określono w nim ponadto kryteria lakunarności i metodę wykrywania luk frazeologicznych. Scharakteryzowano miejsce luki i jej funkcjonowanie w arealnych związkach frazeologicznych oraz możliwość zastosowania teorii lakunarności w badaniach nad arealnym systemem frazeologicznym ukraińskiego continuum. Szczególną uwagę zwraca autorka na etymologiczną analizę luk frazeologicznych i na przyczyny ich występowania. Jak wiadomo, luki są semantyczną próżnią, która funkcjonuje w modusach języka, mowy i zachowania językowego. Udowodniono, że przezwyciężenie problemów continuum językowego wymaga znajomości nie tylko bezpośredniego znaczenia słów i zwrotów, ale także ich miejsca i roli w danej wspólnocie społeczno-kulturowej, w której gwara jest rzeczywistym środkiem komunikacji. W artykule ponadto określono podstawowe wymiary omawianego systemu frazeologicznego, a więc tematykę znaczeń frazeologizmów, charakter ich podstawy figuratywnej i sposób, w jaki te wymiary są ze sobą powiązane.