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Sexually transmitted infection laboratory testing and education trends in US outpatient physician offices,2009-2016

Family Medicine and Community Health 2021年第3期9卷 27-32页

作者： Amina R Zeidan Kelsey Strey Michelle N Vargas kelly R reveles College of Pharmacy The University of Texas at AustinSan AntonioTexasUSA Pharmacotherapy Education&Research Center The University of Texas Health Science Center at San AntonioSan AntonioTexasUSA

Objective To describe national rates of sexually transmitted infection(STI)testing and education overall and among patient subgroups in US outpatient physician offices from 2009 to *** This was a cross-sectional study of the Centers for Disease Control and Prevention’s National Ambulatory Medical Care Survey from 2009 to *** weights were applied to extrapolate to national *** Data were collected from a systematic random sample of outpatient physician office visits throughout *** office types include free standing clinics,private or group setting practices,centres offering community and mental health services,family planning clinics and health maintenance organisations/other prepaid *** All sampled patient visits were eligible for inclusion and were assessed for the provision of STI prevention education and STI testing for chlamydia,gonorrhoea,hepatitis,human papillomavirus(HPV)and *** Of 7.6 billion total visits,123 million included an STI *** was the most commonly tested STI(9.12 per 1000),followed by chlamydia(6.67 per 1000),gonorrhoea(6.00 per 1000),HIV(5.40 per 1000)and HPV(5.03 per 1000).Testing rates for the three STIs measured for the entire 8-year period increased over time and peaked in 2015 compared with 2009:chlamydia(R2=0.36),HPV(R2=0.28)and HIV(R2=0.51).Testing was highest among women(21.93 per 1000),15-24-year olds(46.04 per 1000),non-Hispanic blacks(37.33 per 1000)and those seen by obstetrics/gynaecology specialists(103.75 per 1000).STI prevention education was provided to 4.89 per 1000 patients and remained relatively unchanged from 2013 to *** STI testing in outpatient physician offices increased over the study period but varied by patient characteristics and site of *** patients received STI prevention education,highlighting a potential gap in resource utilisation in these settings.

关键词： prevention education testing

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Next Generation Sequencing for Microbial Analysis to Select Prophylactic Antibiotic Selection before Urologic Stone Surgery: A Culture Change

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Open Journal of Urology 2021年第7期11卷 289-304页

作者： Rishi Das Tim Tseng Meghan I. Short kelly reveles Allison Wheeler Robert Hudson Bernard Fongang Michael A. Liss Department of Urology University of Texas Health San Antonio San Antonio USA Glenn Biggs Institute for Alzheimer’s and Neurodegenerative Diseases San Antonio Texas USA The University of Texas at Austin—College of Pharmacy (PHR) Austin USA

Background: This paper aims to determine if the combination of polymerase chain reaction (PCR) and next-generation sequencing (NGS) could identify bacteria in culture-negative urine that would alter prophylaxis management. Methods: We sent approximately 5 - 10 mL of a preoperative urine sample to MicrogenDx for PCR/NGS analysis performed after surgery (blind to the surgeon). The physician prescribed standard of care antibiotic prophylaxis. Cases modeling the hospital course of 3 random patients were reviewed by eight urologists after surgery to determine if NGS results would change their prophylaxis regimen. An infectious disease pharmacist reviewed the cases and provided the “ideal” regimen. Results: Urine cultures identified bacteria in 11% (2/18) of cases. Culture speciation results were consistent with NGS results. NGS detected a dominant bacteria in 56% (10/18) of negative cultures and targetable bacteria in all samples. There was a 15% (3/20) infection rate. In both cases, NGS results suggest inadequate prophylaxis. In response to the case scenarios, 100%, 88%, and 88% of the urologists reported they would change prophylaxis with NGS results. During a case scenario, physicians would tend to overprescribe antibiotics given PCR/NGS data for prophylaxis selection. Conclusion: NGS identifies a targetable bacterium in up to 80% of negative urine cultures before urologic stone surgery. Responses to case scenarios indicate that physicians would change management based on NGS results. Inter-professional (urologic and pharmacy) antibiotic selection with PCR/16S DNA testing may be helpful to improve antibiotic stewardship.

关键词： Health-Care Associated Infection Urinary Tract Infection Infection Prevention Surgical Site Infection

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Non-Linear Analysis of Energy Absorption Systems under Impact Loads through FEM

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Journal of Mechanics Engineering and Automation 2012年第8期2卷 487-494页

作者： Elias Rigoberto Ledesma-Orozco Jose Angel Diosdado-De la Pena Gerardo Israel Pdrez-Soto Alonso Salazar-Garibay Juan Francisco reveles-Arredondo Gilberto Villalobos-Llamas Pedro Duran-Resendiz Department of Mechanical Engineering Universidad de Guanajuato (DICIS) Salamanca M~xico

This paper presents a non-linear simulation of the impact on a structure with different energy absorption systems using finite element models. Literature review on bistable structure, aluminum foam and expandable polystyrene is presented and taken as basis to propose energy absorption systems. Using a base structure, these systems are implemented by means of finite element modeling. A comparison of the damage caused to the structure in case of impact without implementing energy absorption system, and implementing energy absorption systems based on bistable structures, polystyrene foam and aluminum foam are shown here in. The results demonstrate the advantages of using energy absorption systems on structures under impact loads.

关键词： Bistable impact loads non-linear analysis energy absorption.

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