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BACKGROUND: The continuous decrease of healthcare resources requires hospitals to improve efficiency while striving to improve quality standards that deliver better patient outcomes. OBJECTIVE: The objective of this study was to analyze whether the implementation of digital support systems during orthopedic surgery positively affected clinical processes and quality ratios. METHODS: A retrospective case-control study of 297 knee joint replacement procedures was conducted between 2015 and 2020. Thirty-five patients were allocated to the treatment and control groups after they were identified with exact matching and estimation of the propensity score. Both groups were balanced regarding the selected covariates. The effect of the surgical procedure manager (SPM) on the incidence of acute haemorrhagic anaemia between the two groups was evaluated with a t-test, and the odds ratio was calculated. RESULTS: SPM-supported surgery has no significant influence on the incidence of acute haemorrhagic anaemia but leads to significantly shorter hospital stay (1.93 days), changeover (4.14 minutes) and recovery room time (20.20 minutes). In addition, it reduces the standard deviation of operation room times. CONCLUSIONS: The study concludes that SPM enhances surgical efficiency and maintains quality outcomes. To overcome their increasing financial pressure hospital management should commercially evaluate the implementation of digital support systems.

[EN] The Master Plans (MP) used for Architectural Cultural Heritage conservation require specific standards for the documentation process. They must facilitate the achievement of the intended objectives about the knowledge acquisition and conservation of the building assets throughout the entire building lifecycle. Over time, the documentation of an MP, once the heritage building is under use, tends to become dispersed and the documentation generated during the building use is rarely introduced in the MP. Therefore, this contribution has the following objectives: 1) study of the requirements of MP deliverables; 2) study of the maturation requirements of the documentation processes and deliverables that are generated when applying the Building Information Modelling (BIM) methodology to an MP; 3) investigate if the application of the BIM strategies are suitable to respond to the needs of an MP in such a way that knowledge and conservation of heritage buildings are achieved; 4) verify that the exchange of information and the collaborative work among the different disciplines that generate documentation and deliverables guarantee a single, comprehensive, open, three-dimensional, and clear repository., [ES] Los Planes Directores (PD) sobre el Patrimonio Cultural arquitectónico requieren de unos estándares específicos de organización de la documentación que faciliten la obtención de los objetivos pretendidos sobre el conocimiento y la conservación de los bienes edilicios a lo largo de todo su ciclo de vida. A lo largo del tiempo, la documentación de un PD tiende a dispersarse e incluso es raramente integrada en el PD durante el uso del edificio. Por ello, se plantea la presente contribución con los siguientes objetivos: 1) Estudiar los requisitos de los entregables de los PD. 2) Estudiar los requisitos de maduración de los procesos y entregables documentales que se generan al aplicar la metodología Building Information Modelling (BIM) en un PD. 3) Verificar si la aplicación de las estrategias BIM son adecuadas para dar respuesta a las necesidades de un PD de tal forma que se logre el conocimiento y conservación de las edificaciones patrimoniales. 4) Verificar que el intercambio de información y el trabajo colaborativo entre las diferentes disciplinas que generan documentación y entregables garanticen un repositorio único, integral, abierto, tridimensional y claro., This contribution belongs to the work of the project financed by the Ministry of Science and Innovation of the Government of Spain, in a public call, for the development of the R+D+I project entitled Analysis and development of the integration of HBIM in GIS for the elaboration of a tourism planning protocol for the cultural heritage of a destination (PID2020-119088RB-I00) led by a team from the Polytechnic University of Valencia in collaboration with the universities of Alicante and Auburn, Alabama, USA.

[ES] La última década ha traído retos para el sector turístico, relacionados tanto con las nuevas necesidades y expectativas de los turistas originados a raíz de la Covid19, como con la creciente concienciación y preocupación por la sostenibilidad del turismo. El objetivo del presente trabajo se centra en poner de manifiesto la contribución que pueden y deben tener los guías turísticos no sólo en proveer una experiencia turística de calidad a los visitantes de los destinos, sino también cómo su labor puede afectar positivamente la consecución de la sostenibilidad a nivel socio-cultural. El trabajo analiza la evolución que ha experimentado el papel del guía turístico en el último siglo a través de una revisión de la literatura. Los resultados evidencian cómo la función tradicional informativa del guía turístico debe completarse hoy en día con una faceta más emocional del papel del guía, que, con su actuación, debe involucrar a los turistas de manera que cocreen juntos la experiencia del tour. Además, la formación de los guías turísticos en la nueva era post-covid debe contemplar contenidos de sostenibilidad, para impactar tanto las actividades responsables del turista en el destino, como sus actitudes y comportamientos sostenibles post-visita., [EN] The last decade has brought challenges for the tourism sector, related both to the new needs and expectations of tourists brought about by Covid19, and to the growing awareness and concern for the sustainability of tourism. The aim of this paper is to highlight the contribution that tour guides can and should make not only in providing a quality tourism experience to visitors to destinations, but also how their work can positively affect the achievement of sustainability at a socio-cultural level. The paper analyses the evolution of the role of the tour guide over the last century through a review of the literature. The results show how the traditional informative function of the tour guide must nowadays be complemented by a more emotional facet of the role of the guide, who, through his or her actions, must involve tourists in such a way that they co-create the tour experience together. Furthermore, the training of tour guides in the new post-covid era must include sustainability content, in order to impact both the tourist's responsible activities at the destination and their sustainable attitudes and behaviour post-visit.

El nuevo paradigma de la gestión de las organizaciones reserva un papel clave a la gestión del Crowdsourcing, y al denominado Masscapital. La gestión de este último elemento es vital en una era nueva donde las denominadas “Estructuras de Innovación Abierta o Masscapital” juegan cada vez un papel más relevante. No obstante, la literatura se ha decantado más por remarcar la relevancia del Crowdsourcing y el denominado Masscapital en la generación de recursos y capacidades a la empresa, que en cómo gestionar su desempeño y desarrollo.Este trabajo se centra en la gestión del Crowdsourcing y el denominado Masscapital dentro de las nuevas concepciones de “Estructuras Organizativas de Innovación Abierta o Masscapital”. Tras remarcar la relevancia del Crowdsourcing y el Masscapital en las organizaciones, y una vez establecidos los elementos esenciales de diseño de estas estructuras el trabajo incide en los elementos clave de gestión de la misma, remarcando elementos importantes en la gestión del Masscapital. El trabajo proporciona ejemplos reales de estas organizaciones en empresas, así como las limitaciones de su uso, gestión y desarrollo práctico.----------------------------------------------------------The new paradigm of organizational management reserves a key role for the management of Crowdsourcing, and the so-called Masscapital. The management of this last element is vital in a new era where the so-called "Open Innovation Structures or Masscapital" play an increasingly relevant role. However, the literature has focused more on the relevance of creowdsourcing and the so-called Masscapital in the generation of resources and capabilities to the company, than on how to manage its performance and development. This paper focuses on the management of Crowdsourcing and Masscapital within the new conceptions of "Open Innovation Organional Structures or Masscapital". After highlighting the relevance of Crowdsourcing and Masscapital in organizations, and once established the essential elements of design of these structures, the work focuses on the key elements of their management, highlighting important elements in the management of Masscapital. The work provides real examples of these organizations in companies, as well as the limitations of their use, management and practical development.

Background Acquired antimicrobial resistance among Achromobacter isolates from cystic fibrosis (CF) patients is frequent. Data concerning the mechanisms involved are scarce. The role of the AxyXY-OprZ and AxyEF-OprN Resistance Nodulation Division (RND) efflux systems has been demonstrated, but not that of AxyABM. Objectives To explore the role of efflux systems in the acquired multiresistance observed in a one-step mutant selected after ofloxacin exposure. Methods The in vitro resistant mutant NCF-39-Bo2 and its parental strain NCF-39 (MICs of meropenem of 8 and 0.19 mg/L, of ceftazidime of 12 and 3 mg/L, of cefiderocol of 0.094 and 0.032 mg/L and of ciprofloxacin of 8 and 1.5 mg/L, respectively) were investigated by RNA-seq and WGS. Gene inactivation and reverse transcription quantitative PCR (RT–qPCR) were used to explore the role of the efflux systems of interest. Results RNA-seq showed that the AxyABM efflux system was overproduced (about 40-fold) in the in vitro mutant NCF-39-Bo2 versus its parental strain NCF-39. A substitution in AxyR, the putative regulator of AxyABM, was detected in NCF-39-Bo2. Gene inactivation of axyB (encoding the transporter component) in NCF-39-Bo2 led to a decrease in MICs of ciprofloxacin (5-fold), meropenem (64-fold), ceftazidime (12-fold) and cefiderocol (24-fold). Inactivation of axyB in the clinical isolate AXX-H2 harbouring a phenotype of resistance close to that of NCF-39-Bo2 enhanced the activity of the same molecules, especially meropenem. Conclusions AxyABM overproduction is involved in acquired resistance of Achromobacter to ciprofloxacin, meropenem and ceftazidime, antibiotics widely used in CF patients, and increases the MIC of the new promising antibiotic cefiderocol.

Background There are nonestablished protocols in use for first-line allergy screening based on IgE testing. These protocols attempt to address an unmet need for sustainability of clinical laboratories, at a time when demand is increasing. Objective To present a novel protocol for first-line allergy screening and to evaluate the implementation benefits for patients, the health care system, and payers. Methods We carried out an observational retrospective study analyzing 4359 interventions on primary care testing requests. Interventions included overriding redundant serum IgE (sIgE) testing for allergen mixes, extracts included in mixes, low-prevalence extracts, and milk and egg molecular components without previous positive results when exposed to extracts. We also added prevalent allergen testing. Results The strategy saved 683 tests from being performed unnecessarily. Test volume decline was primarily driven by the cancelation of 2186 egg and milk components tests; 561 tests were added for mixes, together with 942 allergen extracts tests. Discussion The results of this study show how the allergy laboratory plays a key role in actively managing demand for sIgE testing, leading to optimized diagnosis.

This short note gathers known results to state that the squared distance function to a (nonconvex) closed set of an Euclidean space is Polyak-Łojasiewicz. As a fuzzy reciprocate, we also recall that every Polyak-Łojasiewicz function can be bounded from below by the squared distance function to its set of minimizers., 8 pages, 2 figures

This is a handbook of simple proofs of the convergence of gradient and stochastic gradient descent type methods. We consider functions that are Lipschitz, smooth, convex, strongly convex, and/or Polyak-{\L}ojasiewicz functions. Our focus is on ``good proofs'' that are also simple. Each section can be consulted separately. We start with proofs of gradient descent, then on stochastic variants, including minibatching and momentum. Then move on to nonsmooth problems with the subgradient method, the proximal gradient descent and their stochastic variants. Our focus is on global convergence rates and complexity rates. Some slightly less common proofs found here include that of SGD (Stochastic gradient descent) with a proximal step, with momentum, and with mini-batching without replacement., Comment: 70 pages, 1 figure

Background Fungal infections following pancreas transplantation carry significant morbidity and mortality with an estimated incidence of 3 to 28%. The American Society of Transplantation (AST) suggests considering fluconazole prophylaxis in pancreas transplant recipients (PTR) at high-risk of invasive candidiasis (IC). However, optimal dosage and duration of prophylaxis is unclear. Weekly fluconazole for prevention of IC has been previously reported in liver and bone marrow transplant recipients. We analyzed outcomes of once weekly fluconazole prophylaxis in PTR. Methods We retrospectively reviewed all pancreas transplants performed at our institution from January 2017 through September 2021. PTR at high-risk for IC were defined per AST criteria as those with enteric drainage, vascular thrombosis, and post-perfusion pancreatitis. Patients received once weekly oral fluconazole 200 mg for 12 weeks post-transplant for IC prophylaxis. We analyzed incidence of breakthrough IC within the first 6 months post-transplant. Results We identified a total of 22 PTR, all of whom received simultaneous kidney transplantation from deceased donors. Of these, 12/22 (55%) were male and 11/22 (50%) were African American. Median age at the time of transplantation was 39 years (IQR 34-46). The most common indication for transplantation was type 1 diabetes mellitus (17/22, 21%) with associated nephropathy. No donor organ cultures were positive for fungi and all pancreas transplants were performed using enteric drainage. Notably, one patient developed pancreas allograft thrombosis while another developed pancreatitis. No patients required early discontinuation of fluconazole due to intolerance or side effects and none developed breakthrough IC within 6 months post-transplant (Table 1). Table 1. Conclusion Weekly fluconazole prophylaxis has not been previously studied in PTR. In our cohort, this approach was well tolerated, with no cases of IC at 6 months post-transplantation in patients at high-risk. Randomized controlled clinical trials are needed to define the optimal strategy in this population. Disclosures M. Rizwan Sohail, MD, Aziyo Biologics: Honoraria|Boston Scientific Corporation: Honoraria|Medtronic: Grant/Research Support|TRYX: Grant/Research Support.

Background Mycoplasma hominis, Ureaplasma urealyticum, and Ureaplasma parvum may cause post-transplant infections in lung transplant recipients. We evaluated routine pretransplant screening for these Mollicutes. Methods We retrospectively reviewed records of lung transplant recipients at our tri-site institution from 01/01/2015 to 11/15/2019. M. hominis and/or Ureaplasma polymerase chain reaction (PCR) was performed on pretransplant recipient urine specimens and donor bronchial swabs at the time of transplantation. Development of Mollicute infection and hyperammonemia syndrome (HS) was recorded. Results A total of 268 patients underwent lung transplantation during the study period, of whom 105 were screened with at least 1 Mollicute PCR. Twelve (11%) screened positive; 10 donors, 1 recipient, and 1 both. Among positive donors, 3 were positive for M. hominis, 5 for U. urealyticum, and 4 for U. parvum. Preemptive therapy included doxycycline, levofloxacin, and/or azithromycin administered for 1–12 weeks. Despite therapy, 1 case of M. hominis mediastinitis and 1 case of HS associated with Ureaplasma infection occurred, both donor-derived. Of those screened before transplant, cases with positive screening were more likely (P < 0.05) to develop Mollicute infection despite treatment (2/12, 17%) than those who screened negative (1/93, 1%). Conclusions Pretransplant recipient urine screening had a low yield and was not correlated with post-transplant Mollicute infection, likely because most M. hominis and U. parvum/urealyticum infections in lung transplant recipients are donor-derived. Routine donor bronchus swab PCR for M. hominis, U. urealyticum, and U. parvum followed by preemptive therapy did not obviously impact the overall incidence of Mollicute infection or HS in this cohort.

Background: The American Heart Association has sponsored both guidelines and scientific statements that address the diagnosis, management, and prevention of infective endocarditis. As a result of the unprecedented and increasing incidence of infective endocarditis cases among people who inject drugs, the American Heart Association sponsored this original scientific statement. It provides a more in-depth focus on the management of infective endocarditis among this unique population than what has been provided in prior American Heart Association infective endocarditis–related documents. Methods: A writing group was named and consisted of recognized experts in the fields of infectious diseases, cardiology, addiction medicine, and cardiovascular surgery in October 2021. A literature search was conducted in Embase on November 19, 2021, and multiple terms were used, with 1345 English-language articles identified after removal of duplicates. Conclusions: Management of infective endocarditis in people who inject drugs is complex and requires a unique approach in all aspects of care. Clinicians must appreciate that it requires involvement of a variety of specialists and that consultation by addiction-trained clinicians is as important as that of more traditional members of the endocarditis team to improve infective endocarditis outcomes. Preventive measures are critical in people who inject drugs and are cured of an initial bout of infective endocarditis because they remain at extremely high risk for subsequent bouts of infective endocarditis, regardless of whether injection drug use is continued.

Objective To delineate the rate and duration of transient hepatitis B surface antigenemia following Heplisav-B vaccination. Patients and Methods We retrospectively reviewed the medical records of all adult patients who received Heplisav-B vaccination at our institution from January 1, 2019, through March 31, 2020, and who had hepatitis B surface antigen (HBsAg) testing within 30 days following immunization. Patients with laboratory evidence of prior hepatitis B virus infection or immunization were excluded. Results A total of 39 of 1933 patients were tested for HBsAg within 30 days after completing the Heplisav-B vaccination series; of these 39, only 6 (15.4 %) had a positive HBsAg result. Compared with the patients with negative HBsAg results, those with a positive HBsAg result had a significantly lower body mass index (24.8 kg/m2 [interquartile range (IQR), 23 to 26.4 kg/m2] vs 28.6 kg/m2 [IQR, 26.4 to 30.6 kg/m2]; P=.01) and higher prevalence of chronic kidney disease (2 of 6 [33.3%] vs 2 of 33 [6%]; P=.04). The timing of HBsAg testing after completing the vaccination series in the HBsAg-positive group was significantly earlier compared with that of the HBsAg-negative group (2 days [IQR, 0.43 to 2.25 days) vs 12 days [IQR, 10 to 15 days]; P=.0008). Active hepatitis B infection was excluded in all 6 patients. In the HBsAg-positive group, the median time from the date of Heplisav-B administration to a negative HBsAg test result was 17 days (IQR, 8 to 36 days). Conclusion As with all conventional hepatitis B vaccines, transient hepatitis B surface antigenemia can be observed with Heplisav-B vaccine, particularly in those with chronic kidney disease and low body mass index.

We retrospectively reviewed records of lung transplant recipients at our tri-site institution from 01/01/2015 to 11/15/2019.A total of 268 patients underwent lung transplantation during the study period, of whom 105 were screened with at least 1 Mollicute PCR. Twelve (11%) screened positive; 10 donors, 1 recipient, and 1 both. Among positive donors, 3 were positive forPretransplant recipient urine screening had a low yield and was not correlated with post-transplant Mollicute infection, likely because most

We describe here the overproduction and oriented membrane insertion of membrane protein inside intracellular vesicles named heterologous caveolae within E. coli. The method is described with BmrA, a multidrug efflux pump from Bacillus subtilis. BmrA is produced in these vesicles, thanks to the coexpression with the canine caveolin-1β, one of the two isoforms of caveolin-1. Enriched by sucrose gradient, the caveolae-containing fraction allows to probe the ATPase and Hoechst 33342 transport activities, the latter displaying a higher specific activity than the same without caveolin-1β.

Achromobacter spp. are nonfermenting Gram-negative bacilli mainly studied among cystic fibrosis (CF) patients. The identification of the 19 species within the genus is time-consuming (nrdA-sequencing), thus data concerning the distribution of the species are limited to specific studies. Recently, we built a database using MALDI-TOF mass spectrometry (MS) (Bruker) that allows rapid and accurate species identification and detection of the multiresistant epidemic clones: A. xylosoxidans ST137 spreading among CF patients in various French and Belgium centers, and A. ruhlandii DES in Denmark. Here, we first assessed whether species identification could be achieved with our database solely by analysis of MS spectra without availability of isolates. Then, we conducted a multicentric study describing the distribution of Achromobacter species and of the clone ST137 among French CF centers. We collected and analyzed with our local database the spectra of Achromobacter isolates from 193 patients (528 samples) from 12 centers during 2020. In total, our approach enabled to conclude for 502/528 samples (95.1%), corresponding to 181 patients. Eleven species were detected, only five being involved in chronic colonization, A. xylosoxidans (86.4%), A. insuavis (9.1%), A. mucicolens (2.3%), A. marplatensis (1.1%) and A. genogroup 3 (1.1%). This study confirmed the high prevalence of A. xylosoxidans in chronic colonizations and the circulation of the clone A. xylosoxidans ST137 in France: four patients in two centers. The present study is the first to report the distribution of Achromobacter species from CF patients samples using retrospective MALDI-TOF/MS data. This easy approach could enable future large-scale epidemiological studies.

[EN] The present work examined how the esthetic impression caused by a specific mug selection seems to influence the expected flavor elicited by a coffee beverage. Participants from Mexico viewed online photographs of espresso, Americano, latte and cappuccino presented in two different mugs, including a transparent glass mug and a white ceramic mug. The type of mug influenced participants' subjective ratings of the drinks. Espresso and Americano were expected to be more aromatic, bitter, hotter and more intense when served in a transparent glass mug rather than in a white ceramic mug. Results extend the knowledge of consumer preferences and bring an idea for the best way to better fulfill customer's sensory expectations.

Background: Long non-coding RNAs (LncRNAs) are important regulators of gene expression, acting at almost all regulatory levels, both transcriptional and post-transcriptional. It has been described that LncRNAs have a relevant role both in biological processes and in the growth and progression of tumors. Specifically, LncRNAs have been identified in breast cancer as predictors in the development of the disease. Nowadays, neoadjuvant systemic therapy for breast cancer is used increasingly but, there is a group of patients which do not benefit from this therapy. With these premises, we stablished that our main objective was to identify the differential expression LncRNAs in paraffin-embedded breast cancer samples ER-PR-/Her2+, ER+PR+/Her2+ and triple negative (TN) subtypes in responders (R) and non-responders (NR) patients (pts) to neoadjuvant therapy. Methods: All samples were collected from biobank of University Hospital Virgen del Rocio. RNA from formalin fixed paraffin embedded tumor samples from 40 pts with breast cancer that had received neoadjuvant therapy was extracted with mirVana miRNA isolation kit (Ambion). All samples were diagnostic biopsies. Patients with TN subtype received neoadjuvant chemotherapy based on anthracyclines and taxanes and patients with the Her2+ subtype received treatment with taxanos-trastuzumab and anthracyclines. The expression RNAs was analyzed by ClariomD Asssay (ThermoFisher). Results were analyzed with Transcriptome Analysis Console and with in-house scripts in R (version 3.5.1). Data were corrected and normalized using Robust Multichip Average method from the oligo package. Expression was summarized at gene level using the corresponding annotation for ClariomD array BrainArray. Expression analyses were performed with limma package. A fold change ≥ 2 and p Results: From the analysis of the results, we obtained seventeen LncRNAs differentially expressed in R vs NR groups. The expression of these LncRNAs was also different in each subtype of patients. A fold change ≥ 2, p Conclusions: We found seventeen LncRNAs differentially expressed in the different molecular cancer subtypes involved in the response to neoadjuvant therapy. In particular, RP1-290I10.5, RP11-140I16.3, RP1-288H2.2, RP4-704D23.1, LINC01087 in ER-PR-/Her2+ subtype showed a strong difference with a significant adjusted p-value and a fold change more than 2. These results suggest that these LncRNAs could represent valid predictive biomarkers in neoadjuvant therapy for these patients. Table 1p adj < 0.05FC > 2p Citation Format: Javier Salvador, Ana Gil, Marta Benavent, Sonia Molina-Pinelo, Rosario Gonzalez, Álvaro Montaño, Manuel Ruiz, Alejandro Falcón, Alberto Sánchez, Carmen Garrigós. Role of long non coding RNAs in response to neoadjuvant therapy in triple negative and Her2+ subtypes breast cancer [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P1-05-09.

Despite diagnostic advances in microbiology, the etiology of neutropenic fever remains elusive in most cases. In this study, we evaluated the utility of a metagenomic shotgun sequencing based assay for detection of bacteria and viruses in blood samples of patients with febrile neutropenia. We prospectively enrolled 20 acute leukemia patients and obtained blood from these patients at three time points: 1) anytime from onset of neutropenia until before development of neutropenic fever, 2) within 24 hours of onset of neutropenic fever, 3) 5–7 days after onset of neutropenic fever. Blood samples underwent sample preparation, sequencing and analysis using the iDTECT® Dx Blood v1® platform (PathoQuest, Paris, France). Clinically relevant viruses or bacteria were detected in three cases each by metagenomic shotgun sequencing and blood cultures, albeit with no concordance between the two. Further optimization of sample preparation methods and sequencing platforms is needed before widespread adoption of this technology into clinical practice.

This study was funded by the Spanish Ministry of Science, Innovation, and Universities (MCIU), State Research Agency (AEI), and European Regional Development Fund (FEDER); PGC2018-098229-B-100 to JF and by Seneca Foundation (19904/GERM/15)., Most of the studies on neurochemical mapping, connectivity, and physiology in the hypothalamic region were carried out in rats and under the columnar morphologic paradigm. According to the columnar model, the entire hypothalamic region lies ventrally within the diencephalon, which includes preoptic, anterior, tuberal, and mamillary anteroposterior regions, and sometimes identifying dorsal, intermediate, and ventral hypothalamic partitions. This model is weak in providing little or no experimentally corroborated causal explanation of such subdivisions. In contrast, the modern prosomeric model uses different axial assumptions based on the parallel courses of the brain floor, alar-basal boundary, and brain roof (all causally explained). This model also postulates that the hypothalamus and telencephalon jointly form the secondary prosencephalon, separately from and rostral to the diencephalon proper. The hypothalamus is divided into two neuromeric (transverse) parts called peduncular and terminal hypothalamus (PHy and THy). The classic anteroposterior (AP) divisions of the columnar hypothalamus are rather seen as dorsoventral subdivisions of the hypothalamic alar and basal plates. In this study, we offered a prosomeric immunohistochemical mapping in the rat of hypothalamic cells expressing tyrosine hydroxylase (TH), which is the enzyme that catalyzes the conversion of L-tyrosine to levodopa (L-DOPA) and a precursor of dopamine. This mapping was also combined with markers for diverse hypothalamic nuclei [agouti-related peptide (Agrp), arginine vasopressin (Avp), cocaine and amphetamine-regulated transcript (Cart), corticotropin releasing Hormone (Crh), melanin concentrating hormone (Mch), neuropeptide Y (Npy), oxytocin/neurophysin I (Oxt), proopiomelanocortin (Pomc), somatostatin (Sst), tyrosine hidroxilase (Th), and thyrotropin releasing hormone (Trh)]. TH-positive cells are particularly abundant within the periventricular stratum of the paraventricular and subparaventricular alar domains. In the tuberal region, most labeled cells are found in the acroterminal arcuate nucleus and in the terminal periventricular stratum. The dorsal retrotuberal region (PHy) contains the A13 cell group of TH-positive cells. In addition, some TH cells appear in the perimamillary and retromamillary regions. The prosomeric model proved useful for determining the precise location of TH-positive cells relative to possible origins of morphogenetic signals, thus aiding potential causal explanation of position-related specification of this hypothalamic cell type., State Research Agency (AEI), European Commission PGC2018-098229-B-100, Fundacion Seneca 19904/GERM/15, Spanish Government

(1) Background: Risk factors for extended-spectrum beta-lactamase (ESBL) infections could vary geographically. The purpose of this study was to identify local risk factors for ESBL production in patients with Gram-negative bacteremia. (2) Methods: This retrospective observational study included adult patients admitted from January 2019 to July 2021 and had positive blood cultures for E. coli, K. pneumoniae, K. oxytoca, and P. mirabilis. Patients with ESBL infection were matched to a non-ESBL-producing infection with the same organism. (3) Results: A total of 150 patients were included: 50 in the ESBL group and 100 in the non-ESBL group. Patients in the ESBL group had a longer length of stay (11 vs. 7 days, p < 0.001), but not increased mortality (14% vs. 15%, p = 0.87) Multivariate analysis identified the receipt of >1 antibiotic in the last 90 days as a risk factor for ESBL infection (OR = 3.448, 95% CI = 1.494–7.957; p = 0.004); (4) Conclusions: Recent antimicrobial use was identified as an independent risk factors for ESBL-producing Enterobacterales infections. Knowledge of this risk may improve empirical therapy and reduce inappropriate use.

We observed a higher rate of blood-culture contamination during the COVID-19 pandemic at our institution compared to a prepandemic period. Given the potential implications of blood contamination in antibiotic and diagnostic test utilization as well as added cost, it is imperative to continue efforts to minimize these episodes during the pandemic.

BACKGROUND: The practice environment influences the quality of care and the nursing outcomes achieved in their workplaces. OBJECTIVE: To examine the perception of the clinical practice environment among nurses working in mental health units in the context of their participation in an action research study aimed at improving the nurse–patient relationship. METHOD: An explanatory sequential mixed methods study was designed. The data were collected in three phases in 18 mental health units ( n = 95 nurses). Quantitative data were collected through the Practice Environment Scale of the Nursing Work Index, and qualitative data were collected through reflective diaries and focus groups in the context of participatory action research. RESULTS: The nurses’ assessment of their practice environment shifted from positive to negative. Nurse manager leadership was the aspect that worsened the most. In addition, the perception of their participation in the affairs of the center and nursing foundations for quality of care decreased. The nurses considered it essential to be able to influence decision-making bodies and that the institution should promote a model of care that upholds the therapeutic relationship in actual clinical practice. CONCLUSIONS: Nurses perceived that they should be involved in organizational decisions and required more presence and understanding from managers. Furthermore, nurses stated that institutions should promote nursing foundations for quality of care. This study contributes to understanding how nurses in mental health units perceive their work environment and how it affects the improvement of the nurse–patient relationship in clinical practice.

This qualitative study examines the digitisation of HRM in a cloud-based environment. The influencing factors for the transformation from conventional HRM to eHRM are examined with a special focus on the success factors from a strategic to the operational level. Additionally, an in-depth analysis of the currently existing and new HR metrics which emerge during the transformation takes place. The study is based on interviews with HR experts with extensive experience in transforming and working with the new technology. Active participation of the HR department is relevant for the success of the digital transformation HRM project. HR metrics have not been applied extensively so far and are used less for controlling and optimizing HR processes. New metrics would increase the acceptance of the new technology and thus the success of the overall HR transformation. The main contribution is related to the field of HR software adoption of cloud-based solutions.

International audience; We described here the overproduction and oriented membrane insertion of membrane protein inside intracellular vesicles named heterologous caveolae within E. coli. The method is described with BmrA, a multidrug efflux pump from Bacillus subtilis. BmrA is produced in these vesicles, thanks to the co-expression with the canine caveolin-1b, one of the two isoforms of caveolin-1. Enriched by sucrose gradient, the caveolae-containing fraction allows to probe the ATPase and Hoechst 33342 transport activities, the latter displaying a higher specific activity than the same without caveolin-1b.

Despite the development of effective systemic antibiotic therapy, bacterial meningitis continues to be a significant cause of morbidity and mortality in the United States. Numerous studies of different populations report that Steptococcus pneumoniae is the species most commonly involved in bacterial meningitis cases. The prevalence of S pneumoniae in bacterial meningitis can range from 50% to 70%, and incidence rates increase with age. In recent years, pneumococcal vaccination has decreased the incidence of meningitis cases caused by the serotypes included in the vaccine. The current recommended treatment for suspected pneumococcal meningitis is vancomycin plus a third-generation cephalosporin until susceptibilities are determined.

Legionnaires disease (LD) is caused by an intracellular gram-negative bacillus of the genus Legionella. Human infection occurs via inhalation of infectious aerosols. Fever with pulse-temperature dissociation, diarrhea, nonproductive cough, and confusion can indicate LD. The preferred method for diagnosis is to perform both a urine antigen test and a sputum culture. Levofloxacin and azithromycin are the antibiotics that are most active against LD. The usual antibiotic course lasts for 7 to 10 days, with up to 21 days of therapy recommended for immunocompromised patients. LD is noncontagious and person-to-person transmission does not occur.

Delays in the treatment of proven invasive fungal disease have been shown to be harmful. However, empiric treatment for all patients at risk of infection has not demonstrated benefit. This study evaluates the effects of a micafungin stewardship initiative on the duration of therapy and clinical outcomes at the University of Mississippi Medical Center in Jackson, Mississippi. This single-center quasi-experiment evaluated patients who received micafungin. Adult inpatients who received at least one treatment dose of micafungin in the pre-intervention (1 October 2020 to 30 September 2021) or post-intervention (1 October 2021 to 30 April 2022) groups were included. Patients were placed on micafungin for prophylaxis and those who required definitive micafungin therapy were excluded. An algorithm was used to provide real-time recommendations in order to assess change in the treatment days of micafungin therapy. A total of 282 patients were included (141 pre-group versus 141 post-group). Over 80% of the patients included in the study were in an intensive care unit, and other baseline characteristics were similar. The median number of treatment days with micafungin was 4 [IQR 3-6] in the pre-group and 3 [IQR 2-6] in the post-group (p = 0.005). Other endpoints, such as time to discontinuation or de-escalation, hospital mortality, and hospital length of stay, were not significantly different between the groups. An antifungal stewardship initiative can be an effective way to decrease unnecessary empiric antifungal therapy for patients who are at risk of invasive fugal disease.

The heterologous expression in Spodoptera frugiperda 21 (Sf21) insect cells of the β isoform of canine caveolin-1 (caveolin-1β), using a baculovirus-based vector, resulted in intracellular vesicles enriched in caveolin-1β. We investigated whether these vesicles could act as membrane reservoirs, and promote the production of an active membrane protein (MP) when co-expressed with caveolin-1β. We chose hMGST1 (human microsomal glutathione S-transferase 1) as the co-expressed MP. It belongs to the membrane-associated proteins in eicosanoid and glutathione metabolism (MAPEG) family of integral MPs, and, as a phase II detoxification enzyme, it catalyzes glutathione conjugation of lipophilic drugs present in the lipid membranes. In addition to its pharmaceutical interest, its GST activity can be conveniently measured. The expression of both MPs were followed by Western blots and membrane fractionation on density gradient, and their cell localization by immunolabeling and transmission electron microscopy. We showed that caveolin-1β kept its capacity to induce intracellular vesicles in the host when co-expressed with hMGST1, and that hMGST1 is in part addressed to these vesicles. Remarkably, a fourfold increase in the amount of active hMGST1 was found in the most enriched membrane fraction, along with an increase of its specific activity by 60% when it was co-expressed with caveolin-1β. Thus, heterologously expressed caveolin-1β was able to induce cytoplasmic vesicles in which a co-expressed exogenous MP is diverted and sequestered, providing a favorable environment for this cargo.

Introduction Young patients (p) with atrial fibrillation (AF) tend to be more symptomatic and more reluctant to take long-term antiarrhythmic drugs. However, AF ablation (especially when persistent) is often used as second-line treatment regardless of age. Purpose The aim is to compare clinical outcome and safety of catheter ablation of atrial fibrillation in young adults in comparison to older adults. Secondary endpoints were to compare the influence of other comorbidities in AF ablation outcomes. Methods From 2012–2019, consecutive patients (mean age 56±9,4 years; 72,8% men) with symptomatic paroxysmal AF (PAF 68,8%) and persistent (Pers) AF (31,2%) underwent PVI through radiofrequency (91%) or cryoballoon (9%) at our centre. Two groups were defined (group A ≤45 years, group B >45 years). Follow-up was based on outpatient visits including 24h Holter-ECG at 3, 6 and, 12 months post ablation, and every 12 months thereafter. Results A total of 202 patients undergoing AF ablation were included (group A: 35, 17,3%; group B: 167, 82,7%). Male gender (91,4 vs 68,9%, p=0,006) and smoking (37,1% vs 13,2%, p=0,001) were significantly more often present in group A. HTA (50,9% vs 22,9%, p=0,002) and CHA2DS2-VASc score (1,3±1 vs 0,4±0,6; p=0,01) were higher in the older population group. Median follow-up was 29±18 months. After 12 months AF recurrence were less common in group A: 1-year arrhythmia-free survival was 88,6% (31/35) vs 73,7% (123/167) in the older group [P 0.049]. However, outcomes at the end of follow up were similar between the two groups, the freedom from AF was 57.1% (20/35) in young patients vs 65,3% (109/167) in older group, p=0,42. Multivariate analysis demonstrated that left atrial volume was a predictor of being freedom from AF recurrent [HR 0,96 (95% IC 0,95–0,99), p=0.003]. Major complications occurred more frequently in older patients, although without reaching statistical significance (4.8% (8) vs 2.9% (1); p=0.61), in the young there was only one complication that was pulmonary vein stenosis. Redo AF ablation rate was comparable between the two groups. Conclusion(s) Catheter ablation of AF in young adults is associated with higher 1-year success rates but similar long-term outcomes. The young patients tended to have lower rates of complications in comparison to the older population. These findings suggest that it may be appropriate to consider ablative therapy as first-line therapy in this age group, but further study may be needed to confirm this Funding Acknowledgement Type of funding sources: None. Figure 1Table 1

What is known and objective Despite its frequent use in clinical practice, fentanyl's pro-serotonergic effects are underrecognized, especially in combination with linezolid. Life-threatening reactions can occur. Case summary We report a case of serotonin syndrome developed shortly after the initiation of linezolid in a 63-year-old patient in whom selective serotonin reuptake inhibitor therapy was discontinued for the duration of antibiotic therapy. However, fentanyl transdermal patch treatment was inadvertently continued. Noteworthy, 24 hours following discontinuation of linezolid, the patient experienced complete resolution of symptoms. What is new and conclusion Fentanyl can increase the intrasynaptic release of serotonin through their effects on y-amino butyric acid and its phenylpiperidine chemical structure. We illustrate the importance of thorough medication reconciliation and review of all potential drug-to-drug interactions when indicating linezolid therapy to ensure patient safety. We believe that our case provides novel observations and insight that could help recognize similar cases in clinical practice.

Spinal cord stimulation (SCS) is the most utilized invasive electrical neuromodulation treatment for the management of refractory chronic pain syndromes. Infection is one of the most dreaded complications related to SCS implantation and may prevent patients from receiving adequate pain treatment, adding to the initial cost and disability. Most SCS infections present as generator pocket infection. However, delay in diagnosis may lead to complications such as meningitis, epidural abscess, and/or vertebral osteomyelitis. Early recognition of SCS-related infections and associated complications is based on clinical suspicion, laboratory testing, and appropriate diagnostic imaging. While superficial surgical site infection following SCS implant may be treated with antibiotic therapy alone, deep infection involving implant warrants device removal to achieve cure. Duration of antimicrobial therapy depends on severity of clinical presentation and presence or absence of associated complications. Several preventive strategies can be incorporated in surgical practice to reduce the risk of SCS infection.

Objective Implant-based breast reconstruction after mastectomy remains the most common reconstructive modality worldwide. Infection is a frequent complication that negatively affects the reconstructive outcome and increases health-care costs. The aim of this study is to evaluate the accuracy of ultrasonography in identifying fluid collections in patients with breast implant infection. Methods After receiving institutional review board approval, a retrospective chart review was performed on patients who presented with breast implant infection after breast reconstruction, during the period 2009–2017. To estimate the sensitivity and specificity of ultrasound (US) in detecting fluid collections, only patients with US evaluation and surgery during the same admission were included. Results In total, 64 patients with 64 infected implants met the inclusion criteria. Infected devices included 44 (69%) tissue expanders, and 20 (31%) implants, of which 40 (62%) were placed in the subpectoral and 24 (38%) prepectoral positions. Periprosthetic fluid was identified by US preoperatively in 45 (70%) of the patients, and a fluid collection was found in 61 (95%) of the patients during surgery. Sensitivity and specificity of US were 74% and 100%, respectively. Inaccurate US results were more likely in patients with silicone implants than patients with saline expander implants. Conclusion Caution should be exercised in interpreting negative US findings in patients with silicone implants in the setting of infection. Other imaging modalities should be explored if US results are negative in cases with high clinical suspicion.

This paper presents a new ultrafast dc solid-state circuit breaker (SSCB) that uses a silicon carbide cascode as the main switching and limiting semiconductor and an isolated photovoltaic driver to control it. The proposed topology is self-powered and fully implemented with discrete parts. The SSCB's cascode can work in three different states—fully on during nominal operation, linear mode for current limitation, and fully off to disconnect the load. The time the SSCB operates in linear mode and the maximum current limit is easily set by discrete components. Control inputs have also been included to reset the SSCB after a fault has been removed or to remotely switch it on or off . This device can be used in dc distribution avoiding deterioration due to the problems associated with electric arcs and mechanical aging of moving parts, limiting inrush currents and also minimizing conduction losses respect other kind of circuit breakers. Functional, thermal, and efficiency tests have been carried out with three different 380 V prototypes. Experimental results show the excellent behavior of the SSCB, it is able to block a 380 V short circuit failure in 570 ns; the authors have not found any faster results in the literature.

[EN] As the digitization of HR processes in companies continues to increase, at the same time, the underlying technical basis is also developing at a rapid pace. Electronic human resources (e-HRM) solutions are used to map a variety of HR processes. However, the introduction of such systems has various consequences, which are not only technical but also imply organizational and functional changes within the organization. Additionally, the cloud environment contributes to enhancing e-HRM capabilities and introduces new factors in its adoption. A systematic review of the available literature on the different dimensions of electronic resources management was conducted to assess the current state of research in this field. This review includes topics such as the evolution of e-HRM, its practical application, use of technology, implementation as well as HR analytics. By identifying and reviewing articles under e-HRM, IT technology, and HR journals, it was possible to identify relevant controversial themes and gaps as well as limitations.

To describe and compare the clinical presentation, management, and outcomes of cardiovascular implantable electronic device (CIED) infections due to gram-negative bacteria (GNB) and CIED infections due to gram-positive bacteria (GPB).We retrospectively reviewed all CIED infection cases at Mayo Clinic from January 1, 1992, through December 31, 2015. Cases were classified based on positive microbiology data from extracted devices or blood cultures.Of the 623 CIED infections during the study period, 31 (5.0%) were caused by GNB and 323 (51.8%) by GPB. Patients in the GNB group were more likely to present with local inflammatory findings at the pocket site (90.3% vs 72.4%; P=.03). All patients with bacteremia due to GNB had concomitant pocket infection compared with those with GPB (100% vs 33.9%; P=.002). After extraction, 41.9% of patients in the GNB group were managed with oral antibiotics vs 2.4% in the GPB group (P.001). There were no statistically significant differences in infection relapse/recurrence or 1-year survival rates between the 2 groups.Compared with CIED infections caused by GPB, those due to GNB are more likely to present with pocket infection. Device-related GNB bacteremia almost always originates from the generator pocket. After extraction, oral antibiotic drug therapy may be a reasonable option in select cases of pocket infections due to GNB. No difference in outcomes was observed between the 2 groups.