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Describe the epidemiological and molecular characteristics of an outbreak of Klebsiella pneumoniae carbapenemase (KPC)–producing organisms and the novel use of a cohorting unit for its control.
A 566-room academic teaching facility in Milwaukee, Wisconsin.
Solid-organ transplant recipients.
Infection control bundles were used throughout the time of observation. All KPC cases were intermittently housed in a cohorting unit with dedicated nurses and nursing aids. The rooms used in the cohorting unit had anterooms where clean supplies and linens were placed. Spread of KPC-producing organisms was determined using rectal surveillance cultures on admission and weekly thereafter among all consecutive patients admitted to the involved units. KPC-positive strains underwent pulsed-field gel electrophoresis and whole-genome sequencing.
A total of 8 KPC cases (5 identified by surveillance) were identified from April 2016 to April 2017. After the index patient, 3 patients acquired KPC-producing organisms despite implementation of an infection control bundle. This prompted the use of a cohorting unit, which immediately halted transmission, and the single remaining KPC case was transferred out of the cohorting unit. However, additional KPC cases were identified within 2 months. Once the cohorting unit was reopened, no additional KPC cases occurred. The KPC-positive species identified during this outbreak included Klebsiella pneumoniae, Enterobacter cloacae complex, and Escherichia coli. blaKPC was identified on at least 2 plasmid backbones.
A complex KPC outbreak involving both clonal and plasmid-mediated dissemination was controlled using weekly surveillances and a cohorting unit.
The goal of this study was to perform in situ electrochemical polymerization of poly(3,4-ethylenedioxythiophene) (PEDOT) in peripheral nerves to create a soft, precisely located injectable conductive polymer electrode for bi-directional communication. Intraneural PEDOT polymerization was performed to target both outer and inner fascicles via custom fabricated 3D printed cuff electrodes and monomer injection strategies using a combination electrode-cannula system. Electrochemistry, histology, and laser light sheet microscopy revealed the presence of PEDOT at specified locations inside of peripheral nerve. This work demonstrates the potential for using in situ PEDOT electrodeposition as an injectable electrode for recording and stimulation of peripheral nerves.
The ability to interface electronic materials with the peripheral nervous system is required for stimulation and monitoring of neural signals. Thus, the design and engineering of robust neural interfaces that maintain material-tissue contact in the presence of material or tissue micromotion offer the potential to conduct novel measurements and develop future therapies that require chronic interface with the peripheral nervous system. However, such remains an open challenge given the constraints of existing materials sets and manufacturing approaches for design and fabrication of neural interfaces. Here, we investigated the potential to leverage a rapid prototyping approach for the design and fabrication of nerve cuffs that contain supporting features to mechanically stabilize the interaction between cuff electrodes and peripheral nerve. A hybrid 3D printing and robotic-embedding (i.e., pick-and-place) system was used to design and fabricate silicone nerve cuffs (800 µm diameter) containing conforming platinum (Pt) electrodes. We demonstrate that the electrical impedance of the cuff electrodes can be reduced by deposition of the conducting polymer poly(3,4-ethylenedioxythiophene) polystyrene sulfonate (PEDOT:PSS) on cuff electrodes via a post-processing electropolymerization technique. The computer-aided design and manufacturing approach was also used to design and integrate supporting features to the cuff that mechanically stabilize the interface between the cuff electrodes and the peripheral nerve. Both ‘self-locking’ and suture-assisted locking mechanisms are demonstrated based on the principle of making geometric alterations to the cuff opening via 3D printing. Ultimately, this work shows 3D printing offers considerable opportunity to integrate supporting features, and potentially even novel electronic materials, into nerve cuffs that can support the design and engineering of next generation neural interfaces.
The COMA report on The Nutritional Aspects of Cardiovascular Disease (1994) recommended that the intake of long chain n-3 polyunsaturated fatty acids, including eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), by the UK population should double. EPA and DHA in the human diet are derived principally from oily fish. The aim of this experiment was to determine the effect of increasing levels of fish oil in the diet at two levels of vitamin E supplementation, on intake, milk production, the extent of uptake of EPA and DHA into milk fat at levels exceeding those investigated to date, and the effect of a dietary supplement of vitamin E on fatty acid content.
Mansbridge (1995) reported that replacing ground wheat with a mix of ground wheat and maize grain increased milk protein concentration, which led the authors to speculate that increased inclusion of maize grain increased rumen by-pass starch. Indeed, de Visser et al (1990) reported that feeding less rapidly degradable starches has led to increased milk protein concentration.
The objective of this study was to examine the effects of starch concentration and source on feed intake, milk yield and milk composition of dairy cows.
The Taipan galaxy survey (hereafter simply ‘Taipan’) is a multi-object spectroscopic survey starting in 2017 that will cover 2π steradians over the southern sky (δ ≲ 10°, |b| ≳ 10°), and obtain optical spectra for about two million galaxies out to z < 0.4. Taipan will use the newly refurbished 1.2-m UK Schmidt Telescope at Siding Spring Observatory with the new TAIPAN instrument, which includes an innovative ‘Starbugs’ positioning system capable of rapidly and simultaneously deploying up to 150 spectroscopic fibres (and up to 300 with a proposed upgrade) over the 6° diameter focal plane, and a purpose-built spectrograph operating in the range from 370 to 870 nm with resolving power R ≳ 2000. The main scientific goals of Taipan are (i) to measure the distance scale of the Universe (primarily governed by the local expansion rate, H0) to 1% precision, and the growth rate of structure to 5%; (ii) to make the most extensive map yet constructed of the total mass distribution and motions in the local Universe, using peculiar velocities based on improved Fundamental Plane distances, which will enable sensitive tests of gravitational physics; and (iii) to deliver a legacy sample of low-redshift galaxies as a unique laboratory for studying galaxy evolution as a function of dark matter halo and stellar mass and environment. The final survey, which will be completed within 5 yrs, will consist of a complete magnitude-limited sample (i ⩽ 17) of about 1.2 × 106 galaxies supplemented by an extension to higher redshifts and fainter magnitudes (i ⩽ 18.1) of a luminous red galaxy sample of about 0.8 × 106 galaxies. Observations and data processing will be carried out remotely and in a fully automated way, using a purpose-built automated ‘virtual observer’ software and an automated data reduction pipeline. The Taipan survey is deliberately designed to maximise its legacy value by complementing and enhancing current and planned surveys of the southern sky at wavelengths from the optical to the radio; it will become the primary redshift and optical spectroscopic reference catalogue for the local extragalactic Universe in the southern sky for the coming decade.
Parasites of the genera Plasmodium and Haemoproteus (Apicomplexa: Haemosporida) are a diverse group of pathogens that infect birds nearly worldwide. Despite their ubiquity, the ecological and evolutionary factors that shape the diversity and distribution of these protozoan parasites among avian communities and geographic regions are poorly understood. Based on a survey throughout the Neotropics of the haemosporidian parasites infecting manakins (Pipridae), a family of Passerine birds endemic to this region, we asked whether host relatedness, ecological similarity and geographic proximity structure parasite turnover between manakin species and local manakin assemblages. We used molecular methods to screen 1343 individuals of 30 manakin species for the presence of parasites. We found no significant correlations between manakin parasite lineage turnover and both manakin species turnover and geographic distance. Climate differences, species turnover in the larger bird community and parasite lineage turnover in non-manakin hosts did not correlate with manakin parasite lineage turnover. We also found no evidence that manakin parasite lineage turnover among host species correlates with range overlap and genetic divergence among hosts. Our analyses indicate that host switching (turnover among host species) and dispersal (turnover among locations) of haemosporidian parasites in manakins are not constrained at this scale.
Borehole inclinometers are standard equipment for field glaciologists and are commonly used for investigating the flow law of ice and for measuring the spatial position of englacial and sub-surface sensors. The recent development, at the University of British Columbia (UBC), of a prototype inclinometer that employs a three-component fluxgate magentometer to obtain a compass bearing has stimulated our interest in borehole inclinometry. Following a review of various approaches to glacier inclinometry, we present a unified theory of data interpretation that can be applied to all inclinometers, discuss the application of the theory to the UBC inclinometer, and discuss the sensitivity of the theory to error in the data.
Direct measurements of the properties of subglacial water are necessary for understanding water flow beneath glaciers. In this paper we describe the construction, calibration and field usage of two instruments—one that measures turbidity and the other that measures electrical conductivity of subglacial water. The sensors are inexpensive and reliable. To demonstrate the potential usefulness of these devices, we present samples of data obtained from beneath Trapridge Glacier, Yukon Territory, Canada.
Deformation beneath soft-bedded glaciers may be a physical mechanism that contributes to flow instabilities such as surging. If the role of bed deformation is to be understood, a rheological description is required, but the development of a rheology is hampered by a lack of in situ stress and strain measurements. In this paper, we describe four techniques for measuring subglacial strain. Three of these give continuous strain measurements, a capability that permits calculation of instantaneous strain rates and allows comparison of strain data with other time series. To demonstrate the practicability of the techniques, sample results from three summers of experimentation beneath Trapridge Glacier. Yukon Territory, are presented. The data show that subglacial strain rate can vary in amplitude and polarity on an hourly time-scale,and that the instantaneous strain rate can exceed the mean strain rale by an order of magnitude. Observed negative strain rates suggest extrusive flow within basal sediments.
Streptococcus pneumoniae (Spn) is a leading cause of community-acquired pneumonia (CAP), yet existing diagnostic tools remain inadequate. We aimed to evaluate laboratory and radiological methods for detecting pneumococcal aetiology in CAP patients and to estimate Spn prevalence in this group. All-aged patients hospitalized with clinically defined CAP in northern Togo were enrolled during 2010–2013. Latent class analysis pooled results of semi-automated blood culture (SABC), whole blood lytA real-time polymerase chain reaction (rt-PCR), serum C-reactive protein (CRP), and chest radiography (CXR) and categorized patients as likely pneumococcal or non-pneumococcal CAP. We enrolled 1684 patients; 1501 had results for all tests. CXR, SABC, lytA rt-PCR and CRP >71·2 mg/l had sensitivities of 94% [95% confidence interval (CI) 87–100], 13% (95% CI 10–16), 17% (95% CI 14–21) and 78% (95% CI 75–80), and specificities of 88% (95% CI 84–93), 100% (95% CI 99–100), 97% (95% CI 96–99) and 77% (95% CI 75–79), respectively. Pneumococcal attributable proportion was 34% (95% CI 32–37), increasing with age and in men. We estimated that Spn caused one third of CAP. Whole blood lytA rt-PCR was more sensitive than SABC; both had low sensitivity and high specificity. Conversely CXR was highly sensitive and reasonably specific; it could be a useful tool for epidemiological studies aiming to define Spn pneumonia incidence across all ages.
ɛ Per (45 Per, HR 1220, HD 24760, ADS 2888A) is a star which was used for years as a spectrophotometric and MKK classification standard. Nowadays it is known as an archetype of early-type line-profile variables (LPV). The variations are so pronounced that they were misinterpreted for a composite spectrum (B0.5+A2) and the star was even reported to be a double-lined spectroscopic binary (Petrie 1958). Since 1983, the characteristics of line-profile variability in the spectrum of ɛ Per have been intensively studied (Bolton 1983, Smith 1985, Gies & Kullavanijaya 1988). The recent investigations of RV variations of ɛ Per led to the conclusion that ɛ Per is a spectroscopic binary with a period of about 14.05 days and a rather eccentric orbit (Harmanec & Tarasov 1990). The issue of the binary nature (with a very eccentric orbit) is of utmost importance since it could be causally related to the extremely large observed line-profile variations (e.g., Polfliet & Smeyers 1990, Tassoul & Tassoul 1992).
Just over a century ago Heinrich Hagenmeyer published his definitive book on Peter the Hermit. It has shaped most subsequent discussions of Peter’s career, and it must be said at once that no completely new material has come to light since then. There is, however, a problem of perpetual interest posed by the divergences among twelfth-century accounts of the origins of the First Crusade. Until the advent of modern historiography, it was accepted that the expedition was provoked by an appeal from the church of Jerusalem, brought to the west by Peter the Hermit, who had visited it as a pilgrim, had seen a vision of Christ and had been entrusted by the patriarch with a letter asking for help against the oppression of the Christians there. The crusade was on this view born in the atmosphere of pilgrimage, visions and popular preaching which continued to mark its course, and is so evident in, for example, the discovery of the Holy Lance and the visions and messages which accompanied it. Peter is in some sense the embodiment of these charismatic elements, and there is no controversy about his prominence in the history of the movement. He appears as a sensationally successful preacher, who recruited and led a large contingent which left in advance of the main armies, and was cut to pieces in Asia Minor. Thereafter, he appears in the chronicles in a variety of capacities: as a runaway, and an ambassador to the Moslems, as an adviser, as an associate with the popular element among the crusaders, and finally as a guide to the sacred sites at Jerusalem. It is, however, not with these wider aspects of his career that we wish to deal in this paper, but with his special role in the summoning of the expedition. The older view was that he was its first author. Every student of the early church is familiar with militant monks and hermits. It was once believed that Peter, their spiritual descendant, was the most supremely successful of all the ascetic warmongers.
In order to solve the partial differential equations that arise in the Hartree- Fock theory for diatomicmolecules and inmolecular theories that include electron correlation, one needs efficient methods for solving partial differential equations. In this article, we present numerical results for a two-variablemodel problem of the kind that arises when one solves the Hartree-Fock equations for a diatomic molecule. We compare results obtained using the spline collocation and domain decomposition methods with third-order Hermite splines to results obtained using the more-established finite difference approximation and the successive over-relaxation method. The theory of domain decomposition presented earlier is extended to treat regions that are divided into an arbitrary number of subregions by families of lines parallel to the two coordinate axes. While the domain decomposition method and the finite difference approach both yield results at the micro-Hartree level, the finite difference approach with a 9- point difference formula produces the same level of accuracy with fewer points. The domain decompositionmethod has the strength that it can be applied to problemswith a large number of grid points. The time required to solve a partial differential equation for a fine grid with a large number of points goes down as the number of partitions increases. The reason for this is that the length of time necessary for solving a set of linear equations in each subregion is very much dependent upon the number of equations. Even though a finer partition of the region has more subregions, the time for solving the set of linear equations in each subregion is very much smaller. This feature of the theory may well prove to be a decisive factor for solving the two-electron pair equation, which – for a diatomic molecule – involves solving partial differential equations with five independent variables. The domain decomposition theory also makes it possible to study complex molecules by dividing them into smaller fragments that are calculated independently. Since the domain decomposition approachmakes it possible to decompose the variable space into separate regions in which the equations are solved independently, this approach is well-suited to parallel computing.
Although television (TV) viewing is frequently paired with snacking among young children, little is known about the environment in which caregivers promote this behaviour. We describe low-income pre-schoolers’ snacking and TV viewing habits as reported by their primary caregivers, including social/physical snacking contexts, types of snacks and caregiver rationales for offering snacks. These findings may support the development of effective messages to promote healthy child snacking.
Semi-structured interviews assessed caregiver conceptualizations of pre-schoolers’ snacks, purpose of snacks, snack context and snack frequency.
Interviews occurred in Boston, Massachusetts and Philadelphia, Pennsylvania, USA.
Forty-seven low-income multi-ethnic primary caregivers of children aged 3–5 years (92 % female, 32 % Hispanic/Latino, 34 % African American) described their child’s snacking in the context of TV viewing.
TV viewing and child snacking themes were described consistently across racial/ethnic groups. Caregivers described snacks offered during TV viewing as largely unhealthy. Labels for TV snacks indicated non-nutritive purposes, such as ‘time out’, ‘enjoyment’ or ‘quiet.’ Caregivers’ primary reasons for providing snacks included child’s expectations, behaviour management (e.g. to occupy child) and social time (e.g. family bonding). Some caregivers used TV to distract picky children to eat more food. Child snacking and TV viewing were contextually paired by providing child-sized furniture (‘TV table’) specifically for snacking.
Low-income caregivers facilitate pre-schoolers’ snacking and TV viewing, which are described as routine, positive and useful for non-nutritive purposes. Messages to caregivers should encourage ‘snack-free’ TV viewing, healthy snack options and guidance for managing children’s behaviour without snacks or TV.