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Comparison of pediatric and adult antibiotic-associated diarrhea and Clostridium difficile infections

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World Journal of Gastroenterology 2016年第11期22卷 3078-3104页

作者： Lynne Vernice mc farland Metehan Ozen Ener Cagri Dinleyici Shan Goh Department of Medicinal Chemistry School of PharmacyUniversity of Washington Faculty of Medicine Department of PediatricsDivision of Pediatric Infectious Diseaseatakent acibadem University Hospital Faculty of Medicine Department of PediatricsPediatric Intensive Care UnitEskisehir Osmangazi University Department of Pathology and Pathogen Biology Royal Veterinary College

Antibiotic-associated diarrhea(AAD) and Clostridum difficile infections(CDI) have been well studied for adult cases, but not as well in the pediatric population. Whether the disease process or response to treatments differs between pediatric and adult patients is an important clinical concern when following global guidelines based largely on adult patients. A systematic review of the literature using databases Pub Med(June 3, 1978-2015) was conducted to compare AAD and CDI in pediatric and adult populations and determine significant differences and similarities that might impact clinical decisions. In general, pediatric AAD and CDI have a more rapid onset of symptoms, a shorter duration of disease and fewer CDI complications(required surgeries and extended hospitalizations) than in adults. Children experience more community-associated CDI and are associated with smaller outbreaks than adult cases of CDI. The ribotype NAP1/027/BI is more common in adults than children. Children and adults share some similar risk factors, but adults have more complex risk factor profiles associated with more co-morbidities, types of disruptive factors and a wider range of exposures to C. difficile in the healthcare environment. The treatment of pediatric and adult AAD is similar(discontinuing or switching the inciting antibiotic), but other treatment strategies for AAD have not been established. Pediatric CDI responds better to metronidazole, while adult CDI responds better to vancomycin. Recurrent CDI is not commonly reported for children. Prevention for both pediatric and adult AAD and CDI relies upon integrated infection control programs, antibiotic stewardship and may include the use of adjunctive probiotics. Clinical presentation of pediatric AAD and CDI are different than adult AAD and CDI symptoms. These differences should be taken into account when rating severity of disease and prescribing antibiotics.

关键词： Antibiotics Antibiotic-associated diarrhea Clostridum difficile infections Adults Pediatrics Diarrhea Risk factors Treatments Prevention

Prosthetic design of reverse shoulder arthroplasty contributes to scapular notching and instability

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World Journal of Orthopedics 2016年第11期7卷 738-745页

作者： Gazi Huri Filippo Familiari Nima Salari Steve A Petersen Mahmut Nedim Doral Edward G mc farland Department of Orthopaedic and Traumatology Surgery Hacettepe University Medical School Division of Shoulder Surgery Department of Orthopaedic Surgerythe Johns Hopkins University

AIM To evaluate whether implant design, glenoid positioning, and other factors influenced instability and scapular notching in reverse total shoulder *** We retrospectively reviewed records of patients who had undergone reverse total shoulder arthroplasty by the senior author from July 2004 through October 2011 and who had at least 24 mo of follow-up. The 58 patients who met the criteria had 65 arthroplasties: 18 with a Grammont-type prosthesis(Grammont group) and 47 with a lateral-based prosthesis(lateral-design group). We compared the groups by rates of scapular notching and instability and by radiographic markers of glenoid position and tilt. We also compared glenoid sphere sizes and the number of subscapularis tendon repairs between the groups. Rates were compared using the Fisher exact test. Notching severity distribution was compared using the χ2 test of association. Significance was set at P < *** The Grammont group had a higher incidence of scapular notching(13 of 18; 72%) than the lateral-design group(11 of 47; 23%)(P < 0.001) and a higher incidence of instability(3 of 18; 17%) than the lateral-design group(0 of 47; 0%)(P = 0.019). Glenoid position, glenoid sphere size, and subscapularis tendon repair were not predictive of scapular notching or instability, independent of implantdesign. With the lateral-based prosthesis, each degree of inferior tilt of the baseplate was associated with a 7.3% reduction in the odds of developing notching(odds ratio 0.937, 95%CI: 0.894-0.983). CONCLUSION The lateral-based prosthesis was associated with less instability and notching compared with the Grammonttype prosthesis. Prosthesis design appears to be more important than glenoid positioning.

关键词： Arthroplasty Reverse Instability Scapular notching Shoulder

Preventing pediatric antibiotic-associated diarrhea and Clostridium difficile infections with probiotics: A metaanalysis

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World Journal of Meta-Analysis 2013年第3期1卷 102-120页

作者： Lynne V mc farland Shan Goh Department of Medicinal Chemistry University of Washington Seattle WA 98101 United States Department of Pathology and Pathogen Biology Royal Veterinary College Hawkshead Lane Hatfield Hertfordshire AL9 7TA United Kingdom

AIM： To assess the effcacy and safety of probiotics for preventing pediatric：（1） antibiotic associated diarrhea and （2） Clostridium diffcile （C. diffcile） ***： On June 3, 2013, we searched PubMed （1960-2013）, EMBASE （1974-2013）, Cochrane Da-tabase of Systematic Reviews （1990-2013）, CINAHL （1981-2013）, AMED （1985-2013）, and ISI Web of Science （2000-2013）. Additionally, we conducted an extensive grey literature search including contact with National Institutes of Health Clinical Trials Registry, abstracts from annual infectious disease and gastroen-terology meetings, experts in the feld and correspondence with authors. The primary outcomes were the incidence of antibiotic-associated diarrhea （AAD） and C. difficile infections （CDI）. Dichotomous outcomes （e.g. , incidence of AAD or CDI） were pooled using a random-effects model to calculate the relative risk and corresponding 95% confidence interval （95%CI） and weighted on study quality. To explore possible explanations for heterogeneity, a priori subgroup analysis were conducted on probiotic strain type, daily dose, quality of study and safety of probiotics. The overall quality of the evidence supporting each outcome was assessed using the grading of recommendations, assessment, development and evaluation ***： A total of 1329 studies were identifed with 22 trials （23 treatment arms and 4155 participants） meeting eligibility requirements for our review of prevention of AAD and 5 trials （1211 participants） for the prevention of CDI. Trials in adult populations, trials of uncertain antibiotic exposure or studies which did not provide incidence of AAD were excluded. We found 12 trials testing a single strain of probiotic and 10 trials testing a mixture of probiotic strains. Probiotics （all strains combined） signifcantly reduced the incidence of pediatric AAD （pooled RR = 0.42, 95%CI： 0.33-0.53） and significantly reduced pediatric CDI （pooled RR = 0.35, 95%CI： 0.13-0.92）. Of the two strains wi

关键词： Probiotics Pediatric Antibiotic-associated diarrhea Clostridium diffcile Saccharomyces boulardii Lactobacillus rhamnosus Safety Meta-analysis Randomized clinical trials

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考虑过阻尼模态参与的改进复模态叠加法

Journal of Southeast University(English Edition) 2023年第3期39卷 213-224页

作者：陈勇 Donald M.mc.farland Billie F.Spencer,Jr Lawrence A.Bergman 浙江大学建筑工程学院杭州310027 Department of Civil and Environmental Engineering University of Illinois at Urbana-ChampaignUrbana 61801USA Department of Aerospace Engineering University of Illinois at Urbana-ChampaignUrbana 61801USA 浙江工业大学机械工程学院杭州310014

为处理非比例阻尼系统可能出现的过阻尼模态,提出了一种改进的复模态叠加强迫振动分析方法,建议无论模态是否过阻尼,复模态振动分析时应成对使用复模态.以一个连接任意布置外部阻尼器的悬臂梁典型非比例阻尼系统为例,其第1阶模态会随阻... 详细信息

为处理非比例阻尼系统可能出现的过阻尼模态,提出了一种改进的复模态叠加强迫振动分析方法,建议无论模态是否过阻尼,复模态振动分析时应成对使用复模态.以一个连接任意布置外部阻尼器的悬臂梁典型非比例阻尼系统为例,其第1阶模态会随阻尼系数的增加而过阻尼.在厘清复模态响应与实际动力响应关系的基础上阐述了采用改进复模态叠加法获得时域响应、传递函数和方差的完整理论方法.将方程分为实部和虚部,使得原复数域运动方程成为基于实数矩阵的增广状态空间方程,从而克服了采用复数矩阵计算时变响应的困难.此外,针对基于白噪声滤波的外部激励,提出了一种高效方差响应评估方法,降低了计算资源消耗.结果表明,相较于假设模态法,复模态叠加法的结果更接近于有限元结果.基于遍历法研究最优阻尼器参数和位置时,采用多个小阻尼阻尼器优于单个大阻尼阻尼器.

关键词：非经典阻尼系统连续系统强迫振动复模态叠加法过阻尼模态动力响应

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含V型贯穿裂缝矩形薄板的模态局部化研究

噪声与振动控制 2020年第3期40卷 57-63页

作者：黄天明 D.Michael mc farland 卢奂采浙江工业大学机械工程学院杭州310014

以含V型贯穿裂缝的矩形薄板为研究对象,利用区域分解法结合改进的傅里叶级数,提出一种弹性边界条件下板自由振动的计算方法,并针对V型贯穿裂缝引起的模态局部化展开讨论。首先根据裂缝的特征,矩形板被分解为若干个矩形子域和三角形子域... 详细信息

以含V型贯穿裂缝的矩形薄板为研究对象,利用区域分解法结合改进的傅里叶级数,提出一种弹性边界条件下板自由振动的计算方法,并针对V型贯穿裂缝引起的模态局部化展开讨论。首先根据裂缝的特征,矩形板被分解为若干个矩形子域和三角形子域的组合,选取两类改进的傅里叶级数分别作为这两类子域的横振动位移函数。然后利用Rayleigh-Ritz法建立求解方程的矩阵表达式,通过求解其特征值和特征向量得到固有频率和振型。最后对不同参数的裂缝对固有频率和模态局部化的影响进行讨论。结果表明,裂缝越长、夹角越小、边界约束越强时,板的固有频率和振型受影响越大,也越容易出现模态局部化现象。

关键词：振动与波模态局部化矩形薄板裂缝弹性边界条件自由振动

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收集大粒子的大容量预分离器

环境科学与管理 1981年第11期 145-151页

作者： Andrew R.mc farland 李爱真韩仲琪

由于粒子重新气溶胶化的问题,使沉积在经典的惯性撞击器每一节上的量只有几毫克。因此,在用该种撞击器采集烟道样品的时候,尤其是在采集控制设备的上游样品时,必须把采样时间限制得非常短暂。大容量预分离器就是为解决上述问题而设计的... 详细信息

由于粒子重新气溶胶化的问题,使沉积在经典的惯性撞击器每一节上的量只有几毫克。因此,在用该种撞击器采集烟道样品的时候,尤其是在采集控制设备的上游样品时,必须把采样时间限制得非常短暂。大容量预分离器就是为解决上述问题而设计的一种装置,现已用单分散气溶胶和干尘对这种装置进行了检验。检验结果是,在流速为14.2升/分(0.5cfm)时,临界空气动力学直径是10.8μm,其相应的Stokes数是0.115;用Detroit Edison飞灰进行检验,结果类同;即,其动力学粒径为11.2μm。在该装置所收集的飞灰粒子中,大于15μm的气溶胶粒子有92.5％是予分离器收集的。

关键词：过滤器惯性撞击器分离设备大气微粒分散体系气溶胶