Managing community acquired pneumonia in the elderly – the next generation of pharmacotherapy on the horizon

Introduction: Community acquired pneumonia (CAP) is associated with high rates of morbidity and mortality, especially among the elderly. Antibiotic treatment for CAP in the elderly is particularly challenging for many reasons, including compliance issues, immunosuppression, polypharmacy and antimicrobial resistance. There are few available antibiotics that are able to address these concerns.

Areas covered: After a systematic review of the current literature, we describe seven novel antibiotics that are currently in advanced stages of development (phase 3 and beyond) and show promise for the treatment of CAP in those over the age of 65. These antibiotics are: Solithromycin, Pristinamycin, Nemonaxacin, Lefamulin, Omadacycline, Ceftobiprole and Delafloxacin. Using a novel conceptual framework designed by the present authors, known as the ‘San Antonio NIPS model’, we evaluate their strengths and weaknesses based on their ability to address the unique challenges that face the elderly.

Expert opinion: All seven antibiotics have potential value for effective utilization in the elderly, but to varying degrees based on their NIPS model score. The goal of this model is to reorganize a clinician’s focus on antibiotic choices in the elderly and bring attention to a seldom discussed topic that may potentially become a health-care crisis in the next decade.     

Effect of Medicaid payment levels on access to obstetrical care.

Across the nation, the number of providers serving pregnant Medicaid clients has dropped precipitously. In an effort to retain providers, in 1986 the Maryland Medicaid program tripled reimbursement fees for deliveries. This raised Medicaid payments for perinatal care to levels roughly comparable to those paid by private insurers. Providers' participation can be measured using two criteria: the total number of participating providers in a given country and the number of deliveries performed by targeted providers. The fee increase was associated with an overall stabilization in the number of providers performing deliveries. Providers performed slightly more deliveries after the fee increase, relative to predictions derived from statistical models. One-quarter of all providers increased their participation on a scale commensurate with the fee increase.     

Negotiating Sex and Sexualities: The Use of Sexual Tags in the Brazilian Sex Trade Workplace

Based on data from participant observation and interviews with Brazilian sex workers and their clients, I examined the intersections of sexual and gender identities with sexual behaviors. Specifically, I was interested in how sex workers managed and negotiated their sexualities in the workplace. First, I described the layout and the social actors at a popular termas in a major Brazilian city. Then, I examined the interactions in the termas and how Brazilian sex workers use sexual identity terms to describe themselves. I argued that the use of these terms do not necessarily indicate sex workers’ adoption of that sexual identity. Critical to them are the symbolic presentation of gender identity and the presentation of self at the work place. I developed a theoretical construct, sexual tags, which contributes to the literature by suggesting that sexual identity is situational and, more importantly, that the terms may not mean as much to the individuals or to be consistent with our understanding of what they ought to imply, especially when individuals are importing western terms to relate to their foreign clients. While using sexual tags does not preclude sex workers from eventually adopting that identity, it could also mean that some sex workers are claiming a sexual identity simply for strategic purposes. Another possible scenario is that sexual tags reflect the diverse interpretations of sexuality because of the available choices created by the situational manipulation of sexual meanings within a local context.     

From well-being to positive mental health: conceptualization and qualitative development of an instrument in Singapore

Purpose

There is no global definition of well-being. Cultural differences in the perception of well-being and the social and behavioral contexts further limit its measurement. Existing instruments are developed in Western societies that differ in their conceptualization of well-being from Asian populations. Moreover, very few instruments address the multidimensional construct of well-being.

Methods

Literature was reviewed to develop a priori conceptual framework of mental health and well-being. Concepts were identified based on specific criteria to guide the qualitative investigations. Finally, focus group discussions were conducted among adults belonging to the three major ethnicities in Singapore to identify salient domains of mental health and well-being.

Results

Mental well-being is a multidimensional construct constituting of positive affect, satisfaction, and psychological functioning. While well-being explains the functional and psychological components, positive mental health is a combination of these and the skills required to achieve them. Although there is an overlap between the concepts identified from the literature and those identified in Singapore, certain differences existed, particularly with the relevance attributed to family interactions and religiosity or spirituality. Similar findings were observed across the three ethnic groups.

Conclusion

Domains identified can be used to develop a culturally relevant instrument in Singapore.     

Biodegradation of a polyurethane in vitro

This study examines the effect of in vitro exposure to enzymes on the performance properties of Biomer, a segmented polyetherurethane used in a number of blood-contacting devices such as catheters, heart assist pumps, and chambers for artificial hearts. The ultrathin samples were treated with two proteolytic enzymes, papain and urease, for periods of 1-6 months at 37 degrees C. The treated Biomer samples were subjected to chemical and physical analysis. Effects of biodegradation by the enzymes were assessed by fatigue tests, gel permeation chromatography (GPC), and attenuated total reflectance-Fourier transform infrared (ATR-FTIR) analysis. Papain was found to be more effective in degrading the polymer than urease. Mechanisms for enzymic degradation are proposed.     

Ankle: surface coil MR imaging at 1.5 T

High-field surface coil magnetic resonance (MR) images were obtained of 12 ankles: two from healthy volunteers, seven from patients, and three from fresh cadavers. The cadaver ankles were sectioned in the coronal, sagittal, and axial planes for direct comparison with the MR images. Plain film confirmation of pathologic conditions was obtained in all patients, and five underwent arthroscopy or surgery, or both. MR imaging provided excellent delineation of ligaments and cartilaginous structures in all cases.