Impact of targeted antifungal prophylaxis in heart transplant recipients at high risk for early invasive fungal infection.

BACKGROUND: Invasive fungal infection (IFI) is associated with high mortality after heart transplantation (HTx). After two undiagnosed fatal cases of early disseminated fungal infections in our heart transplant program, a retrospective analysis was conducted to identify risk factors for the development of IFI and implement a new antifungal prophylaxis policy. METHODS: Clinical characteristics of HTx recipients hospitalized in our center (2004-2010) were recorded (Period 1), and risk factors associated with IFI were investigated using Cox regression analysis. From October 2010 to October 2012 (Period 2), targeted caspofungin prophylaxis was administered to all recipients at high risk for IFI, based on the results of the Period 1 analysis. RESULTS: During Period 1, 10% (6/59) of the patients developed IFI at a median onset of 9 days after transplantation. By multivariate analysis, the use of posttransplant extracorporeal membrane oxygenation (ECMO) was the strongest predictor for fungal infection (OR, 29.93; 95% CI, 1.51-592.57, P=0.03), whereas renal replacement therapy (RRT) and Aspergillus colonization were significant predictors only by univariate analysis. During Period 2, only 4% (1/26) of the patients developed IFI. In patients at high risk for IFI, antifungal prophylaxis was administered to 17% (4/23) in Period 1 versus 100% (13/13) in Period 2 (P<0.01). By survival analysis, antifungal prophylaxis was associated with a reduction in 90-day IFI incidence (HR, 0.14; 95% CI, 0.03-0.84, P=0.03) and 30-day mortality (HR, 0.25; 95% CI, 0.09-0.8, P=0.02). CONCLUSION: Extracorporeal membrane oxygenation was identified an important risk factor for IFI after HTx, and its use may require targeted administration of antifungal prophylaxis in the immediate posttransplant period.

Intervalo hídrico ótimo em um Latossolo vermelho cultivado em sistema semeadura direta por 25 anos

O Intervalo Hídrico Ótimo (IHO) integra atributos físicos do solo relacionados ao crescimento das culturas e corresponde ao intervalo entre os limites superior e inferior do conteúdo de água no solo, no qual são mínimas as limitações para o crescimento radicular. Em áreas agrícolas, o manejo do solo pode alterar sua estrutura, de forma que, principalmente em razão da compactação, a densidade do solo (Ds) poderá ficar fora desses limites em que as condições são ideais para o crescimento das plantas. O objetivo deste trabalho foi utilizar o IHO para avaliação da qualidade física do solo e identificação de áreas com restrição para crescimento de plantas, visando ao manejo localizado. O estudo foi realizado em um Latossolo Vermelho argiloso sob sistema semeadura direta (SSD) com cultivos sucessivos de grãos por 25 anos em Campinas, SP. Foram coletadas amostras volumétricas de solo, nas camadas de 0,00-0,10, 0,10-0,20 e 0,20-0,30 m, destinadas à obtenção dos seguintes atributos: Ds, curva de resistência à penetração, curva de retenção de água e porosidade do solo para determinação do IHO e da densidade crítica do solo (Dsc). Dados de variabilidade e dependência espacial da Ds foram analisados por semivariogramas para elaboração de mapas desse atributo. O IHO diminuiu em profundidade e foi limitado na parte superior pela umidade na capacidade de campo e na parte inferior pela resistência à penetração, nas três profundidades avaliadas. A Dsc foi de 1,42 Mg m-3 para a camada de 0,00-0,10 m e de 1,39 e 1,41 Mg m-3, respectivamente, para as camadas de 0,10-0,20 e 0,20-0,30 m. Verificou-se que a Ds foi maior que a Dsc nas camadas de 0,00-0,10 e 0,10-0,20 m, em porções localizadas no terço inferior do terreno, indicando condição crítica para o crescimento das plantas. A utilização do IHO, associado a mapas de variabilidade espacial da Ds, para determinação de pontos em que ela é maior que a Dsc, auxilia a tomada de decisão para intervenção ou modificação do manejo do solo, enquanto que o critério de escolha do valor crítico da resistência à penetração pode contribuir para a interpretação dos resultados de campo.

EPI Update, May 25, 2012

Weekly newsletter for Center For Acute Disease Epidemiology of Iowa Department of Public Health.

Friday Facts, May 25, 2012, Vol. 142

Bureau of Nutrition and Health Promotion part of the Iowa Department of Public Health produces of weekly newsletter about the Iowa WIC Program for the State of Iowa citizen.

From Empirical Bayes to Full Bayes: Methods for Analysing Traffice Safety Data, October 25, 2004

Traffic safety engineers are among the early adopters of Bayesian statistical tools for analyzing crash data. As in many other areas of application, empirical Bayes methods were their first choice, perhaps because they represent an intuitively appealing, yet relatively easy to implement alternative to purely classical approaches. With the enormous progress in numerical methods made in recent years and with the availability of free, easy to use software that permits implementing a fully Bayesian approach, however, there is now ample justification to progress towards fully Bayesian analyses of crash data. The fully Bayesian approach, in particular as implemented via multi-level hierarchical models, has many advantages over the empirical Bayes approach. In a full Bayesian analysis, prior information and all available data are seamlessly integrated into posterior distributions on which practitioners can base their inferences. All uncertainties are thus accounted for in the analyses and there is no need to pre-process data to obtain Safety Performance Functions and other such prior estimates of the effect of covariates on the outcome of interest. In this slight, fully Bayesian methods may well be less costly to implement and may result in safety estimates with more realistic standard errors. In this manuscript, we present the full Bayesian approach to analyzing traffic safety data and focus on highlighting the differences between the empirical Bayes and the full Bayes approaches. We use an illustrative example to discuss a step-by-step Bayesian analysis of the data and to show some of the types of inferences that are possible within the full Bayesian framework.

From Empirical Bayes to Full Bayes: Methods for Analyzubg Traffic Safey Data, October 25, 2004

Traffic safety engineers are among the early adopters of Bayesian statistical tools for analyzing crash data. As in many other areas of application, empirical Bayes methods were their first choice, perhaps because they represent an intuitively appealing, yet relatively easy to implement alternative to purely classical approaches. With the enormous progress in numerical methods made in recent years and with the availability of free, easy to use software that permits implementing a fully Bayesian approach, however, there is now ample justification to progress towards fully Bayesian analyses of crash data. The fully Bayesian approach, in particular as implemented via multi-level hierarchical models, has many advantages over the empirical Bayes approach. In a full Bayesian analysis, prior information and all available data are seamlessly integrated into posterior distributions on which practitioners can base their inferences. All uncertainties are thus accounted for in the analyses and there is no need to pre-process data to obtain Safety Performance Functions and other such prior estimates of the effect of covariates on the outcome of interest. In this light, fully Bayesian methods may well be less costly to implement and may result in safety estimates with more realistic standard errors. In this manuscript, we present the full Bayesian approach to analyzing traffic safety data and focus on highlighting the differences between the empirical Bayes and the full Bayes approaches. We use an illustrative example to discuss a step-by-step Bayesian analysis of the data and to show some of the types of inferences that are possible within the full Bayesian framework.

Guidance Document for Executive Order Number 17, March 25, 2010

Executive Order 17, signed by Governor Chester J. Culver on September 25, 2009, emphasizes revitalization of historic properties and cultural and entertainment districts and also supports safe and healthy work places, sustainable design and cost effective use of state resources. Specifically, the Executive Order requires that State entities managing or leasing real estate on behalf of the State shall give priority to the needs of public entities and the populations they serve consistent with the cost effective use of state revenues. It also indicates that existing resources and facilities shall be used where adequate, cost competitive and appropriate for efficient and effective current state operations.

Iowa Crop and Weather Report, June 25, 2012, Vol. 12. no. 17

Report produced by the The Department of Agriculture and Land Stewardship, Climatology Bureau. Iowa Secretary of Agriculture Bill Northey today commented on the Iowa Crops and Weather report released by the USDA National Agricultural Statistical Service. The report is released weekly from April through October.

Iowa Workforce News, August 2012, Issue 25

Iowa Workforce Development's bi-monthly newsletter.

Iowa Crop and Weather Report, August 20, 2012, Vol. 12. no. 25

Report produced by the The Department of Agriculture and Land Stewardship, Climatology Bureau. Iowa Secretary of Agriculture Bill Northey today commented on the Iowa Crops and Weather report released by the USDA National Agricultural Statistical Service. The report is released weekly from April through October.

[Collection de cartes postales classées méthodiquement pour l'enseignement de la géographie, Paris, F. Nathan, s.d. (1928), offert par l'éditeur. 353 cartes postales en 15 paquets. 1. Généralités, définitions principales (1-25) 2. Ports de commerce, de pêche, militaires, fluviaux (26-50) 3. Pêches et industries diverses (51-75) 4. Relief du sol (76-95) 5. Communications en montagne (96-119) 6. Histoire d'un fleuve (120-139) 7. Phénomènes dus à l'érosion (140-159) 8. Voies de communication (160-179) 9. Paris (180-204) 10. Algérie (205-228) 11. Tunisie (229-253) 12. Maroc (254-278) 13. A.O.F. et A.E.F. (279-303) 14. Madagascar (304-328) 15. Indochine (329-353)]

Donateur : Nathan, Fernand (1858-1947)

Iowa Agri-News, November 16, 2012, Vol. 25

Crop and livestock summaries for the state of Iowa, produced by the Iowa Department of Agriculture.

Aging Watch, May 25, 2012, Vol. 12, no. 3

The reintroduction of the Iowa Department on Aging legislative and policy update, now known as “Aging Watch.” The Department is providing this update to better inform you about policy affecting older Iowans. In addition to policy updates from the statehouse and the nation’s capitol, you’ll learn about Department programs and changes affecting the landscape. As you’ll learn reading this and future editions, big changes are coming for the Iowa Aging Network. Over the next year the Department will be reducing the number of local Area Agencies on Aging, as required by legislative action. Not surprisingly, this is a major change for everyone.