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Background Following a global shortage of piperacillin/tazobactam in 2017, a formulary decision was taken at a large District General Hospital in the East of England to partly replace piperacillin/tazobactam with either temocillin as monotherapy or as part of a combination regimen. A retrospective audit was then conducted to assess the clinical effectiveness of temocillin therapy. Methods Data from patients admitted to Watford General Hospital between May and August 2017 and treated with temocillin were reviewed retrospectively. Clinical characteristics of patients, data related to the episode of infection, clinical success, tolerance and mortality were analysed. Results Temocillin was used in 126 patients with median age of 73 years. Infection episodes mostly originated from the abdomen (n = 46), the lung (n = 40) and the urinary tract (n = 21). Seventy-seven patients received temocillin as first-line therapy and 106 received it empirically, with temocillin prescribed in combination with another antibiotic in 82% of the empirically treated cases. Clinical success was observed in 88.9% of cases with no difference between patients treated empirically and others (89.6% versus 85%) or in efficacy among abdominal (91%), pulmonary (87.5%) and urinary (81%) infections. One case of Clostridioides difficile infection was reported in a patient treated with four different antibiotics. During the shortage period, the hospital’s standardized mortality ratio was significantly lower when compared with the same period of the preceding year (85 versus 96). Conclusions Using temocillin as part of an empirical strategy is feasible and safe as long as appropriate antibiotic combination is recommended based upon the indication and the likely bacterial pathogen.

In systems ranging from mobile devices to servers, DRAM has a big impact on performance and contributes a significant part of the total consumed power. The performance and power of the system depends on the architecture of the DRAM chip, the design of the memory controller and the access patterns received by the memory controller. Thus, evaluating the impact of DRAM design decisions requires a holistic approach that includes an appropriate model of the DRAM bank, a realistic controller and DRAM power model, and a representative workload, which requires a full system simulator running a complete software stack. In this paper, we introduce DRAMSpec, a high-level DRAM bank/chip modeling tool. Our contribution is to move the DRAM modeling abstraction level from the circuit level to the DRAM bank and by the integration in full system simulators we allow system or processor designers (non-DRAM experts) to tune future DRAM architectures for their target applications. We demonstrate the merits of DRAMSpec by exploring the influence of DRAM row-buffer (page) size and the number of banks on performance and power of a server application (memcached). Our new DRAM design offers a 16% DRAM performance improvement and 13% DRAM energy saving compared to standard comodity DDR3 devices. Additionally, we demonstrate how our tool is able to aid in evaluating novel DRAM architectures, such as the Hybrid Memory Cube (HMC), for which no DRAM datasheets are available. Finally, we highlight the DRAM technology scaling for a specific HMC architecture and we quantify the impact on latency and power.

It is recognized today that human lives the information age, which ischaracterized by the multiplicity of its data and the complexity of its aspects andthe most important thing is characterized by "information" that will determine theprogress of the people, the more able countries to devise ways to protect theinformation and how to make the best use of them whenever it is an indication ofits progress and its ability to face obstacles to development and the informationsources are diverse and interrelated up to the level of complexity that they can beanalyzed and dealt with the existence of developed computer systems, that storedand processed the information .And because maps are also considered sources ofinformation which use in management and project planning, and being animportant means of connecting ideas and planning them so it necessitated the needfor the emergence of advanced systems have the ability to draw and designschemes and production of digital maps. With possibility of linking information(metadata) with the real location on the Earth's surface, called the (spatial data).The emergence of these systems are scientific leap on the in geographic scienceespecially spatial data that has accumulated over the centuries and resulted in ahuge amount of data and information. These systems added a lot in the field ofbuilding spatial database which can updating and help in treating maps accuratelyand effectively combines the advantages of the two systems (information systemsand systems of digital maps), which was named "GIS" systems which electronic NO.10digital competent to enter, store and retrieve, analyze data . And connect themwith large areas of maps that can not be saved on security on the paper. The data issaved with maps in a coherent manner so as to facilitate the user to display the datawith maps and several methods as well as a calculation processing to extract theresults and reports in a few time and effort and use them in decision-making whichhelps to speed the study and analysis the information and support decision-makersin a number of important decisions concerning projects which requires accuracyand speed.

The purpose of this study was to present an arthroscopic technique for the treatment for posteromedial and central cartilage defects of the talus using anterior arthroscopic portals and without performing a medial malleolar osteotomy.Nine fresh cadavers were dissected. Autografts were implanted under arthroscopy using a retrograde osteochondral transplantation system, and their position was estimated using specific angular calibrators and later confirmed by software analysis of two photographs of the disarticulated ankle joint.In eight cases, the congruence between the surrounding articular cartilage and the cartilage of the graft was high, with differences measuring1 mm. There were no iatrogenic cartilage lesions of the tibial plafond and no fractures of the talus. All the autografts remained stable during full range of motion cycles of the ankle joint. One failure was reported.This cadaveric study showed that the retrograde osteochondral autograft transplantation technique in the talus is feasible. It can be used to restore the posteromedial and central talar articular surfaces using conventional ankle arthroscopic instrumentation and anterior arthroscopic portals without resorting to a medial malleolar osteotomy. Further clinical and biomechanical studies are required to prove the efficacy of this technique and its reproducibility in routine clinical practice.

DRAMs are very sensitive to temperature changes as they use capacitors as volatile and leaky bit storage elements. 3D stacking of heterogenous dies provokes more and more challenges, such as high power densities and thermal dissipation, and has a much stronger impact on the retention time of 3D stacked WIDE I/O DRAMs that are placed on top of an MPSoC. Consequently, it is very important to study the temperature behavior of WIDE I/O DRAMs and explore on high-level with advanced modeling how the thermal issues can be mitigated. In this paper, we demonstrate thermal modeling of 3D integrated ICs and we further provide detailed measurements on temperature-dependent bit error rates of WIDE I/O DRAMs based on real silicon (WIOMING chip) and high-level explorations with advanced modeling and tools, such as gem5 (full system-simulator), DRAMSys and DOCEAs Ace Thermal ModelerTM (ATM), to obtain mitigation paths for thermal problems in 3D stacked DRAMs.

In systems ranging from mobile devices to servers, DRAM has a big impact on performance and contributes a significant part of the total consumed power. The performance and power of the system depends on the architecture of the DRAM chip, the design of the memory controller and the access patterns received by the memory controller. Evaluating the impact of DRAM design decisions therefore requires a holistic approach that includes an appropriate model of the DRAM bank, a realistic controller and DRAM power model, and a representative workload which requires a full system simulator, running a complete software stack. In this paper, we introduce DRAMSpec, an open source high-level DRAM bank modeling tool. As major contribution, we move the DRAM modeling abstraction level from detailed circuit level to the DRAM bank and by the integration in full system simulators we allow system or processor designers (non-DRAM experts) to tune future DRAM architectures for their target applications and use cases. We demonstrate the merits of DRAMSpec by exploring the influence of DRAM row buffer size and the number of banks on performance and power of a server application (memcached). Our new DRAM design offers a 16% DRAM performance improvement and 13% DRAM energy saving compared to standard comodity DDR3 devices. Additionally, we demonstrate how our tool is able to aid in evaluating novel DRAM architectures for which no datasheets are available.