Antibiotic Prescribing in the Acute Care in Iraq

Background: Excessive and inappropriate use of antimicrobial agents among hospitalized patients remains an important patient safety and public health issue worldwide. Not only does this behavior incur unnecessary cost but it is also associated with increased morbidity and mortality. The objective of this study is to obtain an insight into the prescribing patterns of antibiotics in surgical and medical wards, to help identify a scope for improvement in service delivery. Method: A simple point prevalence survey included a convenience sample of 200 patients admitted to medical and surgical wards in a government teaching hospital in Baghdad between October 2017 and April 2018. Data were collected by a trained pharmacy intern using a standardized form. Patient’s demographics and details of the prescribed antibiotics, including dose, frequency of dosing and route of administration, were reported. Patients were included if they had been admitted at least 24 hours before the survey. Patients under 18 years of age, having a diagnosis of cancer or shock, or being admitted to the intensive care unit, were excluded. Data were checked and entered by the authors into Excel and were subjected to frequency analysis, which was carried out on anonymized data to protect patient confidentiality. Results: Overall, 88.5% of patients (n=177) received 293 antibiotics during their hospital admission, with a small variation between wards (80%-97%). The average number of antibiotics prescribed per patient was 1.65, ranging from 1.3 for medical patients to 1.95 for surgical patients. Parenteral third-generation cephalosporins were the most commonly prescribed at a rate of 54.3% (n=159) followed by nitroimidazole 29.4% (n=86), quinolones 7.5% (n=22) and macrolides 4.4% (n=13), while carbapenems and aminoglycosides were the least prescribed together accounting for only 4.4% (n=13). The intravenous route was the most common route of administration, used for 96.6% of patients (n=171). Indications were reported in only 63.8% of cases. Culture to identify pathogenic organisms was employed in only 0.5% of cases. Conclusion: Broad-spectrum antibiotics are prescribed at an alarming rate. This practice may provoke antibiotic resistance and adversely affect the patient outcome. Implementation of an antibiotic stewardship program is warranted to enhance the efficacy, safety and cost-effectiveness of antimicrobial agents.

Studying the Dynamical Response of Nano-Microelectromechanical Devices for Nanomechanical Testing of Nanostructures

Characterizing the fatigue and fracture properties of nanostructures is one of the most challenging tasks in nanoscience and nanotechnology due to lack of a MEMS/NEMS device for generating uniform cyclic loadings at high frequencies. Here, the dynamic response of a recently proposed MEMS/NEMS device under different inputs signals is completely investigated. This MEMS/NEMS device is designed and modeled based on the electromagnetic force induced between paired parallel wires carrying electrical currents, known as Ampere’s Force Law (AFL). Since this MEMS/NEMS device only uses two paired wires for actuation part and sensing part, it represents highly sensitive and linear response for nanostructures with any stiffness and shapes (single or arrays of nanowires, nanotubes, nanosheets or nanowalls). In addition to studying the maximum gains at different resonance frequencies of the MEMS/NEMS device, its dynamical responses are investigated for different inputs and nanostructure properties to demonstrate the capability, usability, and reliability of the device for wide range of nanostructures. This MEMS/NEMS device can be readily integrated into SEM/TEM instruments to provide real time study of the fatigue and fracture properties of nanostructures as well as their softening or hardening behaviors, and initiation and/or propagation of nanocracks in them.

Designing and Analyzing Sensor and Actuator of a Nano/Micro-System for Fatigue and Fracture Characterization of Nanomaterials

This paper presents a MEMS/NEMS device for fatigue and fracture characterization of nanomaterials. This device can apply static loads, cyclic loads, and their combinations in nanomechanical experiments. It is based on the electromagnetic force induced between paired parallel wires carrying electrical currents. Using this concept, the actuator and sensor parts of the device were designed and analyzed while considering the practical limitations. Since the PWCC device only uses two wires for actuation part and sensing part, its fabrication process is extremely easier than the available MEMS/NEMS devices. The total gain and phase shift of the MEMS/NEMS device were calculated and investigated. Furthermore, the maximum gain and sensitivity of the MEMS/NEMS device were studied to demonstrate the capability and usability of the device for wide range of nanomaterials samples. This device can be readily integrated into SEM/TEM instruments to provide real time study of the mechanical behaviors of nanomaterials as well as their fatigue and fracture properties, softening or hardening behaviors, and initiation and propagation of nanocracks.

Potential of Sunflower (Helianthus annuus L.) for Phytoremediation of Soils Contaminated with Heavy Metals

A field study was conducted to evaluate the efficacy of the sunflower (Helianthus annuus L.) for phytoremediation of contaminated soils. The experiment was performed on an agricultural field contaminated by the Non-Ferrous-Metal Works near Plovdiv, Bulgaria. Field experiments with a randomized, complete block design with five treatments (control, compost amendments added at 20 and 40 t/daa, and vemicompost amendments added at 20 and 40 t/daa) were carried out. The accumulation of heavy metals in the sunflower plant and the quality of the sunflower oil (heavy metals and fatty acid composition) were determined. The tested organic amendments significantly influenced the uptake of Pb, Zn and Cd by the sunflower plant. The incorporation of 40 t/decare of compost and 20 t/decare of vermicompost to the soil led to an increase in the ability of the sunflower to take up and accumulate Cd, Pb and Zn. Sunflower can be subjected to the accumulators of Pb, Zn and Cd and can be successfully used for phytoremediation of contaminated soils with heavy metals. The 40 t/daa compost treatment led to a decrease in heavy metal content in sunflower oil to below the regulated limits. Oil content and fatty acids composition were affected by compost and vermicompost amendment treatments. Adding compost and vermicompost increased the oil content in the seeds. Adding organic amendments increased the content of stearic, palmitoleic and oleic acids, and reduced the content of palmitic and gadoleic acids in sunflower oil. The possibility of further industrial processing of seeds to oil and use of the obtained oil will make sunflowers economically interesting crops for farmers of phytoremediation technology.

Accumulation of Heavy Metals in Safflower (Carthamus tinctorius L.)

Comparative research has been conducted to allow us to determine the accumulation of heavy metals (Pb, Zn and Cd) in the vegetative and reproductive organs of safflower, and to identify the possibility of its growth on soils contaminated by heavy metals and efficacy for phytoremediation. The experiment was performed on an agricultural field contaminated by the Non-Ferrous-Metal Works (MFMW) near Plovdiv, Bulgaria. The experimental plots were situated at different distances (0.1, 0.5, 2.0, and 15 km) from the source of pollution. The contents of heavy metals in plant materials (roots, stems, leaves, seeds) were determined. The quality of safflower oils (heavy metals and fatty acid composition) was also determined. The quantitative measurements were carried out with inductively-coupled plasma (ICP). Safflower is a plant that is tolerant to heavy metals and can be referred to the hyperaccumulators of lead and cadmium and the accumulators of zinc. The plant can be successfully used in the phytoremediation of heavy metal contaminated soils. The processing of safflower seeds into oil and the use of the obtained oil will greatly reduce the cost of phytoremediation.

Nonlinear Structural Behavior of Micro- and Nano-Actuators Using the Galerkin Discretization Technique

In this paper, the influence of van der Waals, as well as electrostatic forces on the structural behavior of MEMS and NEMS actuators, has been investigated using of a Euler-Bernoulli beam continuous model. In the proposed nonlinear model, the electrostatic fringing-fields and the mid-plane stretching (geometric nonlinearity) effects have been considered. The nonlinear integro-differential equation governing the static structural behavior of the actuator has been derived. An original Galerkin-based reduced-order model has been developed to avoid problems arising from the nonlinearities in the differential equation. The obtained reduced-order model equations have been solved numerically using the Newton-Raphson method. The basic design parameters such as the pull-in parameters (voltage and deflection at pull-in), as well as the detachment length due to the van der Waals force of some investigated micro- and nano-actuators have been calculated. The obtained numerical results have been compared with some other existing methods (finite-elements method and finite-difference method) and the comparison showed good agreement among all assumed numerical techniques.

Microbiological Profile of UTI along with Their Antibiotic Sensitivity Pattern with Special Reference to Nitrofurantoin

Urinary Tract Infections are considered as one of the most common bacterial infections with an estimated annual global incidence of 150 million. Antimicrobial drug resistance is one of the major threats due to wide spread usage of uncontrolled antibiotics. In this study, a total number of 9149 urine samples were collected from R.H Patiala and processed in the Department of Microbiology G. M. C Patiala (January 2013 to December 2013). Urine samples were inoculated on MacConkey’s and blood agar plates and incubated at 370C for 24 hrs. The organisms were identified by colony characters, Gram’s staining, and biochemical reactions. Antimicrobial susceptibility of the isolates was determined against various antimicrobial agents (Hi – Media Mumbai India) by Kirby Bauer DISK diffusion method on Muller Hinton agar plates. Maximum patients were in the age group of 21-30 yrs followed by 31-40 yrs. Males (34%) are less prone to urinary tract infections than females (66%). Culture was positive in 25% of the samples. Escherichia coli was the most common isolate 60.3% followed by Klebsiella pneumoniae 13.5%, Proteus spp. 9% and Staphylococcus aureus 7.6%. Most of the urinary isolates were sensitive to, carbepenems, Aztreonam, Amikacin, and Piperacillin + Tazobactum. All the isolates showed a good sensitivity towards Nitrofurantoin (82%). ESBL production was found to be 70.6% in Escherichia coli and 29.4% in Klebsiella pneumonia. Susceptibility of ESBL producers to Imipenem, Nitrofurantoin and Amikacin were found to be 100%, 76%, and 75% respectively. Uropathogens are increasingly showing resistance to many antibiotics making empiric management of outpatient UTIs challenging. Ampicillin, Cotrimoxazole and Ciprofloxacin should not be used in empiric treatment. Nitrofurantoin could be used in lower urinary tract infection. Knowledge of uropathogens and their antimicrobial susceptibility pattern in a geographical region will help in appropriate and judicious antibiotic usage in a health care setup.

Valuation on MEMS Pressure Sensors and Device Applications

The MEMS pressure sensor has been introduced and presented in this paper. The types of pressure sensor and its theory of operation are also included. The latest MEMS technology, the fabrication processes of pressure sensor are explored and discussed. Besides, various device applications of pressure sensor such as tire pressure-monitoring system, diesel particulate filter and others are explained. Due to further miniaturization of the device nowadays, the pressure sensor with nanotechnology (NEMS) is also reviewed. The NEMS pressure sensor is expected to have better performance as well as lower in its cost. It has gained an excellent popularity in many applications.

From Micro to Nanosystems: An Exploratory Study of Influences on Innovation Teams

What influences microsystems (MEMS) and nanosystems (NEMS) innovation teams apart from technology complexity? Based on in-depth interviews with innovators, this research explores the key influences on innovation teams in the early phases of MEMS/NEMS. Projects are rare and may last from 5 to 10 years or more from idea to concept. As fundamental technology development in MEMS/NEMS is highly complex and interdisciplinary by involving expertise from different basic and engineering disciplines, R&D is rather a 'testing of ideas' with many uncertainties than a clearly structured process. The purpose of this study is to explore the innovation teams- environment and give specific insights for future management practices. The findings are grouped into three major areas: people, know-how and experience, and market. The results highlight the importance and differences of innovation teams- composition, transdisciplinary knowledge, project evaluation and management compared to the counterparts from new product development teams.

Effects of Dopant Concentrations on Radiative Properties of Nanoscale Multilayer with Coherent Formulation for Visible Wavelengths

Semiconductor materials with coatings have a wide range of applications in MEMS and NEMS. This work uses transfermatrix method for calculating the radiative properties. Dopped silicon is used and the coherent formulation is applied. The Drude model for the optical constants of doped silicon is employed. Results showed that for the visible wavelengths, more emittance occurs in greater concentrations and the reflectance decreases as the concentration increases. In these wavelengths, transmittance is negligible. Donars and acceptors act similar in visible wavelengths. The effect of wave interference can be understood by plotting the spectral properties such as reflectance or transmittance of a thin dielectric film versus the film thickness and analyzing the oscillations of properties due to constructive and destructive interferences. But this effect has not been shown at visible wavelengths. At room temperature, the scattering process is dominated by lattice scattering for lightly doped silicon, and the impurity scattering becomes important for heavily doped silicon when the dopant concentration exceeds1018cm-3 .