By K. Rakus. Caldwell College.
Water treatment might increase the antibiotic resistance of surviving bacteria 300 mg wellbutrin mastercard, and water distribution systems may serve as an important reservoir for the spread of antibiotic resistance to opportunistic pathogens cheap 300 mg wellbutrin with amex. Nasal microenvironments and interspecific interactions influence nasal microbiota complexity and S buy wellbutrin 300mg online. Patterns of spatial variation in microbiota composition may help explain Staphylococcus aureus colonization and reveal interspecies and species-host interactions. To assess the biogeography of the nasal microbiota, we sampled healthy subjects, representing both S. Phylogenetic compositional and sparse linear discriminant analyses revealed communities that differed according to site epithelium type and S. In vitro cocultivation experiments provided supporting evidence of interactions among these species. These results highlight spatial variation in nasal microbial communities and differences in community composition between S. Evolution of antibiotic occurrence in a river through pristine, urban and agricultural landscapes. Community-acquired methicillin-resistant Staphylococcus aureus: An emerging threat. Antibiotic resistance as a global threat: evidence from China, Kuwait and the United States. S…China also has the most rapid growth rate of resistance (22% average growth in a study spanning 1994 to 2000). To date, there is no strong international convergence in the countries’ resistance patterns. This finding may change with the greater international travel that will accompany globalization. Future research on the determinants of drug resistance patterns, and their international convergence or divergence, should be a priority. Wastewater treatment contributes to selective increase of antibiotic resistance among Acinetobacter spp. Environmental residues and ecotoxicity of antibiotics and their resistance gene pollution: A review. Changing epidemiology of infections in patients with Neutropenia and Cancer: emphasis on Gram-positive and Resistant bacteria. Infections from resistant bacteria are now too common, and some pathogens have even become resistant to multiple types or classes of antibiotics (antimicrobials used to treat bacterial infections). The loss of effective antibiotics will undermine our ability to fight infectious diseases and manage the infectious complications common in vulnerable patients undergoing chemotherapy for cancer, dialysis for renal failure, and surgery, especially organ transplantation, for which the ability to treat secondary infections is crucial. When first-line and then second-line antibiotic treatment options are limited by resistance or are unavailable, healthcare providers are forced to use antibiotics that may be more toxic to the patient and frequently more expensive and less effective. Even when alternative treatments exist, research has shown that patients with resistant infections are often much more likely to die, and survivors have significantly longer hospital stays, delayed recuperation, and long-term disability. Efforts to prevent such threats build on the foundation of proven public health strategies: immunization, infection control, protecting the food supply, antibiotic stewardship, and reducing person-to-person spread through screening, treatment and education. Centers for Disease Control and Prevention Meeting the Challenges of Drug-Resistant Diseases in Developing Countries Committee on Foreign Affairs Subcommittee on Africa, Global Health, Human Rights, and International Organizations United States House of Representatives April 23, 2013 108 Antibiotic Resistance Threats in the United States, 2013 Executive Summary Antibiotic Resistance Threats in the United States, 2013 is a snapshot of the complex problem of antibiotic resistance today and the potentially catastrophic consequences of inaction. The overriding purpose of this report is to increase awareness of the threat that antibiotic resistance poses and to encourage immediate action to address the threat. This document can serve as a reference for anyone looking for information about antibiotic resistance. This report covers bacteria causing severe human infections and the antibiotics used to treat those infections. In addition, Candida, a fungus that commonly causes serious illness, especially among hospital patients, is included because it, too, is showing increasing resistance to the drugs used for treatment. When discussing the pathogens included in this report, Candida will be included when referencing “bacteria” for simplicity. The report consists of multiple one or two page summaries of cross-cutting and bacteria- specific antibiotic resistance topics. The first section provides context and an overview of antibiotic resistance in the United States. In addition to giving a national assessment of the most dangerous antibiotic resistance threats, it summarizes what is known about the burden of illness, level of concern, and antibiotics left to defend against these infections. This first section also includes some basic background information, such as fact sheets about antibiotic safety and the harmful impact that resistance can have on high-risk groups, including those with chronic illnesses such as cancer. The estimates are based on conservative assumptions and are likely minimum estimates. They are the best approximations that can be derived from currently available data. Four core actions that fight the spread of antibiotic resistance are presented and explained, including 1) preventing infections from occurring and preventing resistant bacteria from spreading, 2) tracking resistant bacteria, 3) improving the use of antibiotics, and 4) promoting the development of new antibiotics and new diagnostic tests for resistant bacteria. These summaries can aid in discussions about each bacteria, how to manage infections, and implications for public health. They also highlight the similarities and differences among the many different types of infections. Preventing the spread of antibiotic resistance can only be achieved with widespread engagement, especially among leaders in clinical medicine, healthcare leadership, agriculture, and public health. Although some people are at greater risk than others, no one can completely avoid the risk of antibiotic-resistant infections. Only through concerted commitment and action will the nation ever be able to succeed in reducing this threat. A reference section provides technical information, a glossary, and additional resources. Any comments and suggestions that would improve the usefulness of future publications are appreciated and should be sent to Director, Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road, Mailstop A-07, Atlanta, Georgia, 30333. New forms of antibiotic resistance can cross international boundaries and spread between continents with ease. World health leaders have described antibiotic-resistant microorganisms as “nightmare bacteria” that “pose a catastrophic threat” to people in every country in the world. Each year in the United States, at least 2 million people acquire serious infections with bacteria that are resistant to one or more of the antibiotics designed to treat those infections. At least 23,000 people die each year as a direct result of these antibiotic-resistant infections. Many more die from other conditions that were complicated by an antibiotic-resistant infection. In addition, almost 250,000 people each year require hospital care for Clostridium difficile (C. In most of these infections, the use of antibiotics was a major contributing factor leading to the illness. Antibiotic-resistant infections add considerable and avoidable costs to the already overburdened U. In most cases, antibiotic-resistant infections require prolonged and/or costlier treatments, extend hospital stays, necessitate additional doctor visits and healthcare use, and result in greater disability and death compared with infections that are easily treatable with antibiotics. Estimates vary but have ranged as high as $20 billion in excess direct healthcare costs, 1 with additional costs to society for lost productivity as high as $35 billion a year (2008 dollars).
Threats to internal validity involve potential inaccuracies in assumptions about the causal role of the independent variable on the dependent variable wellbutrin 300 mg visa. Threats to external validity involve potential inaccuracy regarding the generality of observed findings cheap 300mg wellbutrin overnight delivery. Informed consumers of research are aware of the strengths of research but are also aware of its potential limitations cheap wellbutrin 300mg. Chapter 3 Brains, Bodies, and Behavior Did a Neurological Disorder Cause a Musician to Compose Boléro and an Artist to Paint It 66 Years Later? In 1986 Anne Adams was working as a cell biologist at the University of Toronto in Ontario, Canada. She took a leave of absence from her work to care for a sick child, and while she was away, she completely changed her interests, dropping biology entirely and turning her attention to art. In 1994 she completed her painting Unravelling Boléro, a translation of Maurice Ravel‘s famous orchestral piece onto canvas. Each bar of music is represented by a lacy vertical figure, with the height representing volume, the shape representing note quality, and the color representing the music‘s pitch. Shortly after finishing the painting, Adams began to experience behavioral problems, including increased difficulty speaking. Neuroimages of Adams‘s brain taken during this time show that regions in the front part of her brain, which are normally associated with language processing, had begun to deteriorate, while at the same time, regions of the brain responsible for the integration of information from the five senses were unusually well developed (Seeley et al. The deterioration of the frontal cortex is a symptom of frontotemporal dementia, a disease that is associated with changes in artistic and musical tastes and skills (Miller, Boone, Cummings, Read, & Mishkin,   2000), as well as with an increase in repetitive behaviors (Aldhous, 2008). What Adams did not know at the time was that her brain may have been undergoing the same changes that Ravel‘s had undergone 66 years earlier. In fact, it appears that Ravel may have suffered from the same neurological disorder. Ravel composed Boléro at age 53, when he himself was beginning to show behavioral symptoms that were interfering with his ability to move and speak. Scientists have concluded, based on an analysis of his written notes and letters,  that Ravel was also experiencing the effects of frontotemporal dementia (Amaducci, Grassi, & Boller, 2002). If Adams and Ravel were both affected by the same disease, this could explain why they both became fascinated with the repetitive aspects of their arts, and it would present a remarkable example of the influence of our brains on behavior. Our behaviors, as well as our thoughts and feelings, are produced by the actions of our brains, nerves, muscles, and glands. In this chapter we will begin our journey into the world of psychology by considering the biological makeup of the human being, including the most remarkable of human organs—the brain. We’ll consider the structure of the brain and also the methods that psychologists use to study the brain and to understand how it works. We will see that the body is controlled by an information highway known as the nervous system, a collection of hundreds of billions of specialized and interconnected cells through which messages are sent between the brain and the rest of the body. And we will see that our behavior is also influenced in large part by the endocrine system, the chemical regulator of the body that consists of glands that secrete hormones. Although this chapter begins at a very low level of explanation, and although the topic of study may seem at first to be far from the everyday behaviors that we all engage in, a full understanding of the biology underlying psychological processes is an important cornerstone of your new understanding of psychology. We will consider throughout the chapter how our biology influences important human behaviors, including our mental and physical health, our reactions to drugs, as well as our aggressive responses and our perceptions of other people. This chapter is particularly important for contemporary psychology because the ability to measure biological aspects of behavior, including the structure and function of the human brain, is progressing rapidly, and understanding the biological foundations of behavior is an increasingly important line of psychological study. Maurice Ravel and right-hemisphere musical creativity: Influence of disease on his last musical works? A neuron is a cell in the nervous system whose function it is to receive and transmit information. The axons are also specialized, and some, such as those that send messages from the spinal cord to the muscles in the hands or feet, may be very long—even up to several feet in length. To improve the speed of their communication, and to keep their electrical charges from shorting out Attributed to Charles Stangor Saylor. The myelin sheath is a layer of fatty tissue surrounding the axon of a neuron that both acts as an insulator and allows faster transmission of the electrical signal. Axons branch out toward their ends, and at the tip of each branch is a terminal button. Neurons Communicate Using Electricity and Chemicals The nervous system operates using an electrochemical process (see Note 3. An electrical charge moves through the neuron itself and chemicals are used to transmit information between neurons. Within the neuron, when a signal is received by the dendrites, is it transmitted to the soma in the form of an electrical signal, and, if the signal is strong enough, it may then be passed on to the axon and then to the terminal buttons. If the signal reaches the terminal buttons, they are signaled to emit chemicals known as neurotransmitters, which communicate with other neurons across the spaces between the cells, known as synapses. Video Clip: The Electrochemical Action of the Neuron This video clip shows a model of the electrochemical action of the neuron and neurotransmitters. The electrical signal moves through the neuron as a result of changes in the electrical charge of the axon. Normally, the axon remains in the resting potential, a state in which the interior of the neuron contains a greater number of negatively charged ions than does the area outside the cell. When the segment of the axon that is closest to the cell body is stimulated by an electrical signal from the dendrites, and if this electrical signal is strong enough that it passes a certain level or threshold, the cell membrane in this first segment opens its gates, allowing positively charged sodium ions that were previously kept out to enter. This change in electrical charge that occurs in a neuron when a nerve impulse is transmitted is known as the action potential. Once the action potential occurs, the number of positive ions exceeds the number of negative ions in this segment, and the segment temporarily becomes positively charged. The electrical charge moves down the axon from segment to segment, in a set of small jumps, moving from node to node. When the action potential occurs in the first segment of the axon, it quickly creates a similar change in the next segment, which then stimulates the next segment, and so forth as the positive electrical impulse continues all the way down to the end of the axon. As each new segment becomes positive, the membrane in the prior segment closes up again, and the segment returns to its negative resting potential. In this way the action potential is transmitted along the axon, toward the terminal buttons. The entire response along the length of the axon is very fast—it can happen up to 1,000 times each second. An important aspect of the action potential is that it operates in an all or nothing manner. What this means is that the neuron either fires completely, such that the action potential moves all the way down the axon, or it does not fire at all. Thus neurons can provide more energy to the neurons down the line by firing faster but not by firing more strongly.
These terms are therefore not used here discount wellbutrin 300mg line, but readers should be aware of their existence and meanings purchase wellbutrin with visa. Carbon dioxide removal requires active tidal ventilation and so is affected by inspiratory pressure tidal volumes expiratory time purchase wellbutrin 300mg online. Manipulating these factors can optimise ventilation while minimising complications. Normal adult alveolar ventilation is about four litres each minute; normal cardiac output is about five litres each minute. Shunting can also occur at tissue level (reduced oxygen extraction ratio, see Chapter 20). Care of ventilated patient The care of ventilated patients should be holistic—the sum of many chapters in this book, especially in Part I. Artificial ventilation causes potential problems with: ■ safety ■ replacing normal functions ■ system complications Ventilated patients have respiratory failure, so ventilator failure or disconnection may be fatal. Modern ventilators include alarms and default settings, but each nurse should check, and where appropriate reset, alarm limits for each patient; Pierce (1995) recommends a ‘rule of thumb’ margin of 10 per cent for alarm settings. Alarms may fail and so nurses should observe ventilated patients both aurally and visually. This necessitates appropriate layout of bed areas to minimise the need for nurses to turn their backs on their patients. Back-up facilities in case of ventilator, power or gas failure should include: ■ manual rebreathing bag, with suitable connections ■ oxygen cylinders ■ equipment for reintubation Additional safety equipment may also be needed (e. Positive pressure ventilation is unphysiological; increased intrathoracic pressure compromises many other body systems (especially cardiovascular), causing problems identified later in this and many other chapters. Intensive care nursing 28 Fighting ventilation (dysynchrony between ventilator and patient-initiated breaths) should not occur, almost all modern ventilators incorporate trigger modes. However patient discomfort from ventilation (coughing, gagging—often from oral tracheal tubes, including biting on tubes) may cause problems. Nurses should monitor effects of ventilation, providing comfort where possible (e. When physical restraint cannot be avoided, it is best limited to manual restraint, using the minimum force necessary, which should be released as soon as possible. Tidal volume Tidal volume affects gas exchange, but can also cause shearing damage to lungs; settings should therefore balance immediate needs of oxygenation and carbon dioxide removal against potential lung damage/healing. While not too dissimilar to peak flow volumes, normal respiration preferentially distributes air to dependent lung bases (especially when standing) (Ryan 1998), matching maximal ventilation with optimum perfusion; lying down reduces the functional residual capacity by about one-third, thus artificial ventilation distributes gas unevenly, overdistending upper lung zones (Ryan 1998). Patients at greatest risk from alveolar trauma usually have poor compliance, low functional lung volumes and hypoxia, creating dilemmas between adequate oxygenation and risks of lung damage. When patient-initiated negative pressure exceeds the set trigger level, patients can ‘breath through’ the ventilator. With most ventilatory modes, triggered breaths are in addition to preset volumes, but included in measured expired minute volume. Incorporating triggering/sensitivity into ventilators aids weaning and facilitates patient comfort by overcoming the problems of ‘fighting’. At rest, self-ventilation negative pressure is approximately −3 mmHg (Adam &; Osborne 1997); trigger levels below this can cause discomfort (fighting). Early methods of immersing expiratory port tubing into water (hence measurement in cmH2O) have been replaced by resistance valves (usually incorporated into ventilators). However, frequent small tidal volumes may achieve minute volume limits without clearing airway dead space. Once a breath is triggered, pressure support delivers gas until the preset peak airway pressure is reached. Thus pressure support encourages patients to initiate breaths, but replaces shortfall in volume from weak respiratory muscles. However tidal volumes are sufficiently consistent; alveolar ventilation is optimised (Bohm & Lachmann 1996) with minimal barotrauma. Flow-by Triggering (and pressure support) require sufficient negative pressure to open a closed valve, causing a delay in ventilation, increasing work of breathing and causing possible distress to patients. Flow-by provides a continuous flow of gas (5–20 litres per minute) through ventilator circuits (Kalia &: Webster 1997) to prevent these problems occurring. Inspiratory:expiratory ratio A breath has three potential parts: ■ inspiration ■ pause/plateau ■ expiration Oxygen transfer occurs primarily during inspiration and plateau; incomplete expiration (e. Changing inspiration to expiration (I:E) ratio therefore manipulates alveolar gas exchange. Some ventilators determine breath pattern by adjusting two of the parts as percentages of the whole breath; other ventilators set an I:E (inspiratory to expiratory) ratio, with separate control for pause/plateau time. Sigh Normal respiration includes a physiological sigh every 5 to 10 minutes (Hough 1996). Ratios between intra-alveolar pressure and volume differ between inspiration and expiration (hysteresis); lung expansion during inspiration increases alveolar surface area, facilitating adsorption of new surfactant adsorbed onto alveolar surfaces; this reduces surface tension during deflation by up to one-fifth (Drummond 1996). Occasional hyperinflation (sigh) prevents atelectasis during shallow respirations (Hough 1996), increases compliance, and so prevents infection. Since physiological sighs are lost with unconsciousness (Hough 1996), mechanical sighs were incorporated into ventilator technology, often delivering double tidal volumes. Bersten and Oh (1997) suggest that with use of smaller tidal volumes, sigh use requires reassessment. Independent lung ventilation With single-lung pathology, patients may benefit from different modes of ventilation being used to each lung. Independent lung ventilation requires double lumen endotracheal Artificial ventilation 33 tubes, one lumen entering each bronchus. Independent ventilators, each using any available mode, may then be used for each lung. Independent lung ventilation may be impractical due to: ■ insufficient ventilators available ■ increased costs and workload (e. However, as air leaks are invariably present and the airway is unprotected, with no access for suction (Elliott et al. Noninvasive ventilation is not intended for prolonged use, although it may facilitate weaning (Wedzicha 1992). The availability of non-invasive ventilation extends ethical dilemmas about decisions not to ventilate. Such decisions should be taken by the multidisciplinary team, nurses being potentially valuable patient advocates. Physiological complications All body systems are affected by artificial ventilation. Although this description is reductionist, and further complications are identified in Chapter 5 and elsewhere, it should be remembered that there are cumulative effects on the whole person. Conversely, positive pressure ventilation ■ impedes venous return ■ increases right ventricular workload ■ causes cardiac tamponade resulting in reduced arterial pressure and extravasation of plasma into interstitial spaces (oedema, including pulmonary). Although maintaining patency of airways, rigid endotracheal tubes (and other ventilator circuitry) create resistance, usually of 5–10 cmH2O (Bersten & Oh 1997).
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