bluuebunny/crossref_metadata_2025_split huggingface dataset:
Emergence of high drug resistant bacterial isolates from patients with health care associated infections at Jimma University medical center: a cross sectional study
Authors: Gashaw Mulatu , Berhane Melkamu , Bekele Sisay , Kibru Gebre , Teshager Lule , Yilma Yonas , Ahmed Yesuf , Fentahun Netsanet , Assefa Henok , Wieser Andreas , Gudina Esayas Kebede , Ali Solomon 
Published: November 2018

Abstract
Background
The rates of resistant microorganisms which complicate the management of healthcare associated infections (HAIs) are increasing worldwide and getting more serious in developing countries. The objective of this study was to describe microbiological features and resistance profiles of bacterial pathogens of HAIs in Jimma University Medical Center (JUMC) in Ethiopia.

Methods
Institution based cross sectional study was carried out on hospitalized patients from May to September, 2016 in JUMC. Different clinical specimens were collected from patients who were suspected to hospital acquired infections. The specimens were processed to identify bacterial etiologies following standard microbiological methods. Antibacterial susceptibility was determined in vitro by Kirby-Bauer disk diffusion method following Clinical and Laboratory Standards Institute guidelines.

Results
Overall, 126 bacterial etiologies were isolated from 118 patients who had HAIs. Of these, 100 (79.4%) were gram negative and the remaining were gram positive. The most common isolates were Escherichia coli 31(24.6%), Klebsiella species 30(23.8%) and Staphylococcus aureus 26 (20.6%). Of 126 bacterial isolates, 38 (30.2%), 52 (41.3%), and 24 (19%) were multidrug-resistant (MDR, resistant to at least one agent in three or more antimicrobial categories), extensively drug resistant (XDR, resistant to at least one agent in all but two or fewer antimicrobial categories (i.e. bacterial isolates remain susceptible to only one or two categories), pan-drug resistant (PDR, resistant to all antibiotic classes) respectively. More than half of isolated gram-negative rods (51%) were positive for extended spectrum beta-lactamase (ESBL) and/or AmpC; and 25% of gram negative isolates were also resistant to carbapenem antibiotics.

Conclusions
The pattern of drug resistant bacteria in patients with healthcare associated infection at JUMC is alarming. This calls for coordinated efforts from all stakeholders to prevent HAIs and drug resistance in the study setting.
A retrospective study comparing the length of admission of medium secure unit patients admitted in the three decades since 1985
Authors: Earnshaw Charles H. , Shaw Lucy , Thomas Deepu , Haeney Owen 
Published: November 2018

Aims and methodAdmissions of patients to secure forensic hospitals are often lengthy. Previous research has examined factors associated with prolonged admission, but studies analysing admission data at a single medium secure unit (MSU) over a prolonged time period are lacking. We compared admission data for all patients admitted to a MSU in England during the years 1985, 1995, 2005 and 2012.ResultsThe median length of admission increased from 167 days in 1985 to 580 days in 2012, though not in the intervening cohorts. There have been changes in the discharge destination of patients, away from independent accommodation in the community towards further care or supported accommodation.Clinical implicationsThe results suggest a change in the delivery of care. Further studies should be performed to assess whether the same trends exist at other sites. If these trends are also found elsewhere, this should trigger a specialty-wide discussion about admission length and its effects on bed availability.Declaration of interestNone.
Screening tools for HIV-associated neurocognitive disorders among adults living with HIV in sub-Saharan Africa: A scoping review
Authors: Mwangala Patrick N. , Newton Charles R. , Abas Melanie , Abubakar Amina 
Published: November 2018

Background: People living with HIV are at risk of developing HIV-associated neurocognitive disorders (HAND) which adversely affects their quality of life. Routine screening of HAND in HIV care is recommended to identify subtle changes in cognitive functioning and allow for early interventions. However, HAND detection is rarely done in sub-Saharan Africa (SSA), partly due to a lack of adequately standardized screening tools. This review was conducted to identify the commonly used screening tools for HAND in SSA and document their psychometric properties and diagnostic accuracy.Methods:We searched Ovid Medline, PsycINFO and Web of Sciences databases for empirical studies published from 1/1/1980 to 31/8/2018 on HAND among adults living with HIV in SSA.Results:We identified 14 eligible studies, of which 9 were from South Africa. The International HIV Dementia Scale (IHDS) was the most frequently reported tool, being used in more than half of the studies. However most studies only reported the diagnostic accuracy of this and other tools, with specificity ranging from 37% to 81% and sensitivity ranging from 45% to 100%. Appropriate data on construct validity and reliability of tools was rarely documented. Although most tools performed well in screening for severe forms of HAND, they lacked sensitivity and specificity for moderate forms of HAND. NeuroScreen, one of the newer tools, yielded good diagnostic accuracy in its initial evaluation in South Africa (81% to 93% sensitivity and 71% to 81% specificity).Conclusions:This review identified a lack of adequately standardized and contextually relevant HAND screening tools in SSA. Most screening tools for HAND used in SSA possess inadequate psychometric properties and diagnostic accuracy. There is a need for further validation of existing tools and development of new tools to make them sensitive and specific enough to identify both severe and moderate forms of HAND in SSA.
Real-time 3D Photoacoustic Visualization System with a Wide Field of View for Imaging Human Limbs
Authors: Nagae Kenichi , Asao Yasufumi , Sudo Yoshiaki , Murayama Naoyuki , Tanaka Yuusuke , Ohira Katsumi , Ishida Yoshihiro , Otsuka Atsushi , Matsumoto Yoshiaki , Saito Susumu , Furu Moritoshi , Murata Koichi , Sekiguchi Hiroyuki , Kataoka Masako , Yoshikawa Aya , Ishii Tomoko , Togashi Kaori , Shiina Tsuyoshi , Kabashima Kenji , Toi Masakazu , Yagi Takayuki 
Published: November 2018

Background: A breast-specific photoacoustic imaging (PAI) system prototype equipped with a hemispherical detector array (HDA) has been reported as a promising system configuration for providing high morphological reproducibility for vascular structures in living bodies. Methods: To image the vasculature of human limbs, a newly designed PAI system prototype (PAI-05) with an HDA with a higher density sensor arrangement was developed. The basic device configuration mimicked that of a previously reported breast-specific PAI system. A new imaging table and a holding tray for imaging a subject's limb were adopted. Results: The device’s performance was verified using a phantom. Contrast of 8.5 was obtained at a depth of 2 cm, and the viewing angle reached up to 70 degrees, showing sufficient performance for limb imaging. An arbitrary wavelength was set, and a reasonable PA signal intensity dependent on the wavelength was obtained. To prove the concept of imaging human limbs, various parts of the subject were scanned. High-quality still images of a living human with a wider size than that previously reported were obtained by scanning within the horizontal plane and averaging the images. The maximum field of view (FOV) was 270 mm × 180 mm. Even in movie mode, one-shot 3D volumetric data were obtained in an FOV range of 20 mm in diameter, which is larger than values in previous reports. By continuously acquiring these images, we were able to produce motion pictures. Conclusion: We developed a PAI prototype system equipped with an HDA suitable for imaging limbs. As a result, the subject could be scanned over a wide range while in a more comfortable position, and high-quality still images and motion pictures could be obtained.
Impaired renal function in a rural Ugandan population cohort
Authors: Kalyesubula Robert , Hau Jeffrey P. , Asiki Gershim , Ssebunya Billy , Kusemererwa Sylvia , Seeley Janet , Smeeth Liam , Tomlinson Laurie A. , Newton Robert 
Published: November 2018

Background: Chronic kidney disease (CKD) is an important cause of morbidity and mortality globally. However, there are limited data on the prevalence of impaired kidney function in sub-Saharan Africa. We aimed to determine the prevalence of CKD and associated factors in a rural Ugandan population. Methods: We undertook a study of a representative sample of the General Population Cohort in South-western Uganda. We systematically collected data on cardiovascular disease risk factors, anthropometric measurements and blood tests for haemoglobin, HIV, HbA1c, Hepatitis B and C and serum creatinine. The estimated glomerular filtration rate (eGFR) was calculated using the CKD-Epi formula, without the race component of the equation. Results: A total of 5,979/6,397 (93.5%) participants had valid creatinine results. The mean age was 39 years (Range: 16-103 years) and 3,627 (60.7%) were female. HIV prevalence was 9.7% and about 40% of the population were pre-hypertensive or hypertensive. The mean serum creatinine level was 0.75 mg/dl (95% CI 0.74–0.75), and the average eGFR was 109.3 ml/min/1.73 m2 (95% CI 108.8–109.9). The overall prevalence of CKD (eGFR <60 ml/min/1.73 m2) was 1.64% (98/5,979) (95% CI 1.34–1.99). Additionally, 4,792 (80.2%) were classified as normal (eGFR ≥90 ml/min/1.73 m2), 1,089 (18.2%) as low (eGFR 60–89 ml/min/1.73 m2), 91 (1.52%) as moderate (eGFR 30–59 ml/min/1.73 m2), 4 (0.07%) as severe (eGFR 15-29 ml/min/1.73 m2), and 3 (0.05%) classified as having kidney failure (eGFR <15 ml/min/1.73 m2). When age-standardised to the WHO Standard Population the prevalence of CKD was 1.79%. Age above 35 years (OR 78.3, 95% CI 32.3–189), and the presence of hypertension (OR 2.98, 95% CI 1.47-6.02) and anaemia (OR 2.47, 95% CI 1.37-4.42) were associated with CKD. Conclusion: We found a substantial prevalence of CKD in rural Uganda, strongly associated with high blood pressure and anaemia.
Embryonic Neocortical Microglia Express Toll-Like Receptor 9 and Respond to Plasmid DNA Injected into the Ventricle: Technical Considerations Regarding Microglial Distribution in Electroporated Brain Walls
Authors: Hattori Yuki , Miyata Takaki 
Published: November 2018

AbstractMicroglia, the resident immune cells in the CNS, play multiple roles during development. In the embryonic cerebral wall, microglia modulate the functions of neural stem/progenitor cells through their distribution in regions undergoing cell proliferation and/or differentiation. Previous studies using CX3CR1-GFP transgenic mice demonstrated that microglia extensively survey these regions. To simultaneously visualize microglia and neural-lineage cells that interact with each other, we applied thein uteroelectroporation (IUE) technique, which has been widely used for gene-transfer in neurodevelopmental studies, to CX3CR1-GFP mice (males and females). However, we unexpectedly faced a technical problem: although microglia are normally distributed homogeneously throughout the mid-embryonic cortical wall with only limited luminal entry, the intraventricular presence of exogenously derived plasmid DNAs induced microglia to accumulate along the apical surface of the cortex and aggregate in the choroid plexus. This effect was independent of capillary needle puncture of the brain wall or application of electrical pulses. The microglial response occurred at plasmid DNA concentrations lower than those routinely used for IUE, and was mediated by activation of Toll-like receptor 9 (TLR9), an innate immune sensor that recognizes unmethylated cytosine-phosphate guanosine motifs abundant in microbial DNA. Administration of plasmid DNA together with oligonucleotide 2088, the antagonist of TLR9, partially restored the dispersed intramural localization of microglia and significantly decreased luminal accumulation of these cells. Thus, via TLR9, intraventricular plasmid DNA administration causes aberrant distribution of embryonic microglia, suggesting that the behavior of microglia in brain primordia subjected to IUE should be carefully interpreted.
Computing Value from Quality and Quantity in Human Decision-Making
Authors: de Berker Archy O. , Kurth-Nelson Zeb , Rutledge Robb B. , Bestmann Sven , Dolan Raymond J. 
Published: November 2018

How organisms learn the value of single stimuli through experience is well described. In many decisions, however, value estimates are computed “on the fly” by combining multiple stimulus attributes. The neural basis of this computation is poorly understood. Here we explore a common scenario in which decision-makers must combine information about quality and quantity to determine the best option. Using fMRI, we examined the neural representation of quality, quantity, and their integration into an integrated subjective value signal in humans of both genders. We found that activity within inferior frontal gyrus (IFG) correlated with offer quality, while activity in the intraparietal sulcus (IPS) specifically correlated with offer quantity. Several brain regions, including the anterior cingulate cortex (ACC), were sensitive to an interaction of quality and quantity. However, the ACC was uniquely activated by quality, quantity, and their interaction, suggesting that this region provides a substrate for flexible computation of value from both quality and quantity. Furthermore, ACC signals across subjects correlated with the strength of quality and quantity signals in IFG and IPS, respectively. ACC tracking of subjective value also correlated with choice predictability. Finally, activity in the ACC was elevated for choice trials, suggesting that ACC provides a nexus for the computation of subjective value in multiattribute decision-making.SIGNIFICANCE STATEMENTWould you prefer three apples or two oranges? Many choices we make each day require us to weigh up the quality and quantity of different outcomes. Using fMRI, we show that option quality is selectively represented in the inferior frontal gyrus, while option quantity correlates with areas of the intraparietal sulcus that have previously been associated with numerical processing. We show that information about the two is integrated into a value signal in the anterior cingulate cortex, and the fidelity of this integration predicts choice predictability. Our results demonstrate how on-the-fly value estimates are computed from multiple attributes in human value-based decision-making.
Honey dressing on a leg ulcer with tendon exposure in a patient with type 2 diabetes
Authors: Teobaldi Ilaria , Stoico Vincenzo , Perrone Fabrizia , Bruti Massimiliano , Bonora Enzo , Mantovani Alessandro 
Published: November 2018

Summary
Honey has been used as a wound dressing for hundreds of years by ancient civilizations, but only recently it has acquired scientific interest because of its relevant biological properties. In the last decade, indeed, several trials and observational studies have reported that, compared to conventional treatment (e.g. antiseptics, polyurethane film, paraffin gauze, soframycin-impregnated gauze), honey dressings seem to be better in healing time of different types of wounds, including diabetic foot ulcers. However, to date, information about a potential favorable biological effect of honey dressings on diabetic ulcers with exposed tendon are still scarce. Notably, foot or leg ulcers with exposed tendon are serious complications in patients with type 2 diabetes, as they are associated with an increased risk of adverse outcome. Therefore, the use of effective and safe treatments to bring these lesions to timely healing is very important in clinical practice. We herein report the case of a Caucasian adult patient with type 2 diabetes presenting a chronic right posterior lower limb ulcer (Texas University Classification (TUC) 2D) with tendon exposure that was successfully treated with honey dressings (glucose oxidase (GOX) positive with peroxide activity) in addition to systemic antibiotic therapy, surgical toilette and skin graft. In our case, the use of honey dressing for treating exposed tendon tissue probably allowed the timely wound healing. Although further studies are required, such treatment may constitute part of the comprehensive management of diabetic wounds, including those with tendon exposure, and should be considered by clinicians in clinical practice.

Learning points:

Honey has been used as a wound dressing for hundreds of years, but only recently it has acquired scientific interest for its biological properties.

Several studies have documented that, compared to conventional dressings, honey seems to be better in healing time of different types of wounds, including diabetic foot ulcers.

Our case report is the first to highlight the importance to use honey dressings also for the treatment of ulcers with tendon exposure in patients with type 2 diabetes, suggesting that this kind of dressing should be considered by clinicians in clinical practice.
Marijuana and Tobacco Coexposure in Hospitalized Children
Authors: Wilson Karen M. , Torok Michelle R. , Wei Binnian , Wang Lanqing , Lowary Michelle , Blount Benjamin C. 
Published: November 2018

BACKGROUND:
The impact of secondhand marijuana smoke exposure on children is unknown. New methods allow for the detection of marijuana smoke exposure in children.

METHODS:
We studied children who were hospitalized in Colorado and had a parent participating in a smoking cessation study; all children had urine samples remaining from the original study as well as consent for future research. Parents completed a survey and urine samples were analyzed for cotinine and marijuana metabolites, including 11-hydroxy-Δ9-tetrahydrocannabinol (COOH-THC), by using liquid chromatography-tandem mass spectrometry.

RESULTS:
The median age of the children was 6.0 years (range 0–17 years); 57% were boys. Half (55%) were white, 12% were African American, and 33% were of another race; 39% identified as Hispanic. Approximately 46% had detectable COOH-THC, and 11% had detectable THC. Of those with detectable THC, 3 were teenagers, and 6 were &lt;8 years of age. There were no significant differences in urinary COOH-THC concentrations by age, sex, race and/or ethnicity, or socioeconomic status. Children with positive results for COOH-THC were more likely to have parents who use marijuana daily, smoke marijuana versus other forms of use, use daily in the home, and smoke marijuana in another room if the children are around compared with smoking outside.

CONCLUSIONS:
Approximately half of the children who qualified for our study had biological evidence of exposure to marijuana. Researchers in studies such as this provide valuable data on secondhand exposure to children from parents using tobacco and marijuana and can inform public health policies to reduce harm.
Epidemiología de la Tuberculosis en el Área de Salud de Pavas, Costa Rica
Authors: Guevara Francesa Giancarlo 
Published: November 2018

Este estudio tuvo por objetivo identificar los factores de riesgo asociados a la aparición de tuberculosis en Rincón Grande, Pavas. Se trata de una investigación cuantitativa realizada en dos fases: la primera correspondió a una descripción de los casos de tuberculosis en toda el área de estudio y la segunda, a un estudio de casos y controles con la población de Rincón Grande. En ambas fases se utilizó la totalidad de casos registrados de tuberculosis pulmonar entre 2010 y 2016. La fuente de datos fue el Sistema de Información Integrado de Salud y el libro de registro de casos. La selección de los controles fue aleatoria simple, con el total de sintomáticos respiratorios y el reporte del ELISA. Entre los resultados se denota que la incidencia en Pavas (periodo 2010-2016), osciló entre 10.2 y 22.2 casos por cada 100 000 habitantes. El 70,4% de los casos tenía entre 20 y 64 años de edad, el 59,0% correspondió a hombres; el 29,6%, a extranjeros. El 18,8% presentó antecedentes de consumo de drogas y el 51,1% tenían estudios con escolaridad primaria o menor. Los factores asociados son hacinamiento crítico, sexo (OR=1.9, IC=0.1-3.6), co-infección con VIH (OR=9.7, IC=2.3-39.6) y estado nutricional. Los hombres presentan 1.9 más veces la posibilidad de desarrollar tuberculosis y las personas con VIH presentan 9.7 veces dicha posibilidad. Se concluye que la seropositividad por VIH, las condiciones de hacinamiento, la desnutrición y el sexo masculino son factores de riesgo para la incidencia de tuberculosis en Rincón Grande
Copper—antimony and copper—bismuth chalcogenides—Research opportunities and review for solar photovoltaics
Authors: Peccerillo Enzo , Durose Ken 
Published: November 2018

AbstractThe ternary Cu-Sb- and Cu-Bi-chalcogenides present a rich range of compounds of potential use for large-scale photovoltaics from Earth abundant elements. This paper reviews the state of fundamental knowledge about them, and their technological status with regard to solar cells. Research targets and missing data are highlighted, which may provide opportunities to help realize the goal of sustainable photovoltaics.The family of ternary Cu-Sb- and Cu-Bi-chalcogenides and their solid solutions present a rich selection of potential candidates for Earth-abundant low toxicity photovoltaic (PV) absorber materials. Moreover, they have some novel features imparted by the ns2lone pair of electrons on the Sb and Bi ions. This review evaluates them as electronic materials, including experimental and theoretical evaluations of their phases, thermodynamic stability, point defects, conductivity, optical data, and PV performances. Formation of the materials in bulk, thin film, and nanoforms and the properties of the materials are critically assessed with relevance to their suitability for PV devices. There is special emphasis on CuSbS2and CuSbSe2which form the mainstay of the device literature and provide the most insights into the present-day limitation of the device efficiencies to 3 or 4%. Missing features of the literature are highlighted and clear statements recommending potential research pathways are made, which may help advance the technological performance from its present stuck position.