1,487 research outputs found
Author Correction: Early pregnancy ultrasound measurements and prediction of first trimester pregnancy loss: A logistic model
No full textThe original version of this Article contained an error in the spelling of the author Patricia J. Goedecke which was incorrectly given as Patricia J. Goeske. The original Article has been corrected
GPT-4-based AI agents—the new expert system for detection of antimicrobial resistance mechanisms?
No full textThe European Committee on Antimicrobial Susceptibility Testing (EUCAST) recommends two steps for detecting beta-lactamases in Gram-negative bacteria. Screening for potential extended-spectrum beta-lactamase (ESBL), plasmid-mediated AmpC beta-lactamase, or carbapenemase production is confirmed. We aimed to validate generative pre-trained transformer (GPT)-4 and GPT-agent for pre-classification of disk diffusion to indicate potential beta-lactamases. We assigned 225 Gram-negative isolates based on phenotypic resistances against beta-lactam antibiotics and additional tests to one or more resistance mechanisms as follows: “none,” “ESBL,” “AmpC,” or “carbapenemase.” Next, we customized a GPT-agent with EUCAST guidelines and breakpoint table (v13.1). We compared routine diagnostics (reference) to those of (i) EUCAST-GPT-expert, (ii) microbiologists, and (iii) non-customized GPT-4. We determined sensitivities and specificities to flag suspect resistances. Three microbiologists showed concordance in 814/862 (94.4%) phenotypic categories and were used in median eight words (interquartile range [IQR] 4–11) for reasoning. Median sensitivity/specificity for ESBL, AmpC, and carbapenemase were 98%/99.1%, 96.8%/97.1%, and 95.5%/98.5%, respectively. Three prompts of EUCAST-GPT-expert showed concordance in 706/862 (81.9%) categories but were used in median 158 words (IQR 140–174) for reasoning. Sensitivity/specificity for ESBL, AmpC, and carbapenemase prediction were 95.4%/69.23%, 96.9%/86.3%, and 100%/98.8%, respectively. Non-customized GPT-4 could interpret 169/862 (19.6%) categories, and 137/169 (81.1%) agreed with routine diagnostics. Non-customized GPT-4 was used in median 85 words (IQR 72–105) for reasoning. Microbiologists showed higher concordance and shorter argumentations compared to GPT-agents. Humans showed higher specificities compared to GPT-agents. GPT-agent’s unspecific flagging of ESBL and AmpC potentially results in additional testing, diagnostic delays, and higher costs. GPT-4 is not approved by regulatory bodies, but validation of large language models is needed.
IMPORTANCE
The study titled "GPT-4-based AI agents—the new expert system for detection of antimicrobial resistance mechanisms?" is critically important as it explores the integration of advanced artificial intelligence (AI) technologies, like generative pre-trained transformer (GPT)-4, into the field of laboratory medicine, specifically in the diagnostics of antimicrobial resistance (AMR). With the growing challenge of AMR, there is a pressing need for innovative solutions that can enhance diagnostic accuracy and efficiency. This research assesses the capability of AI to support the existing two-step confirmatory process recommended by the European Committee on Antimicrobial Susceptibility Testing for detecting beta-lactamases in Gram-negative bacteria. By potentially speeding up and improving the precision of initial screenings, AI could reduce the time to appropriate treatment interventions. Furthermore, this study is vital for validating the reliability and safety of AI tools in clinical settings, ensuring they meet stringent regulatory standards before they can be broadly implemented. This could herald a significant shift in how laboratory diagnostics are performed, ultimately leading to better patient outcomes
Rex J. Rowley
No full textAudio recording of the 10/06/13 UNLV Libraries Author Series event featuring Rex. J. Rowley, author of Everyday Las Vegas: Local Life in a Tourist Town. Includes remarks by Libraries Dean Patricia Iannuzzi, CGR Director Dave Schwartz, and Rowley
Multicenter Clinical Evaluation of Vitek 2 Meropenem-Vaborbactam for Susceptibility Testing of Enterobacterales and Pseudomonas aeruginosa
No full textThe carbapenem/beta-lactamase inhibitor meropenem-vaborbactam (MEV) used to treat complicated urinary tract infections and pyelonephritis in adults was approved in 2017 by the U.S. Food and Drug Administration (FDA). Here, we evaluated Vitek 2 MEV (bioMérieux, Durham, NC) compared to the reference broth microdilution (BMD) method. Of 449 Enterobacterales isolates analyzed per FDA/CLSI breakpoints, the overall performance was 98.2% essential agreement (EA), 98.7% category agreement (CA), and 0% very major errors (VME) or major errors (ME). For 438 FDA intended-for-use Enterobacterales isolates, performance was 98.2% EA, 98.6% CA, and 0% VME or ME. Evaluable EA was 81.0%, but with only 42 on-scale evaluable results. Individual species demonstrated EA and CA rates of ≥90% without any VME or ME. When evaluated using European Committee on Antimicrobial Susceptibility Testing (EUCAST) breakpoints, overall Vitek 2 MEV performance for Enterobacterales and Pseudomonas aeruginosa demonstrated 97.3% EA, 99.2% CA, 2.3% VME, and 0.6% ME (after error resolution: 97.3% EA, 99.4% CA, 2.2% VME, and 0.4% ME) compared to the reference BMD method. Performance for P. aeruginosa included 92.2% EA, 97.4% CA, 0% VME, and 3.0% ME (after error resolution: 92.2% EA, 98.7% CA, 0% VME, and 1.5% ME). Performance for Enterobacterales included 98.2% EA, 99.6% CA, 3.0% VME, and 0.2% ME. Evaluable EA was 80.6% but was based on only 67 evaluable results. These findings support Vitek 2 MEV as an accurate automated system for MEV susceptibility testing of Enterobacterales and P. aeruginosa and could be an alternate solution to the manual-labor-intensive reference BMD method
Multilingual Linguistic Landscapes of NYC as a Pedagogical Tool in a Psychology Classroom
No full textThese are the supplementary materials for Chapter VII(d) (Patricia J. Brooks, co-author) for the forthcoming volume: "Spatializing Language Studies, H. Maxim, & D. Malinovski (Eds.
The Path of More Resistance: a Comparison of National Healthcare Safety Network and Clinical Laboratory Standards Institute Criteria in Developing Cumulative Antimicrobial Susceptibility Test Reports and Institutional Antibiograms
No full textIn the absence of antimicrobial susceptibility data, the institutional antibiogram is a valuable tool to guide clinicians in the empirical treatment of infections. However, there is a misunderstanding about how best to prepare cumulative antimicrobial susceptibility testing reports (CASTRs) to guide empirical therapy (e.g., routine antibiogram) versus monitoring antimicrobial resistance, with the former following guidance from the Clinical and Laboratory Standards Institute (CLSI) and the latter from the Centers for Disease Control and Prevention’s National Healthcare Safety Network (NHSN). These criteria vary markedly in their exclusion or inclusion of isolates cultured repeatedly from the same patient. We compared rates of nonsusceptibility (NS) using annual data from a large teaching health care system subset to isolates eligible by either NHSN criteria or CLSI criteria. For a panel of the three most prevalent Gram-negative pathogens in combination with clinically relevant antimicrobial agents (or priority pathogen-agent combinations [PPACs]), we found that the inclusion of duplicate isolates by NHSN criteria yielded higher NS rates than when CLSI criteria (for which duplicate isolates are not included) were applied. Patients with duplicate isolates may not be representative of antimicrobial resistance within a population. For this reason, users of CASTR data should carefully consider that the criteria used to generate these reports can impact resulting NS rates and, therefore, maintain the distinction between CASTRs created for different purposes
. 25 (1991) octubre-marzo. Historias. Revista de la Dirección de Estudios Históricos
No full text- Texto, símbolos y lo francés por Roger Chartier. - ¿Historia interpretativa o historia cuantitativa? por Philip Benedict. - Chartier, Darnton y la gran matanza del símbolo por Dominick La Capra. - Los historiadores cuentan cuentos: de gatos cartesianos y peleas de gallos gálicos por James Fernández. - Comercio y conquista en el Nuevo Mundo: Vitoria, Sepúlveda y Las Casas. Un análisis de la mentalidad de los tratadistas españoles por Patricia Nettel. - Encomiendas, repartimientos y conquista en Nueva Vizcaya por Chantal Cramaussel. - El poder misionero frente al desafío de la colonización civil (Sonora siglo XVIII) por José Luis Mirafuentes Galván. - "Si Dios no existe, alguien debe otorgar los certificados”. (Nota sobre la Academia de Letrán) por Carlos Monsiváis. - Nuestras propias voces. Las mujeres en la Revolución Mexicana por Martha Eva Rocha Islas. - Del centro occidente al Medio oeste: historiografía chicana por Gerardo Necoechea. - Promesas, seducción y matrimonio en Antioquia colonial por Pablo Rodríguez. - Literatura popular: bibliografía por Isabel Quiñónez. - El Imperio estremecido por J. R. Elliott. - La Odisea de Tocqueville por Julio Bracho. - Población y registros parroquiales por Rodrigo Martínez. - Bajo el signo de Alain Corbin por Eloísa Uribe. - Los primeros artífices de un oficio nuevo por Patricia Masse. - Crestomanía por José Mariano Leyva
Beyond the Veneer of Strategic Philanthropy
No full text· “Strategic philanthropy” has become a dominant theme among foundations in the past few decades.
· While many foundations have developed strategic plans, few have made the internal changes necessary to actually behave strategically.
· Four challenges to strategic philanthropy are identified, including strategies developed in isolation from grantees that execute them and misaligned foundation structures, processes, and cultures that do not support strategic endeavors.
· In order to get beyond the veneer of strategic philanthropy, foundation leaders need to be clearer about their own role in creating change, develop the strategic capacities to do so, and then apply those capacities, learn from them, and improve them over time
The role of pathogens in determining plant recruitment and distribution patterns in a western Amazonian floodplain
No full textThe main objective of this dissertation was to investigate plant host-pathogen dynamics and evaluate the Janzen and Connell (J-C) hypothesis explaining tropical ecosystem mechanism of diversity maintenance. The first chapter of this dissertation explores the influence of distance from fruiting trees and plant density on fungal disease incidence, insect damage and subsequent mortality of conspecific plants (J-C distance effect). I present novel data about plant pathogens, disease mechanisms, herbivores and host-pathogen interactions for one of the most common plant species of western Amazonia, Iriartea deltoidea. I found that insect herbivores are located in the vicinity of fruiting trees causing high mortality of conspecific seedlings as predicted by the J-C hypothesis. Surprisingly, the J-C distance pattern is not observed for lethal fungal pathogens such as Diplodia mutila.
The second chapter evaluates the nature and infection mechanisms of one of the most lethal pathogens found in I. deltoidea seedlings: Diplodia mutila. This fungus is ubiquitous and a generalist pathogen, causing disease and mortality in several host plants from different families. This characteristic could partially explain why I. deltoidea seedlings did not follow a J-C distance pattern. The potential implications of ubiquitous and pathogenic-endophytic fungi effects in tropical ecosystems are discussed. Endophyte-pathogens, hosts, herbivores and environmental conditions interact with each other, determining disease expression or repression.
The third chapter evaluates how environmental conditions, such as light availability, triggers disease expression and potentially defines plant distribution in tropical ecosystems. The ubiquitous and endophytic nature of many fungal pathogens also influences plant recruitment of dispersed propagules.
The fourth chapter examines the fate of dispersed seeds and seedlings in tropical ecosystems. Endophytic fungal pathogens could limit germination of dispersed seeds. Seedling mortality is high when dispersion is spatially and temporally aggregated. However seedling mortality is low when seedlings are randomly dispersed in the forest floor. Seedling mortality of dispersed propagules is produced by the synergistic effect of insect herbivores, fungal pathogens and environmental conditions. I conclude that pathogens in tropical ecosystems are not just agents of mortality or disease, but also organisms that influence survival and recruitment patterns of plant species.Ph.D.Includes bibliographical referencesby Patricia Alvare
AN INVESTIGATION INTO POTENTIAL NON-ANTIBIOTIC CONTRIBUTORS TO ANTIMICROBIAL RESISTANCE AND NON-ANTIBIOTIC THERAPEUTICS FOR ANTIBIOTIC-RESISTANT E. COLI
No full textAntimicrobial resistance is a threat to human health worldwide. It is estimated that by the year 2050, up to ten million deaths every year will be due to antibiotic-resistant bacterial infections and antimicrobial resistance. Many non-antibiotic drugs have been shown to have antibacterial properties, but it is unknown whether non-antibiotic drugs can contribute to antimicrobial resistance. They may also serve as alternative therapeutics for resistant infections.
In this work, we investigated the potential for non-antibiotic drugs to contribute to antibiotic resistance. We examined the antibacterial properties of antiviral drugs in vitro and demonstrated that repeated antiviral exposure can result in antibiotic cross-resistance in Escherichia coli and Bacillus cereus. Whole genome sequencing of antiviral-resistant E. coli revealed that antiviral exposure led to mutations in genes with known roles in antimicrobial resistance.
We explored the repurposing potential of some non-antibiotic drugs using clinical E. coli isolates. Our results showed that two drugs in particular—antiviral nucleoside analog zidovudine and antineoplastic pyrimidine analog fluorouracil—were effective at inhibiting the growth of multidrug-resistant E. coli within relevant physiological concentration ranges of these drugs. In an exploration into the potential for bacteriophages (phages) to serve as non-drug treatments for antibiotic-resistant bacteria, we isolated phages from environmental soil samples and challenged clinical E. coli isolates. Even multidrug-resistant E. coli were susceptible to the isolated phages. To explore the role that non-antibiotic drugs may play in either augmenting or impeding the efficacy of phage therapy, we treated E. coli with the antiviral zidovudine and demonstrated that zidovudine exposure altered phage susceptibility.
To better understand the presence and concentrations of non-antibiotic drugs such as antivirals in environmental water, we quantified antiviral drugs in wastewater samples and assessed their removal through wastewater treatment. We conducted acute aquatic toxicity tests using luminescent Aliivibrio fischeri and concluded that several non-antibiotic drugs exhibit high acute aquatic toxicity and can have additive effects as mixtures.
These findings indicate that non-antibiotics not only have the potential to contribute to antimicrobial resistance and acute aquatic toxicity but also may provide alternative therapeutics to combat antimicrobial resistant infections, all of which warrant further investigation
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