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A large outbreak of Legionnaires’ disease occurred at a California state prison in August 2015. We conducted environmental and epidemiological investigations to identify the most likely source of exposure and characterise morbidity. Sixty-four inmates had probable Legionnaires’ disease; 14 had laboratory-confirmed legionellosis. Thirteen (17%) inmates were hospitalised; there were no deaths. Ill inmates were more likely to be ⩾65 years old (P < 0.01), have the chronic obstructive pulmonary disease (P < 0.01), diabetes mellitus (P = 0.02), hepatitis C infection (P < 0.01), or end-stage liver disease (P < 0.01). The case-patients were in ten housing units throughout the prison grounds. All either resided in or were near the central clinical building (for appointments or yard time) during their incubation periods. Legionella pneumophila serogroup 1 was cultured from three cooling towers on top of the central medical clinic (range, 880–1200 cfu/ml). An inadequate water management program, dense biofilm within the cooling towers, and high ambient temperatures preceding the outbreak created an ideal environment for Legionella sp. proliferation. All state prisons were directed to develop local operating procedures for maintaining their cooling towers and the state health department added a review of the maintenance plans to their environmental inspection protocol.
A salmonellosis outbreak occurred at a California prison in April and May 2016. In a cohort study of 371 inmates, persons who consumed dishes from the prison kitchen made from ground meat had a higher attack rate (15%) than those who did not (4%) (risk ratio 3.4, 95% CI 1.1–10.6). The ground meat product was composed exclusively of beef, mechanically separated chicken (MSC) and textured vegetable protein; eight of eight lots of the product collected from the prison and processing facility were contaminated with Salmonella enterica of eight serotypes and 17 distinct PFGE patterns, including multidrug-resistant S. Infantis. Either the MSC or the beef could have been the source of the particular strains of S. enterica isolated from patients or the product. The microbiological evidence is most consistent with MSC as the source of the high levels of S. enterica in the epidemiologically linked meat product. Our findings contribute to the growing body of evidence about the hazard posed by the use of products containing raw mechanically separated poultry in kitchens in institutions.
Many scholars believe that intense warfare propelled state formation in early modern Europe because rulers built tax institutions to pay for wars. Scholars likewise cite milder geopolitical pressures to explain the lackluster state building in the developing world. The authors analyze episodes of ferocious warfare in and beyond Europe and find that despite similar fiscal strains, not all governments built strong tax institutions to service wartime debt. When net creditors in a country's credit market were part of the ruling political coalition, they pressed governments to diversify taxes and strengthen fiscal institutions to ensure debt service. But when net debtors held political sway, governments were indifferent to debt servicing and fiscal invigoration. Coalitional politics can help to explain why mounting debt-service obligations led to fiscal institution building in some cases, but not others. The analysis highlights how the private economic interests of ruling coalition members can affect state building.
Supernova (SN) 1987A has provided a unique opportunity to study how SN ejecta evolve in 30 years time scale. We report our ALMA spectral observations of SN 1987A, taken in 2014, 2015 and 2016, with detections of CO, 28SiO, HCO+ and SO, with weaker lines of 29SiO.
We find a dip in the SiO line profiles, suggesting that the ejecta morphology is likely elongated. The difference of the CO and SiO line profiles is consistent with hydrodynamic simulations, which show that Rayleigh-Taylor instabilities causes mixing of gas, with heavier elements much more disturbed, making more elongated structure.
Using 28SiO and its isotopologues, Si isotope ratios were estimated for the first time in SN 1987A. The estimated ratios appear to be consistent with theoretical predictions of inefficient formation of neutron rich atoms at lower metallicity, such as observed in the Large Magellanic Cloud (about half a solar metallicity).
The deduced large HCO+ mass and small SiS mass, which are inconsistent to the predictions of chemical model, might be explained by some mixing of elements immediately after the explosion. The mixing might have made some hydrogen from the envelope to sink into carbon and oxygen-rich zone during early days after the explosion, enabling the formation of a substantial mass of HCO+. Oxygen atoms may penetrate into silicon and sulphur zone, suppressing formation of SiS.
Our ALMA observations open up a new window to investigate chemistry, dynamics and explosive-nucleosynthesis in supernovae.
Background: Oncotype DX (ODX), a tumor gene profiling test, has been incorporated into clinical guidelines to aid in adjuvant chemotherapy decision making for early-stage, hormone receptor positive breast cancer patients. Despite United States (U.S.) guidelines, less than half of eligible women receive testing. Reasons for low usage are unclear: Our objective was to better understand U.S. oncologists’ ODX uptake and how they use ODX during adjuvant chemotherapy decision making.
Methods: We conducted semi-structured, ~30-minute phone interviews with medical and surgical oncologists in one U.S. State using purposive sampling. Oncologists were included if they saw greater than or equal to five breast cancer patients per week. Recruitment ended upon thematic saturation. Interviews were recorded, transcribed, and double-coded using template analysis.
Results: During analysis, themes emerged across three domains. First, organizational factors (i.e., departmental structure, ODX marketing, and medical/insurance guidelines) influenced ease of ODX use. Second, oncologists referenced the influence of interpersonal factors (e.g., normative beliefs and peer use of ODX) over their own practices and recommendations. Third, intrapersonal factors (e.g., oncologist attitudes, perceived barriers, and research gaps) were discussed: although oncologists largely held positive attitudes about ODX, they reported challenges with interpreting intermediate scores for treatment decisions and explaining test results to patients. Finally, oncologists identified several research gaps.
Conclusions: As more tumor gene profiling tests are incorporated into cancer care for treatment decision making, it is important to understand their use in clinical practice. This study identified multi-level factors that influence ODX uptake into clinical practice, providing insights into facilitators and modifiable barriers that can be leveraged for improving ODX uptake to aid treatment decision making.
To determine the impact of total household decolonization with intranasal mupirocin and chlorhexidine gluconate body wash on recurrent methicillin-resistant Staphylococcus aureus (MRSA) infection among subjects with MRSA skin and soft-tissue infection.
Three-arm nonmasked randomized controlled trial.
Five academic medical centers in Southeastern Pennsylvania.
Adults and children presenting to ambulatory care settings with community-onset MRSA skin and soft-tissue infection (ie, index cases) and their household members.
Enrolled households were randomized to 1 of 3 intervention groups: (1) education on routine hygiene measures, (2) education plus decolonization without reminders (intranasal mupirocin ointment twice daily for 7 days and chlorhexidine gluconate on the first and last day), or (3) education plus decolonization with reminders, where subjects received daily telephone call or text message reminders.
MAIN OUTCOME MEASURES
Owing to small numbers of recurrent infections, this analysis focused on time to clearance of colonization in the index case.
Of 223 households, 73 were randomized to education-only, 76 to decolonization without reminders, 74 to decolonization with reminders. There was no significant difference in time to clearance of colonization between the education-only and decolonization groups (log-rank P=.768). In secondary analyses, compliance with decolonization was associated with decreased time to clearance (P=.018).
Total household decolonization did not result in decreased time to clearance of MRSA colonization among adults and children with MRSA skin and soft-tissue infection. However, subjects who were compliant with the protocol had more rapid clearance
We present time-dependent, irradiated, accretion disk models for the black hole X-ray novae in the first hundred days of the dwarf nova-like outbursts, including the rise, precursor, maximum and the secondary re-flare. This work is based on the disk instability model (Kim, Mineshige & Wheeler 1996, Kim, Wheeler & Mineshige 1996). The model is reasonably consistent with the observed optical light curves. The irradiators are the central hot region around the black hole, and the corona or chromosphere above the accretion disk. In addition, we include the time-dependent shadowing effect and consequent blocking of the outer portions of the disk from the central irradiator. We find the stagnation phenomenon whereby the disk stays in the intermediate temperature stage between the hot and cool state. This can explain the recently discovered optical precursor rise prior to the maximum light in Nova Sco 1994 (Bailyn et al. 1995: see Fig. 1). We suggest the secondary re-flare after the maximum is due to the coupled effects of the irradiation and stagnation. In the model, the stagnation phenomenon during the rise results from the partial ionization and molecular opacity. In addition, we find irradiation-induced stagnation during the decay phase, which is consistent with the observed secondary re-flare in X-ray novae (see Fig. 1). In the overall evolution of model outbursts in the first hundred days, the outer disk is blocked from the irradiation and, in turn, the companion star may not be strongly irradiated. This suggests that there is no appreciable increase of mass transfer rate during the decay prior to the secondary re-flare, unlike the behaviour in the mass transfer burst models.
An analytic model has been constructed for the change of orbital elements because of tidal drag in a binary system where one of the components is compact (Lecar et al., 1976). The basic assumptions are (i) tides on the compact object are neglected (ii) only P2 deformations of the non-compact star are considered (iii) the lag angle is linearly proportional to the difference between the instantaneous orbital angular velocity and the spin angular velocity of the non-compact star (iv) the semi major axis a and eccentricity e do not change significantly in a single orbit. The results are exact solutions for a and ė as a function of e and the ratio of primary star to orbital angular velocity, Ω/ω.
Tidal instability in this model is manifest by the dynamical inability to attain or sustain synchronism. An analysis to second order in e and first order in (Ω/ω−1) shows that the criterion for instability is the same as in the work of Counselman (1973), namely ma2 > I where m is the reduced mass and I the moment of inertia of the primary star. This criterion is shown to apply to eccentric orbits and is thus more general than the criterion derived from the energetics of circular orbits. Stable systems may overshoot the condition of synchronism before settling into the final circular synchronous orbit.
In this study, we evaluated the association between high-risk human papillomavirus (hrHPV) and the vaginal microbiome. Participants were recruited in Nigeria between April and August 2012. Vaginal bacterial composition was characterized by deep sequencing of barcoded 16S rRNA gene fragments (V4) on Illumina MiSeq and HPV was identified using the Roche Linear Array® HPV genotyping test. We used exact logistic regression models to evaluate the association between community state types (CSTs) of vaginal microbiota and hrHPV infection, weighted UniFrac distances to compare the vaginal microbiota of individuals with prevalent hrHPV to those without prevalent hrHPV infection, and the Linear Discriminant Analysis effect size (LEfSe) algorithm to characterize bacteria associated with prevalent hrHPV infection. We observed four CSTs: CST IV-B with a low relative abundance of Lactobacillus spp. in 50% of participants; CST III (dominated by L. iners) in 39·2%; CST I (dominated by L. crispatus) in 7·9%; and CST VI (dominated by proteobacteria) in 2·9% of participants. LEfSe analysis suggested an association between prevalent hrHPV infection and a decreased abundance of Lactobacillus sp. with increased abundance of anaerobes particularly of the genera Prevotella and Leptotrichia in HIV-negative women (P < 0·05). These results are hypothesis generating and further studies are required.
To identify risk factors for recurrent methicillin-resistant Staphylococcus aureus (MRSA) colonization.
Prospective cohort study conducted from January 1, 2010, through December 31, 2012.
Five adult and pediatric academic medical centers.
Subjects (ie, index cases) who presented with acute community-onset MRSA skin and soft-tissue infection.
Index cases and all household members performed self-sampling for MRSA colonization every 2 weeks for 6 months. Clearance of colonization was defined as 2 consecutive sampling periods with negative surveillance cultures. Recurrent colonization was defined as any positive MRSA surveillance culture after clearance. Index cases with recurrent MRSA colonization were compared with those without recurrence on the basis of antibiotic exposure, household demographic characteristics, and presence of MRSA colonization in household members.
The study cohort comprised 195 index cases; recurrent MRSA colonization occurred in 85 (43.6%). Median time to recurrence was 53 days (interquartile range, 36–84 days). Treatment with clindamycin was associated with lower risk of recurrence (odds ratio, 0.52; 95% CI, 0.29–0.93). Higher percentage of household members younger than 18 was associated with increased risk of recurrence (odds ratio, 1.01; 95% CI, 1.00–1.02). The association between MRSA colonization in household members and recurrent colonization in index cases did not reach statistical significance in primary analyses.
A large proportion of patients initially presenting with MRSA skin and soft-tissue infection will have recurrent colonization after clearance. The reduced rate of recurrent colonization associated with clindamycin may indicate a unique role for this antibiotic in the treatment of such infection.
Infect. Control Hosp. Epidemiol. 2015;36(7):786–793
Amphibian populations have been declining worldwide, with multiple potential causes. At La Selva field station in north-eastern Costa Rica, previous work has shown that populations of many amphibians have decreased significantly since the 1970s, especially in primary forest. Starting in 1998, we investigated one of the most common frog species at La Selva, the poison-dart frog Oophaga pumilio (= Dendrobates pumilio). In a survey of 50 plots of 100 m2 in 1998, adult frogs were 4.6 times more abundant in secondary forest than in primary forest. Tadpoles were found only in secondary-forest plots. Almost all (89%) of the tadpoles were found in leaf axils of Dieffenbachia spp., which were much more abundant in secondary-forest than in primary-forest plots. The greater abundance of Dieffenbachia spp. in secondary forest was confirmed in a broad survey of ~11 km of trails within La Selva in 2002. When the same trails were resampled in 2012, Dieffenbachia spp. had been extirpated from 72% of the 50-m segments where plants were present in 2002; abundance was greatly reduced in the few trail segments where any Dieffenbachia spp. remained in 2012. The loss of Dieffenbachia spp., especially in secondary forest, removed the species most often used by O. pumilio for tadpole rearing. Based on counts of calling frogs in 2010, there was no difference in O. pumilio abundance in primary versus secondary forest, in striking contrast to multiple earlier surveys that found much greater frog abundance in secondary forest. We propose that the reason for the rapid decline in Dieffenbachia spp. is herbivory by the collared peccary (Pecari tajacu), which has increased in abundance at La Selva in recent years. A likely consequence is continued reduction in O. pumilio populations.
New multiple layered perovskites with general formula RbLaNaxNb2+xO7+3x, x = 1 and 2, were synthesized via a ceramic method. While the triple layered compound could be obtained by simple direct reaction, the quadruple layered one was synthesized using a two-step solid state approach. The compounds were characterized by X-ray powder diffraction; the newly obtained compounds appear to be isostructural with the previously reported RbCa2Nb3O10 and RbCa2NaNb4O13 for RbLaNaNb3O10 and RbLaNa2Nb4O13, respectively. Preliminary results show that the new compounds can undergo ion exchange reactions involving alkali metals and transition metal chlorides.
We report on mid-infrared (600 – 4000 cm-1), refection-type optical-Hall effect measurements on epitaxial graphene grown on C-face silicon carbide and present Landau-level transition features detected at 1.5 K as a function of magnetic field up to 8 Tesla. The Landau-level transitions are detected in reflection configuration at oblique incidence for wavenumbers below, across and above the silicon carbide reststrahlen range. Small Landau-level transition features are enhanced across the silicon carbide reststrahlen range due to surface-guided wave coupling with the electronic Landau-level transitions in the graphene layer. We analyze the spectral and magnetic-field dependencies of the coupled resonances, and compare our findings with previously reported Landau-level transitions measured in transmission configuration [4,5,6]. Additional features resemble transitions previously assigned to bilayer inclusion , as well as graphite . We discuss a model description to account for the electromagnetic polarizability of the graphene layers, and which is sufficient for quantitative model calculation of the optical-Hall effect data.
PILOT (the Pathfinder for an International Large Optical Telescope) is a proposed 2.5-m optical/infrared telescope to be located at Dome C on the Antarctic plateau. The atmospheric conditions at Dome C deliver a high sensitivity, high photometric precision, wide-field, high spatial resolution, and high-cadence imaging capability to the PILOT telescope. These capabilities enable a unique scientific potential for PILOT, which is addressed in this series of papers. The current paper presents a series of projects dealing with the distant (redshift >1) Universe, that have been identified as key science drivers for the PILOT facility. The potential for PILOT to detect the first populations of stars to form in the early Universe, via infrared projects searching for pair-instability supernovae and gamma-ray burst afterglows, is investigated. Two projects are proposed to examine the assembly and evolution of structure in the Universe: an infrared survey searching for the first evolved galaxies at high redshift, and an optical survey aimed at characterising moderate-redshift galaxy clusters. Finally, a large-area weak-lensing survey and a program to obtain supernova infrared light-curves are proposed to examine the nature and evolution of dark energy and dark matter.
PILOT (the Pathfinder for an International Large Optical Telescope) is a proposed 2.5-m optical/infrared telescope to be located at Dome C on the Antarctic plateau. Conditions at Dome C are known to be exceptional for astronomy. The seeing (above ∼30 m height), coherence time, and isoplanatic angle are all twice as good as at typical mid-latitude sites, while the water-vapour column, and the atmosphere and telescope thermal emission are all an order of magnitude better. These conditions enable a unique scientific capability for PILOT, which is addressed in this series of papers. The current paper presents an overview of the optical and instrumentation suite for PILOT and its expected performance, a summary of the key science goals and observational approach for the facility, a discussion of the synergies between the science goals for PILOT and other telescopes, and a discussion of the future of Antarctic astronomy. Paper II and Paper III present details of the science projects divided, respectively, between the distant Universe (i.e. studies of first light, and the assembly and evolution of structure) and the nearby Universe (i.e. studies of Local Group galaxies, the Milky Way, and the Solar System).
Here we report studies of photoelectrochemical (PEC) properties and ultrafast charge carrier relaxation dynamics of hydrogen-treated TiO2 (H:TiO2) nanowire arrays. PEC measurements showed the photocurrent density of the H:TiO2 was approximately double that of TiO2, attributed to increased donor density due to the formation of oxygen vacancies in H:TiO2 due to hydrogen treatment Charge carrier dynamics of H:TiO2, measured using fs transient absorption spectroscopy, showed a fast decay of ∼20 ps followed by slower decay persisting to tens of picoseconds. The fast decay is attributed to bandedge electron-hole recombination and the slower decay is attributed to recombination from trap states. Visible absorption is attributed to either electronic transitions from the valence band to oxygen vacancy states or from oxygen vacancy states to the conduction band of the TiO2, which is supported by incident photon to current conversion efficiency (IPCE) data. H:TiO2 represents a unique material with improved photoelectrochemical properties for applications including PEC water splitting, solar cells, and photocatalysis.