Analysis of Human Error as a Factor in Road Crash in Metro Manila (2005-2015)

Introduction. In the Philippines, data on road traffic injuries show that road injury is the 11th leading cause of premature deaths in the Philippines. The World Health Organization estimates that 1.24 million die globally due to road traffic crashes. Objectives. This study aimed to show the trend of the road crash situation in Metro Manila, Philippines, over eleven years (2005–2015) and to analyze human error and other associated hazard factors for road crashes. Methods. This study is a secondary analysis of an 11-year database culled from 2005–2015, for Metro Manila, Philippines. The variables included road crash classification, incidence over months and time of the day, road crash disaggregated by location, region, and city, and type of vehicle. Descriptive statistics were used to describe the incidence of a road crash, road crash fatalities, and risk factors associated with a road crash in Metro Manila. Results. The incidence of road crashes in Metro Manila has increased from 65,111 in 2005 to 95,615 in 2015. Fatalities also increased from 348 to 536. The most predominant type of vehicle involved in road crashes were cars from 46% to 67%, followed by jeepneys, vans, and motorcycles. The most commonly reported human errors were speeding, inattentive and bad turning. The reported percentage of speeding from 2005–2010 ranged between 32% and 58%. In 2014, speeding (96%) was the most reported human error among the other reported errors; such as inattentiveness (range, 28 to 41%) and bad turning (0.6% and 33%). Fatigue and traffic violation made up 0.02% to 0.45% of the reported human factors of road crash-related hospitalization cases in Metro Manila for the period. Suspected alcohol use accounted for 0.04% to 4.57% of the human errors reported. For non-fatal and fatal crashes, the associated human errors were suspected alcohol use, inattentiveness, and speeding. The highest adjusted residual for both fatal and non-fatal (injurious) crashes was for inattentiveness. Human error was associated with years, suggesting that for some years, the number of crashes caused by human errors is significantly higher than expected. Alcohol-suspected crashes are significantly higher than expected for 2005 and 2011, with 2011 having the highest adjusted residual. Inattentiveness-caused crashes were significantly higher than expected for years 2005 to 2010, with 2007 having the highest adjusted residual. Bad turning was significantly higher from 2005 to 2007; while disobedience was significantly higher for 2005 to 2008. Speeding was significantly higher than expected from 2005 to 2010. Conclusion. There is a need to address the public health concern posed by road crashes in Metro Manila, as well as to rectify the ergonomically related risk factors and human error components in a road crash.

The synergetic effect of Imipenem-clarithromycin combination in the Mycobacteroides abscessus complex

Background Nontuberculous mycobacteria (NTM) are ubiquitous organisms and the incidence of NTM infections has been increasing in recent years. Mycobacteroides abscessus (M. abscessus) is one of the most antimicrobial-resistant NTM; however, no reliable antibiotic regimen can be officially advocated. We evaluated the efficacy of clarithromycin in combination with various antimicrobial agents against the M. abscessus complex. Results Twenty-nine clinical strains of M. abscessus were isolated from various clinical samples. Of the isolates, 10 (34.5%) were of M. abscessus subsp. abscessus, 18 (62.1%) of M. abscessus subsp. massiliense, and 1 (3.4%) of M. abscessus subsp. bolletii. MICs of three antimicrobial agents (amikacin, imipenem, and moxifloxacin) were measured with or without clarithromycin. The imipenem-clarithromycin combination significantly reduced MICs compared to clarithromycin and imipenem monotherapies, including against resistant strains. The association between susceptibility of the M. abscessus complex and each combination of agents was significant (p = 0.001). Adjusted residuals indicated that the imipenem-clarithromycin combination had the synergistic effect (adjusted residual = 3.1) and suppressed the antagonistic effect (adjusted residual = − 3.1). In subspecies of M. abscessus complex, the association with susceptibility of M. abscessus subsp. massiliense was similarly statistically significant (p = 0.036: adjusted residuals of synergistic and antagonistic effect respectively: 2.6 and − 2.6). The association with susceptibility of M. abscessus subsp. abscessus also showed a similar trend but did not reach statistical significance. Conclusion Our data suggest that the imipenem-clarithromycin combination could be the recommended therapeutic choice for the treatment of M. abscessus complex owing to its ability to restore antimicrobial susceptibility.

The Synergetic Effect of Imipenem-Clarithromycin Combination in the Mycobacteroides abscessus Complex

Background: Nontuberculous mycobacteria (NTM) are ubiquitous organisms and the incidence of NTM infections has been increasing in recent years. Mycobacteroides abscessus (M. abscessus) is one of the most antimicrobial-resistant NTM; however, no reliable antibiotic regimen can be officially advocated. We evaluated the efficacy of clarithromycin in combination with various antimicrobial agents against the M. abscessus complex. Results: Twenty-nine clinical strains of M. abscessus were isolated from various clinical samples. Of the isolates, 10 (34.5%) were of M. abscessus subsp. abscessus, 18 (62.1%) of M. abscessus subsp. massiliense, and 1 (3.4%) of M. abscessus subsp. bolletii. MICs of three antimicrobial agents (amikacin, imipenem, and moxifloxacin) were measured with or without clarithromycin. The imipenem-clarithromycin combination significantly reduced MICs compared to clarithromycin and imipenem monotherapies, including against resistant strains. The association between susceptibility of the M. abscessus complex and each combination of agents was significant (p = 0.001). Adjusted residuals indicated that the imipenem-clarithromycin combination had the synergistic effect (adjusted residual = 3.1) and suppressed the antagonistic effect (adjusted residual = -3.1). In subspecies of M. abscessus complex, the association with susceptibility of M. abscessus subsp. massiliense was similarly statistically significant (p = 0.036: adjusted residuals of synergistic and antagonistic effect respectively: 2.6 and -2.6). The association with susceptibility of M. abscessus subsp. abscessus also showed a similar trend but did not reach statistical significance. Conclusion: Our data suggest that the imipenem-clarithromycin combination could be the recommended therapeutic choice for the treatment of M. abscessus complex owing to its ability to restore antimicrobial susceptibility.

The Synergetic Effect of Imipenem-Clarithromycin Combination in the Mycobacteroides abscessus Complex

Background: Nontuberculous mycobacteria (NTM) are ubiquitous organisms and the incidence of NTM infections has been increasing in recent years. Mycobacteroides abscessus (M. abscessus) is one of the most antimicrobial-resistant NTM; however, no reliable antibiotic regimen can be officially advocated. We evaluated the efficacy of clarithromycin in combination with various antimicrobial agents against the M. abscessus complex. Results: Twenty-nine clinical strains of M. abscessus were isolated from various clinical samples. Of the isolates, 10 (34.5%) were of M. abscessus subsp. abscessus, 18 (62.1%) of M. abscessus subsp. massiliense, and 1 (3.4%) of M. abscessus subsp. bolletii. MICs of three antimicrobial agents (amikacin, imipenem, and moxifloxacin) were measured with or without clarithromycin. The imipenem-clarithromycin combination significantly reduced MICs compared to clarithromycin and imipenem monotherapies, including against resistant strains. The association between susceptibility of the M. abscessus complex and each combination of agents was significant (p = 0.001). Adjusted residuals indicated that the imipenem-clarithromycin combination had the synergistic effect (adjusted residual = 3.1) and suppressed the antagonistic effect (adjusted residual = -3.1). In subspecies of M. abscessus complex, the association with susceptibility of M. abscessus subsp. massiliense was similarly statistically significant (p = 0.036: adjusted residuals of synergistic and antagonistic effect respectively: 2.6 and -2.6). The association with susceptibility of M. abscessus subsp. abscessus also showed a similar trend but did not reach statistical significance. Conclusion: Our data suggest that the imipenem-clarithromycin combination could be the recommended therapeutic choice for the treatment of M. abscessus complex owing to its ability to restore antimicrobial susceptibility.

Childbirth care in a regional healthcare network of the Mãe Paranaense Network

Objective: to analyze childbirth care in a regional healthcare unit within the Mãe Paranaense Network. Methods: a cross-sectional descriptive study conducted with 395 mothers applying a structured questionnaire, data analysis using the Chi-Squared test or G-test, complemented by an adjusted residual analysis (p<0.05). Results: higher education, higher income, abortion and interpartal period <2 years increased cesarean rates. Intrapartum complications and antibiotic therapy were related to cesarean sections. Most did not visit the maternity, had their delivery choice respected, had a companion and mother-baby contact; however, 28.9% did not have their delivery choice respected. Conclusion: there was a reduction in cesarean sections among multiparous, an increase in women who suffered a miscarriage, with an interpartal interval <2 years. Antibiotic therapy and disrespect for the delivery choice were greater for women undergoing cesarean sections. Use of oxytocin, presence of a companion and mother-baby contact were more evident in vaginal delivery.

Antimicrobial Susceptibility in the Mycobacteroides abscessus Complex is Restored by an Imipenem-Clarithromycin Combination

Nontuberculous mycobacteria (NTM) are ubiquitous organisms and the incidence of NTM infections has been increasing in recent years. Mycobacteroides abscessus (M. abscessus) is one of the most antimicrobial-resistant NTM; however, no reliable antibiotic regimen can be officially advocated. We evaluated the efficacy of clarithromycin in combination with various antimicrobial agents against the M. abscessus complex. Twenty-nine clinical strains of M. abscessus were isolated from various clinical samples. Of the isolates, 10 (34.5%) were of M. abscessus subsp. abscessus, 18 (62.1%) of M. abscessus subsp. massiliense, and 1 (3.4%) of M. abscessus subsp. bolletii. MICs of three antimicrobial agents (amikacin, imipenem, and moxifloxacin) were measured with or without clarithromycin. The imipenem-clarithromycin combination significantly reduced MICs compared to clarithromycin and imipenem monotherapies, including against resistant strains. The association between susceptibility of the M. abscessus complex and each combination of agents was significant (p = 0.001). Adjusted residuals indicated that the imipenem-clarithromycin combination had the synergistic effect (adjusted residual = 3.1) and suppressed the antagonistic effect (adjusted residual = -3.1). In subspecies of M. abscessus complex, the association with susceptibility of M. abscessus subsp. massiliense was similarly statistically significant (p = 0.036: adjusted residuals of synergistic and antagonistic effect respectively: 2.6 and -2.6). The association with susceptibility of M. abscessus subsp. abscessus also showed a similar trend but did not reach statistical significance. Our data suggest that the imipenem-clarithromycin combination could be the recommended therapeutic choice for the treatment of M. abscessus complex owing to its ability to restore antimicrobial susceptibility.

0709 Using The Sleep Adjusted Residual Apnea Hypopnea Index In The Real-World Monitoring Of Obstructive Sleep Apnea

Introduction Treatment efficacy of obstructive sleep apnea (OSA) depends on controlling respiratory events for the majority of sleep time. Apnea-hypopnea index (AHI) and adherence are frequently used to determine efficacy of continuous positive airway (CPAP) therapy, but fail to capture the effect of residual events during untreated sleep-time. The Sleep Adjusted Residual AHI (SARAHI) consolidates treated and untreated AHI and CPAP use into a single number: SARAHI = [(Untreated AHI × Hours Untreated) + (Treated AHI × Hours Treated)] / (Total Sleep Hours). We attempted to determine the clinical applicability of this index as a determinant of OSA control and its relation with sleepiness improvement. Methods As part of a quality assessment project, a convenience sample was haphazardly collected from a database of patients initiated on CPAP in a Veteran’s Affairs Hospital. Patients initiating treatment after OSA diagnosis by polysomnogram or portable sleep study were included. Information from a CPAP-download within a year of diagnosis and Epworth Sleepiness Scale (ESS) at diagnosis and follow-up were collected. SARAHI was calculated using two different measures of “total sleep hours”: 8 hours (SARAHI-8hrs) or recorded sleep time during sleep study (SARAHI-PSG). Results Thirteen patients (12 male) with a mean age of 53.3 years were included. At diagnosis, mean AHI was 26.0 events/hour and ESS was 14.6. At follow-up, CPAP mean adherence was 338 min and average use was 61.8% of days; mean residual AHI was 4.4 events/hour and mean ESS 13.7. SARAHI-8hrs was 16.0 events/hour and SARAHI-PSG was 13.8 events/hr. Simple linear regression did not show a significant correlation between ESS improvement and either of these indexes or with improvement in AHI. Conclusion SARAHI showed no correlation with ESS in this small sample. We recommend further research as SARAHI is simple to use and provides more information than currently used parameters. Support None

An Assessment Of Event Study Methodologies Using Daily Stock Returns

This paper examines Multinational Stock Price reactions to foreign currency translation, using three alternative residual methodologies. The results reveal that when a crude measure such as Mean Adjusted Return, which makes not explicit risk adjustments is used, the null hypothesis of zero abnormal return is rejected in three out of six events. However, market and risk adjusted residual returns reveal that the null hypothesis of zero abnormal return cannot be rejected.