Escal Global - Academia.edu (original) (raw)

Papers by Escal Global

Critical Care, 2010

Introduction: Most data on de-escalation of empirical antimicrobial therapy has focused on ventil... more Introduction: Most data on de-escalation of empirical antimicrobial therapy has focused on ventilator-associated pneumonia. In this retrospective monocentric study, we evaluated de-escalation as part of a global strategy of empiric antibiotherapy management irrespective of the location and the severity of the infection. The goal of this trial was to assess the application of a de-escalation strategy and the impact in terms of re-escalation, recurrent infection and to identify variables associated with de-escalation. Methods: All consecutive patients treated with empiric antibiotic therapy and hospitalized in the intensive care unit for at least 72 hours within a period of 16 months were included. We compared the characteristics and outcome of patients who have experienced de-escalation therapy with those who have not. Results: A total of 116 patients were studied corresponding to 133 infections. Antibiotic therapy was de-escalated in 60 cases (45%). De-escalation, primarily accomplished by a reduction in the number of antibiotics used, was observed in 52% of severe sepsis or septic shock patients. Adequate empiric antibiotic and use of aminoglycoside were independently linked with de-escalation. De-escalation therapy was associated with a significant reduction of recurrent infection (19% vs 5% P = 0.01). Mortality was not changed by de-escalation. Conclusions: As part of a global management of empiric antibiotherapy in an intensive care unit, de-escalation might be safe and feasible in a large proportion of patients.

Biomaterials, 2011

The escalating global incidence of bacterial infection, particularly in chronic wounds, is a prob... more The escalating global incidence of bacterial infection, particularly in chronic wounds, is a problem that requires significant improvements to existing therapies. We have developed hyperbranched poly(NIPAM) polymers functionalized with the antibiotics Vancomycin and Polymyxin-B that are sensitive to the presence of bacteria in solution. Binding of bacteria to the polymers causes a conformational change, resulting in collapse of the polymers and the formation of insoluble polymer/bacteria complexes. We have applied these novel polymers to our tissue engineered human skin model of a burn wound infected with Pseudomonas aeruginosa and Staphylococcus aureus. When the polymers were removed from the infected skin, either in a polymer gel solution or in the form of hydrogel membranes, they removed bound bacteria, thus reducing the bacterial load in the infected skin model. These bacteria-binding polymers have many potential uses, including coatings for wound dressings.

Abstract—Supply chain management has become an important issue for Taiwan's manufacturing in... more Abstract—Supply chain management has become an important issue for Taiwan's manufacturing industry due to escalating global competition. Virtual vertical integration is an important issue in supply chain management. Because organizations only have limited ...

Veterinary Parasitology, 2006

Seriously escalating global anthelmintic resistance in gastrointestinal nematodes of small rumina... more Seriously escalating global anthelmintic resistance in gastrointestinal nematodes of small ruminants has spawned a variety of alternatives to anthelmintics for worm management, based on the need for sustainable Integrated Parasite Management (sIPM).

In the view of escalating global threat in security, it is imperative to have an automated detect... more In the view of escalating global threat in security, it is imperative to have an automated detection system that can pick up suspicious patterns of human movement in physical environments. It can give a forewarning before a planned attack happens or an ultimate security is breached. In the past, significant research on the Intrusion Detection was established, but limited to virtual environments like computer networks and operating systems. In this paper, we proposed a general security model for detecting suspicious patterns in physical environment. Suspicious patterns are subtle and we showed that they can be detected via an experiment.

World Futures, 1996

Genghis Khan's hordes sweeping through Asia killing, pillaging and burning villages, Alexander th... more Genghis Khan's hordes sweeping through Asia killing, pillaging and burning villages, Alexander the Great's army conquering all the countries lying between Macedonia and India, the amazing spread of Islam by sword and fire, the expansion of the Roman Empire, the Crusades, the ventures of Cortez and Pizarro, the colonialism of Great Britain and other European countries, and the Napoleonic warsall these are examples of unbridled violence and insatiable greed.

Advances in Parasitology, 2010

As local, national and international control and elimination efforts for the neglected tropical d... more As local, national and international control and elimination efforts for the neglected tropical diseases (NTDs) expand, there is increasing recognition that the 11 Southeast Asian countries together with the People's Republic of China (P.R. China) account for a significant burden of global poverty and disease. Indeed, approximately one-third of the world's intestinal helminthiases, most of the food-borne trematode infections, one-half of the active trachoma infections and a significant number of cases of lymphatic filariasis (LF), schistosomiasis and arboviral infections occur in this region. Among the Mekong countries, active programmes of mass drug administration are in place for the control and elimination of LF, as well as morbidity control aimed at school-aged children at risk of intestinal helminths. However, treatment coverage for intestinal helminth infections remains low in the largest Southeast Asian countries and in P.R. China's poorest provinces. The food-borne trematodiases, especially liver fluke infections, remain highly endemic in northern Thailand, Lao People's Democratic Republic and four provinces of P.R. China where they are an important risk factor for cholangiocarcinoma, while schistosomiasis continues to be an important zoonosis in P.R. China and the Philippines, although the former country has embarked on an ambitious elimination strategy. Through a global network for NTDs, an innovative finance mechanism Is being created to control the most common neglected diseases across Asia.

With increased availability of antiretroviral therapy, there is an escalating global trend to tes... more With increased availability of antiretroviral therapy, there is an escalating global trend to test all pregnant women for HIV in order to stop perinatal transmission. However, insufficient consideration is given to the impact this may have on the lives of these women and their families. Many women feel pressured into HIV testing during pregnancy, do not receive adequate pre-test counselling or do not give truly informed consent. Some women who test positive experience significantly more discrimination from their partners, families and community members than HIV-positive men do. As a consequence, large numbers of women diagnosed during pregnancy do not tell their husband their status because they fear blame, abandonment or abuse, including physical assault. Women who do disclose their HIV status may face dramatic negative repercussions on their own and their children's wellbeing. Consequently, it is unfair to test women during pregnancy solely or mainly to help prevent perinatal transmission if there are no available support services to protect the women's rights, enable them to live healthily after an HIV-positive diagnosis and engage them in the policies and programmes that affect women's lives. We need to create a climate that encourages HIV testing before pregnancy so that women can make informed reproductive choices. Men must be brought into the testing process through couple counselling before pregnancy and scaling up of voluntary counselling and testing programmes outside the antenatal care setting. In addition, people living with HIV have unique expertise and are very effective as peer counsellors. They have been under-utilised in the health care sector to provide support to newly-diagnosed people and to help eliminate AIDS-related shame and stigma.

SSRN Electronic Journal, 2000

CURRENCY BASKET REGIMES FOR SOUTHEAST ASIA:THE WORST SYSTEM WITH THE EXCEPTION OF ALL OTHERSRamki... more CURRENCY BASKET REGIMES FOR SOUTHEAST ASIA:THE WORST SYSTEM WITH THE EXCEPTION OF ALL OTHERSRamkishen S. RajanFollowing the recent financial crises in Southeast Asia and elsewhere, the perennial issueof the exchange rate policy options for small and open developing countries hasresurfaced. There seems to be an emerging consensus that the frequency with which "softpegs" have been susceptible to speculative attacks in

PLOS Pathogens, 2010

Tuberculosis (TB) is an escalating global health problem and improved vaccines against TB are urg... more Tuberculosis (TB) is an escalating global health problem and improved vaccines against TB are urgently needed. HLA-E restricted responses may be of interest for vaccine development since HLA-E displays very limited polymorphism (only 2 coding variants exist), and is not down-regulated by HIV-infection. The peptides from Mycobacterium tuberculosis (Mtb) potentially presented by HLA-E molecules, however, are unknown. Here we describe human T-cell responses to Mtb-derived peptides containing predicted HLA-E binding motifs and binding-affinity for HLA-E. We observed CD8 + T-cell proliferation to the majority of the 69 peptides tested in Mtb responsive adults as well as in BCG-vaccinated infants. CD8 + T-cells were cytotoxic against target-cells transfected with HLA-E only in the presence of specific peptide. These T cells were also able to lyse M. bovis BCG infected, but not control monocytes, suggesting recognition of antigens during mycobacterial infection. In addition, peptide induced CD8 + T-cells also displayed regulatory activity, since they inhibited T-cell proliferation. This regulatory activity was cell contact-dependent, and at least partly dependent on membrane-bound TGF-b. Our results significantly increase our understanding of the human immune response to Mtb by identification of CD8 + T-cell responses to novel HLA-E binding peptides of Mtb, which have cytotoxic as well as immunoregulatory activity.

Critical Care, 2010

Introduction: Most data on de-escalation of empirical antimicrobial therapy has focused on ventil... more Introduction: Most data on de-escalation of empirical antimicrobial therapy has focused on ventilator-associated pneumonia. In this retrospective monocentric study, we evaluated de-escalation as part of a global strategy of empiric antibiotherapy management irrespective of the location and the severity of the infection. The goal of this trial was to assess the application of a de-escalation strategy and the impact in terms of re-escalation, recurrent infection and to identify variables associated with de-escalation. Methods: All consecutive patients treated with empiric antibiotic therapy and hospitalized in the intensive care unit for at least 72 hours within a period of 16 months were included. We compared the characteristics and outcome of patients who have experienced de-escalation therapy with those who have not. Results: A total of 116 patients were studied corresponding to 133 infections. Antibiotic therapy was de-escalated in 60 cases (45%). De-escalation, primarily accomplished by a reduction in the number of antibiotics used, was observed in 52% of severe sepsis or septic shock patients. Adequate empiric antibiotic and use of aminoglycoside were independently linked with de-escalation. De-escalation therapy was associated with a significant reduction of recurrent infection (19% vs 5% P = 0.01). Mortality was not changed by de-escalation. Conclusions: As part of a global management of empiric antibiotherapy in an intensive care unit, de-escalation might be safe and feasible in a large proportion of patients.

Biomaterials, 2011

The escalating global incidence of bacterial infection, particularly in chronic wounds, is a prob... more The escalating global incidence of bacterial infection, particularly in chronic wounds, is a problem that requires significant improvements to existing therapies. We have developed hyperbranched poly(NIPAM) polymers functionalized with the antibiotics Vancomycin and Polymyxin-B that are sensitive to the presence of bacteria in solution. Binding of bacteria to the polymers causes a conformational change, resulting in collapse of the polymers and the formation of insoluble polymer/bacteria complexes. We have applied these novel polymers to our tissue engineered human skin model of a burn wound infected with Pseudomonas aeruginosa and Staphylococcus aureus. When the polymers were removed from the infected skin, either in a polymer gel solution or in the form of hydrogel membranes, they removed bound bacteria, thus reducing the bacterial load in the infected skin model. These bacteria-binding polymers have many potential uses, including coatings for wound dressings.

Abstract—Supply chain management has become an important issue for Taiwan's manufacturing in... more Abstract—Supply chain management has become an important issue for Taiwan's manufacturing industry due to escalating global competition. Virtual vertical integration is an important issue in supply chain management. Because organizations only have limited ...

Veterinary Parasitology, 2006

Seriously escalating global anthelmintic resistance in gastrointestinal nematodes of small rumina... more Seriously escalating global anthelmintic resistance in gastrointestinal nematodes of small ruminants has spawned a variety of alternatives to anthelmintics for worm management, based on the need for sustainable Integrated Parasite Management (sIPM).

In the view of escalating global threat in security, it is imperative to have an automated detect... more In the view of escalating global threat in security, it is imperative to have an automated detection system that can pick up suspicious patterns of human movement in physical environments. It can give a forewarning before a planned attack happens or an ultimate security is breached. In the past, significant research on the Intrusion Detection was established, but limited to virtual environments like computer networks and operating systems. In this paper, we proposed a general security model for detecting suspicious patterns in physical environment. Suspicious patterns are subtle and we showed that they can be detected via an experiment.

World Futures, 1996

Genghis Khan's hordes sweeping through Asia killing, pillaging and burning villages, Alexander th... more Genghis Khan's hordes sweeping through Asia killing, pillaging and burning villages, Alexander the Great's army conquering all the countries lying between Macedonia and India, the amazing spread of Islam by sword and fire, the expansion of the Roman Empire, the Crusades, the ventures of Cortez and Pizarro, the colonialism of Great Britain and other European countries, and the Napoleonic warsall these are examples of unbridled violence and insatiable greed.

Advances in Parasitology, 2010

As local, national and international control and elimination efforts for the neglected tropical d... more As local, national and international control and elimination efforts for the neglected tropical diseases (NTDs) expand, there is increasing recognition that the 11 Southeast Asian countries together with the People's Republic of China (P.R. China) account for a significant burden of global poverty and disease. Indeed, approximately one-third of the world's intestinal helminthiases, most of the food-borne trematode infections, one-half of the active trachoma infections and a significant number of cases of lymphatic filariasis (LF), schistosomiasis and arboviral infections occur in this region. Among the Mekong countries, active programmes of mass drug administration are in place for the control and elimination of LF, as well as morbidity control aimed at school-aged children at risk of intestinal helminths. However, treatment coverage for intestinal helminth infections remains low in the largest Southeast Asian countries and in P.R. China's poorest provinces. The food-borne trematodiases, especially liver fluke infections, remain highly endemic in northern Thailand, Lao People's Democratic Republic and four provinces of P.R. China where they are an important risk factor for cholangiocarcinoma, while schistosomiasis continues to be an important zoonosis in P.R. China and the Philippines, although the former country has embarked on an ambitious elimination strategy. Through a global network for NTDs, an innovative finance mechanism Is being created to control the most common neglected diseases across Asia.

With increased availability of antiretroviral therapy, there is an escalating global trend to tes... more With increased availability of antiretroviral therapy, there is an escalating global trend to test all pregnant women for HIV in order to stop perinatal transmission. However, insufficient consideration is given to the impact this may have on the lives of these women and their families. Many women feel pressured into HIV testing during pregnancy, do not receive adequate pre-test counselling or do not give truly informed consent. Some women who test positive experience significantly more discrimination from their partners, families and community members than HIV-positive men do. As a consequence, large numbers of women diagnosed during pregnancy do not tell their husband their status because they fear blame, abandonment or abuse, including physical assault. Women who do disclose their HIV status may face dramatic negative repercussions on their own and their children's wellbeing. Consequently, it is unfair to test women during pregnancy solely or mainly to help prevent perinatal transmission if there are no available support services to protect the women's rights, enable them to live healthily after an HIV-positive diagnosis and engage them in the policies and programmes that affect women's lives. We need to create a climate that encourages HIV testing before pregnancy so that women can make informed reproductive choices. Men must be brought into the testing process through couple counselling before pregnancy and scaling up of voluntary counselling and testing programmes outside the antenatal care setting. In addition, people living with HIV have unique expertise and are very effective as peer counsellors. They have been under-utilised in the health care sector to provide support to newly-diagnosed people and to help eliminate AIDS-related shame and stigma.

SSRN Electronic Journal, 2000

CURRENCY BASKET REGIMES FOR SOUTHEAST ASIA:THE WORST SYSTEM WITH THE EXCEPTION OF ALL OTHERSRamki... more CURRENCY BASKET REGIMES FOR SOUTHEAST ASIA:THE WORST SYSTEM WITH THE EXCEPTION OF ALL OTHERSRamkishen S. RajanFollowing the recent financial crises in Southeast Asia and elsewhere, the perennial issueof the exchange rate policy options for small and open developing countries hasresurfaced. There seems to be an emerging consensus that the frequency with which "softpegs" have been susceptible to speculative attacks in

PLOS Pathogens, 2010

Tuberculosis (TB) is an escalating global health problem and improved vaccines against TB are urg... more Tuberculosis (TB) is an escalating global health problem and improved vaccines against TB are urgently needed. HLA-E restricted responses may be of interest for vaccine development since HLA-E displays very limited polymorphism (only 2 coding variants exist), and is not down-regulated by HIV-infection. The peptides from Mycobacterium tuberculosis (Mtb) potentially presented by HLA-E molecules, however, are unknown. Here we describe human T-cell responses to Mtb-derived peptides containing predicted HLA-E binding motifs and binding-affinity for HLA-E. We observed CD8 + T-cell proliferation to the majority of the 69 peptides tested in Mtb responsive adults as well as in BCG-vaccinated infants. CD8 + T-cells were cytotoxic against target-cells transfected with HLA-E only in the presence of specific peptide. These T cells were also able to lyse M. bovis BCG infected, but not control monocytes, suggesting recognition of antigens during mycobacterial infection. In addition, peptide induced CD8 + T-cells also displayed regulatory activity, since they inhibited T-cell proliferation. This regulatory activity was cell contact-dependent, and at least partly dependent on membrane-bound TGF-b. Our results significantly increase our understanding of the human immune response to Mtb by identification of CD8 + T-cell responses to novel HLA-E binding peptides of Mtb, which have cytotoxic as well as immunoregulatory activity.