A persistent problem—The dreaded LVAD driveline infection

2021 ◽  
Author(s):  
Hannah Copeland ◽  
David Baran
Keyword(s):  
Persistent Problem ◽  
Driveline Infection

scholarly journals Low Incidence of Pump-Related Infections in Jarvik 2000 Ventricular Assist Device Recipients with a Subcostal Driveline Exit Site

2019 ◽  
Vol 46 (3) ◽  
pp. 179-182
Author(s):  
George V. Letsou ◽  
Jatin Anand ◽  
Erinn Ogburn ◽  
Rohan M. Shah ◽  
Anand V. Ganapathy ◽  
...  
Keyword(s):  
Ventricular Assist Device ◽  
Vital Signs ◽  
Left Ventricular ◽  
Exit Site ◽  
Assist Device ◽  
Ventricular Assist ◽  
Persistent Problem ◽  
Jarvik 2000 ◽  
Driveline Infection ◽  
Low Incidence

Driveline infection has been a persistent problem with mechanical cardiac assist devices. The reported incidence of infection has been low in patients who receive a Jarvik 2000 continuous-flow left ventricular assist device when a skull-pedestal driveline exit site is used. We evaluated whether this is also true when a subcostal driveline exit site is used. We reviewed baseline demographic variables, postimplantation vital signs, laboratory values, and culture results in patients who underwent Jarvik 2000 implantation at our center from April 2000 through October 2009, including follow-up through June 2014. All patients had a subcostal driveline exit site. We defined device-related infection as a positive blood or wound culture associated with a medical or surgical device intervention. Event and time-to-event rates were calculated. Eighty-one patients received 89 Jarvik 2000 devices, all as bridges to transplantation. The median support duration was 69 days (interquartile range, 27–153 d; range, 2–2,249 d). Five superficial driveline infections and one incision-site infection occurred (0.002 events per patient-year of support). The median time from pump implantation to onset of driveline infection was 30 days; the incision-related infection occurred at 44 days. The Jarvik 2000 has a low incidence of infection when implanted with use of a subcostal driveline exit site. The incidence of pump infections is particularly low. Using a subcostal driveline exit site may be as effective in preventing infections as using a skull-pedestal driveline exit site. We detail our findings in this report.

The solubility of calcium carbonate  in green liquor handling systems

TAPPI Journal ◽  
2019 ◽  
Vol 18 (10) ◽  
pp. 595-602
Author(s):  
ALISHA GIGLIO ◽  
VLADIMIROS G. PAPANGELAKIS ◽  
HONGHI TRAN
Keyword(s):  
Calcium Carbonate ◽  
Systematic Study ◽  
Kraft Pulp ◽  
Thermodynamic Simulation ◽  
Solubility Data ◽  
Pulp Mills ◽  
Persistent Problem ◽  
Green Liquor ◽  
Kraft Pulp Mills ◽  
Salt Systems

The formation of hard calcite (CaCO3) scale in green liquor handling systems is a persistent problem in many kraft pulp mills. CaCO3 precipitates when its concentration in the green liquor exceeds its solubility. While the solubility of CaCO3 in water is well known, it is not so in the highly alkaline green liquor environment. A systematic study was conducted to determine the solubility of CaCO3 in green liquor as a function of temperature, total titratable alkali (TTA), causticity, and sulfidity. The results show that the solubility increases with increased temperature, increased TTA, decreased causticity, and decreased sulfidity. The new solubility data was incorporated into OLI (a thermodynamic simulation program for aqueous salt systems) to generate a series of CaCO3 solubility curves for various green liquor conditions. The results help explain how calcite scale forms in green liquor handling systems.

Design of Arylsulfonylhydrazones as Potential FabH Inhibitors: Synthesis, Antimicrobial Evaluation and Molecular Docking

2019 ◽  
Vol 15 ◽  
Author(s):  
Thais Batista Fernandes ◽  
Natanael Dante Segretti ◽  
Felipe Rebello Lourenço ◽  
Thalita Marcílio Cândido ◽  
André Rolim Baby ◽  
...  
Keyword(s):  
Antioxidant Activity ◽  
Molecular Docking ◽  
Antimicrobial Agents ◽  
Acyl Carrier Protein ◽  
Condensation Reaction ◽  
Lung Fibroblast ◽  
Fibroblast Cells ◽  
Human Lung Fibroblast ◽  
Persistent Problem ◽  
E Coli

Background: Antimicrobial resistance is a persistent problem about infections treatment and carries needing for develop new antimicrobial agents. Inhibiting of bacterial β-ketoacyl acyl carrier protein synthase III (FabH), which catalyzes the condensation reaction between a CoA-attached acetyl group and an ACP-attached malonyl group in bacteria is an interesting strategy to find new antibacterial agents. Objective: The aim of this work was to design and synthesize arylsulfonylhydrazones potentially FabH inhibitors and evaluate their antimicrobial activity. Methods: MIC50 of sulfonylhydrazones against E. coli and S. aureus was determined. Antioxidant activity was evaluated by DPPH (1-1’-diphenyl-2-picrylhydrazyl) assay and cytotoxicity against LL24 lung fibroblast cells was verified by MTT method. Principal component analysis (PCA) was performed in order to suggest a structure-activity relationship. Molecular docking allowed to propose sulfonylhydrazones interactions with FabH. Results: The most active compound showed activity against S. aureus and E. coli, with MIC50 = 0.21 and 0.44 µM, respectively. PCA studies correlated better activity to lipophilicity and molecular docking indicated that sulfonylhydrazone moiety is important to hydrogen-bond with FabH while methylcatechol ring performs π-π stacking interaction. The DPPH assay revealed that some sulfonylhydrazones derived from the methylcatechol series had antioxidant activity. None of the evaluated compounds was cytotoxic to human lung fibroblast cells, suggesting that the compounds might be considered safe at the tested concentration. Conclusion: Arylsufonylhydrazones is a promising scaffold to be explored for design of new antimicrobial agents.

scholarly journals Investigation into the Cause of Iron-Related Clogging of Groundwater Bores Used for Viticulture in the Limestone Coast, South Australia

Water ◽  
2021 ◽  
Vol 13 (5) ◽  
pp. 683
Author(s):  
Birte Moser ◽  
Meruyert Beknazarova ◽  
Harriet Whiley ◽  
Thilini Piushani Keerthirathne ◽  
Nikki Harrington ◽  
...  
Keyword(s):  
Groundwater Resources ◽  
South Australia ◽  
Water Levels ◽  
Clear Correlation ◽  
Problem Analysis ◽  
Persistent Problem ◽  
Root Cause ◽  
Complex Interactions ◽  
Iron Manganese

Iron-related clogging of boreholes, pumps and dripper lines is a significant and costly problem for irrigators worldwide. The primary cause of iron-related clogging is still debated. Previous studies have described complex interactions between biological clogging and inorganic iron/manganese oxide precipitation. This case study examined groundwater bores used for viticulture irrigation in the Limestone Coast region, a highly productive wine growing area in the SE of South Australia. Iron clogging of bore screens, pumps and dripper systems has been a persistent problem in the region and the issue is perceived to be growing, with irrigators suggesting the widespread introduction of iron-related bacteria (IRB) through drilling equipment to be the root cause of the problem. Analysis of the groundwater microbiology and inorganic chemistry found no apparent correlation between the presence of IRB and the clogging status of wells. In fact, IRB proved to be widespread throughout the limestone aquifer. However, a clear correlation could be found between clogging affected bores and the redox potential of the groundwater with the most severely affected bores strongly oversaturated in respect to iron oxide minerals. Elevated dissolved concentrations of Fe(II) thereby tended to be found in deeper bores, which also were generally more recently drilled. Following decades of less than average rainfall, a tendency to deepen bores in response to widespread declines in water levels has been documented for the SE of South Australia. The gradually widening clogging problem in the region is postulated to be related to the changes in climate in the region, with irrigators increasingly driven to rely on deeper, anoxic iron-rich groundwater resources.

scholarly journals There Is No Place like Home! How Willing Are Young Adults to Move to Find a Job?

2021 ◽  
Vol 13 (13) ◽  
pp. 7494
Author(s):  
Julia Weiss ◽  
Livio Ferrante ◽  
Mariano Soler-Porta
Keyword(s):  
Young Adults ◽  
Rural Areas ◽  
Urban Areas ◽  
Youth Unemployment ◽  
Rural Youth ◽  
The European Union ◽  
International Mobility ◽  
Persistent Problem ◽  
Self Sufficiency ◽  
Job Opportunities

The European Union (EU) has undergone significant economic crises in recent years. Therein, young people were amongst the hardest hit groups, with youth unemployment rising as high as 50% in some member states. Particularly high rates of youth unemployment were often observed in rural areas, where labour market supply in relation to demand were notably divergent. One of the core pillars of the EU’s agenda is to tackle the persistent problem of youth unemployment. Since the recent crisis, this has been via the “Youth on the Move” initiative, which involves the promotion of intra- and international mobility of young adults in order to gain access to job opportunities. However, what has received little attention so far is the question of what the general willingness of young adults to move is like, and to what extent this varies, for example, depending upon the area they live in. This paper therefore asks if rural youth differ from youth in urban areas in relation to their willingness to move for a job within their country or to another country. Moreover, what influences the general willingness to be mobile? Based on the Cultural Pathways to Economic Self-Sufficiency and Entrepreneurship (CUPESSE) Survey, which includes data on 18–35-year-olds in a sample of 11 European countries, it is shown that living in a rural area is strongly associated with the willingness to move. Furthermore, it shows that rural youth are more willing to move within the country but less willing to move to another country. Based on the presentation of the various factors, which promote or curb mobility readiness, the results make it clear that the success of EU initiatives depends on the preferences and willingness of the target group in question.

scholarly journals Clinical Identification of Dysregulated Circulating microRNAs and Their Implication in Drug Response in Triple Negative Breast Cancer (TNBC) by Target Gene Network and Meta-Analysis

Genes ◽  
2021 ◽  
Vol 12 (4) ◽  
pp. 549
Author(s):  
Amal Qattan ◽  
Taher Al-Tweigeri ◽  
Wafa Alkhayal ◽  
Kausar Suleman ◽  
Asma Tulbah ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Drug Resistance ◽  
Triple Negative Breast Cancer ◽  
Drug Response ◽  
Triple Negative ◽  
Meta Analysis ◽  
Integrated Analysis ◽  
Circulating Mirnas ◽  
Persistent Problem ◽  
Network Analyses

Resistance to therapy is a persistent problem that leads to mortality in breast cancer, particularly triple-negative breast cancer (TNBC). MiRNAs have become a focus of investigation as tissue-specific regulators of gene networks related to drug resistance. Circulating miRNAs are readily accessible non-invasive potential biomarkers for TNBC diagnosis, prognosis, and drug-response. Our aim was to use systems biology, meta-analysis, and network approaches to delineate the drug resistance pathways and clinical outcomes associated with circulating miRNAs in TNBC patients. MiRNA expression analysis was used to investigate differentially regulated circulating miRNAs in TNBC patients, and integrated pathway regulation, gene ontology, and pharmacogenomic network analyses were used to identify target genes, miRNAs, and drug interaction networks. Herein, we identified significant differentially expressed circulating miRNAs in TNBC patients (miR-19a/b-3p, miR-25-3p, miR-22-3p, miR-210-3p, miR-93-5p, and miR-199a-3p) that regulate several molecular pathways (PAM (PI3K/Akt/mTOR), HIF-1, TNF, FoxO, Wnt, and JAK/STAT, PD-1/PD-L1 pathways and EGFR tyrosine kinase inhibitor resistance (TKIs)) involved in drug resistance. Through meta-analysis, we demonstrated an association of upregulated miR-93, miR-210, miR-19a, and miR-19b with poor overall survival outcomes in TNBC patients. These results identify miRNA-regulated mechanisms of drug resistance and potential targets for combination with chemotherapy to overcome drug resistance in TNBC. We demonstrate that integrated analysis of multi-dimensional data can unravel mechanisms of drug-resistance related to circulating miRNAs, particularly in TNBC. These circulating miRNAs may be useful as markers of drug response and resistance in the guidance of personalized medicine for TNBC.

scholarly journals Why Do Patients Leave against Medical Advice? Reasons, Consequences, Prevention, and Interventions

Healthcare ◽  
2021 ◽  
Vol 9 (2) ◽  
pp. 111
Author(s):  
Asseel Albayati ◽  
Steven Douedi ◽  
Abbas Alshami ◽  
Mohammad A. Hossain ◽  
Shuvendu Sen ◽  
...  
Keyword(s):  
Hospital Admissions ◽  
Medical Advice ◽  
Preventive Strategies ◽  
Against Medical Advice ◽  
Cause Analysis ◽  
Persistent Problem ◽  
Root Cause ◽  
Discharge Against Medical Advice ◽  
Leaving Against Medical Advice

Background: A patient decides to leave the hospital against medical advice. Is this an erratic eccentric behavior of the patient, or a gap in the quality of care provided by the hospital? With a significant and increasing prevalence of up to 1–2% of all hospital admissions, leaving against medical advice affects both the patient and the healthcare provider. We hereby explore this persistent problem in the healthcare system. We searched Medline and PubMed within the last 10 years, using the keywords “discharge against medical advice,” “DAMA,” “leave against medical advice,” and “AMA.” We retrospectively reviewed 49 articles in our project. Ishikawa fishbone root cause analysis (RCA) was employed to explore reasons for leaving against medical advice (AMA). This report presents the results of the RCA and highlights the consequences of discharge against medical advice (DAMA). In addition, the article explores preventive strategies, as well as interventions to ameliorate leaving AMA.

scholarly journals Timing and Route of Contamination of Patient Rooms With Healthcare-Associated Pathogens

2020 ◽  
Vol 41 (S1) ◽  
pp. s412-s412
Author(s):  
Sarah Redmond ◽  
Jennifer Cadnum ◽  
Basya Pearlmutter ◽  
Natalia Pinto Herrera ◽  
Curtis Donskey
Keyword(s):  
Acute Care Hospital ◽  
Current Control ◽  
Pathogen Transmission ◽  
Control Measures ◽  
Effective Control ◽  
Portable Devices ◽  
Care Hospital ◽  
Spa Typing ◽  
Persistent Problem ◽  
Healthcare Associated

Background: Transmission of healthcare-associated pathogens such as Clostridioides difficile and methicillin-resistant Staphylococcus aureus (MRSA) is a persistent problem in healthcare facilities despite current control measures. A better understanding of the routes of pathogen transmission is needed to develop effective control measures. Methods: We conducted an observational cohort study in an acute-care hospital to identify the timing and route of transfer of pathogens to rooms of newly admitted patients with negative MRSA nares results and no known carriage of other healthcare-associated pathogens. Rooms were thoroughly cleaned and disinfected prior to patient admission. Interactions of patients with personnel and portable equipment were observed, and serial cultures for pathogens were collected from the skin of patients and from surfaces, including those observed to come in contact with personnel and equipment. For MRSA, spa typing was used to determine relatedness of patient and environmental isolates. Results: For the 17 patients enrolled, 1 or more environmental cultures became positive for MRSA in rooms of 10 patients (59%), for C. difficile in rooms of 2 patients (12%) and for vancomycin-resistant enterococci (VRE) in rooms of 2 patients (12%). The patients interacted with an average of 2.4 personnel and 0.6 portable devices per hour of observation. As shown in Figure 1, MRSA contamination of the floor occurred rapidly as personnel entered the room. In a subset of patients, MRSA was subsequently recovered from patients’ socks and bedding and ultimately from the high-touch surfaces in the room (tray table, call button, bedrail). For several patients, MRSA isolates recovered from the floor had the same spa type as isolates subsequently recovered from other sites (eg, socks, bedding, and/or high touch surfaces). The direct transfer of healthcare-associated pathogens from personnel or equipment to high-touch surfaces was not detected. Conclusions: Healthcare-associated pathogens rapidly accumulate on the floor of patient rooms and can be transferred to the socks and bedding of patients and to high-touch surfaces. Healthcare facility floors may be an underappreciated source of pathogen dissemination not addressed by current infection control measures.Funding: NoneDisclosures: None

scholarly journals The long-term course of fatigue following breast cancer diagnosis

2020 ◽  
Vol 4 (1) ◽  
Author(s):  
Karin Biering ◽  
Morten Frydenberg ◽  
Helle Pappot ◽  
Niels Henrik Hjollund
Keyword(s):  
Breast Cancer ◽  
Time Course ◽  
Breast Cancer Diagnosis ◽  
Patient Characteristics ◽  
Repeated Measurements ◽  
Diagnosis And Treatment ◽  
Persistent Problem ◽  
Treatment Regimens ◽  
Long Time

Abstract Purpose Fatigue following breast cancer is a well-known problem, with both high and persistent prevalence. Previous studies suffer from lack of repeated measurements, late recruitment and short periods of follow-up. The course of fatigue from diagnosis and treatment to the long-time outcome status is unknown as well as differences in the level of fatigue between treatment regimens. The purpose of this study was to describe the long-time course of fatigue from the time of clinical suspicion of breast cancer, its dependence of patient characteristics and treatment regimens and the comparison with the course of fatigue among women with the same suspicion, but not diagnosed with breast cancer. Methods Three hundred thirty-two women referred to acute or subacute mammography was followed with questionnaires from before the mammography and up to 1500 days. Fatigue was measured by the Multidimensional Fatigue Inventory (MFI-20). The women reported their initial level of fatigue before the mammography and thus without knowledge of whether they had cancer or not. Both women with and without cancer were followed. Women with cancer were identified in the clinical database established by Danish Breast Cancer Cooperative Group (DBCG) to collect information on treatment regimen. Results Compared to fatigue scores before diagnosis, women with breast cancer reported a large increase of fatigue, especially in the first 6 months, followed by a slow decrease over time. Despite the long follow-up period, the women with breast cancer did not return to their level of fatigue at time of the mammography. Women without breast cancer, experienced a rapid decrease of fatigue after disproval of diagnosis followed by a steadier period. Conclusions Fatigue is a persistent problem in women diagnosed with breast cancer, even several years following diagnosis and treatment. The women with breast cancer were most affected by fatigue in the first 6 months after diagnosis.

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