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To investigate a Middle East respiratory syndrome coronavirus (MERS-CoV) outbreak event involving multiple healthcare facilities in Riyadh, Saudi Arabia; to characterize transmission; and to explore infection control implications.
Cases presented in 4 healthcare facilities in Riyadh, Saudi Arabia: a tertiary-care hospital, a specialty pulmonary hospital, an outpatient clinic, and an outpatient dialysis unit.
Contact tracing and testing were performed following reports of cases at 2 hospitals. Laboratory results were confirmed by real-time reverse transcription polymerase chain reaction (rRT-PCR) and/or genome sequencing. We assessed exposures and determined seropositivity among available healthcare personnel (HCP) cases and HCP contacts of cases.
In total, 48 cases were identified, involving patients, HCP, and family members across 2 hospitals, an outpatient clinic, and a dialysis clinic. At each hospital, transmission was linked to a unique index case. Moreover, 4 cases were associated with superspreading events (any interaction where a case patient transmitted to ≥5 subsequent case patients). All 4 of these patients were severely ill, were initially not recognized as MERS-CoV cases, and subsequently died. Genomic sequences clustered separately, suggesting 2 distinct outbreaks. Overall, 4 (24%) of 17 HCP cases and 3 (3%) of 114 HCP contacts of cases were seropositive.
We describe 2 distinct healthcare-associated outbreaks, each initiated by a unique index case and characterized by multiple superspreading events. Delays in recognition and in subsequent implementation of control measures contributed to secondary transmission. Prompt contact tracing, repeated testing, HCP furloughing, and implementation of recommended transmission-based precautions for suspected cases ultimately halted transmission.
This study was conducted to evaluate the effect of a 12-h light, 12-h dark (12L : 12D) photoperiod of green light during day 1 to day 18 of incubation time, on embryo growth, hormone concentration and the hatch process. In the test group, monochromatic light was provided by a total of 204 green light-emitting diodes (522 nm) mounted in a frame which was placed above the top tray of eggs to give even spread of illumination. No light–dark cycle was used in the control group. Four batches of eggs (n=300/group per batch) from fertile Ross 308 broiler breeders were used in this experiment. The beak length and crown–rump length of embryos incubated under green light were significantly longer than that of control embryos at day 10 and day 12, respectively (P<0.01). Furthermore, green light-exposed embryos had a longer third toe length compared with control embryos at day 10, day 14 and day 17 (P=0.02). At group level (n=4 batches), light stimulation had no effect on chick weight and quality at take-off, the initiation of hatch and hatch window. However, the individual hatching time of the light exposure focal chicks (n=33) was 3.4 h earlier (P=0.49) than the control focal chicks (n=36) probably due to the change in melatonin rhythm of the light group. The results of this study indicate that green light accelerates embryo development and alters hatch-related hormones (thyroid and corticosterone), which may result in earlier hatching.
This study aimed to examine the epidemiology and treatment outcomes of community-onset purulent staphylococcal skin and soft tissue infections (SSTI) in Central Australia. We performed a prospective observational study of patients hospitalised with community-onset purulent staphylococcal SSTI (n = 160). Indigenous patients accounted for 78% of cases. Patients were predominantly young adults; however, there were high rates of co-morbid disease. Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) was the dominant phenotype, accounting for 60% of cases. Hospitalisation during the preceding 6 months, and haemodialysis dependence were significant predictors of CA-MRSA infection on univariate analysis. Clinical presentation and treatment outcomes were found to be comparable for methicillin-susceptible S. aureus (MSSA) and methicillin-resistant cases. All MRSA isolates were characterised as non-multi-resistant, with this term used interchangeably with CA-MRSA in this analysis. We did not find an association between receipt of an active antimicrobial agent within the first 48 h, and progression of infection; need for further surgical debridement; unplanned General Practitioner or hospital re-presentation; or need for further antibiotics. At least one adverse outcome was experienced by 39% of patients. Clindamycin resistance was common, while rates of trimethoprim–sulfamethoxazole resistance were low. This study suggested the possibility of healthcare-associated transmission of CA-MRSA. This is the first Australian report of CA-MRSA superseding MSSA as the cause of community onset staphylococcal SSTI.
The Yellow Sea region is of high global importance for waterbird populations, but recent systematic bird count data enabling identification of the most important sites are relatively sparse for some areas. Surveys of waterbirds at three sites on the coast of southern Jiangsu Province, China, in 2014 and 2015 produced peak counts of international importance for 24 species, including seven globally threatened and six Near Threatened species. The area is of particular global importance for the ‘Critically Endangered’ Spoon-billed Sandpiper Calidris pygmaea (peak count across all three study sites: 62 in spring  and 225 in autumn  and ‘Endangered’ Spotted Greenshank Tringa guttifer (peak count across all three study sites: 210 in spring  and 1,110 in autumn ). The southern Jiangsu coast is therefore currently the most important migratory stopover area in the world, in both spring and autumn, for both species. Several serious and acute threats to waterbirds were recorded at these study sites. Paramount is the threat of large-scale land claim which would completely destroy intertidal mudflats of critical importance to waterbirds. Degradation of intertidal mudflat habitats through the spread of invasive Spartina, and mortality of waterbirds by entrapment in nets or deliberate poisoning are also real and present serious threats here. Collisions with, and displacement by, wind turbines and other structures, and industrial chemical pollution may represent additional potential threats. We recommend the rapid establishment of effective protected areas for waterbirds in the study area, maintaining large areas of open intertidal mudflat, and the urgent removal of all serious threats currently faced by waterbirds here.
Declines in populations of the Critically Endangered Spoon-billed Sandpiper Calidris pygmaeus have been rapid, with the breeding population now perhaps numbering fewer than 120 pairs. The reasons for this decline remain unresolved. Whilst there is evidence that hunting in wintering areas is an important factor, loss of suitable habitat on passage and wintering areas is also of concern. While some key sites for the species are already documented, many of their wintering locations are described here for the first time. Their wintering range primarily stretches from Bangladesh to China. Comprehensive surveys of potential Spoon-billed Sandpiper wintering sites from 2005 to 2013 showed a wide distribution with three key concentrations in Myanmar and Bangladesh, but also regular sites in China, Vietnam and Thailand. The identification of all important non-breeding sites remains of high priority for the conservation of the species. Here, we present the results of field surveys of wintering Spoon-billed Sandpipers that took place in six countries between 2005 and 2013 and present species distribution models which map the potential wintering areas. These include known and currently unrecognised wintering locations. Our maximum entropy model did not identify any new extensive candidate areas within the winter distribution, suggesting that most key sites are already known, but it did identify small sites on the coast of eastern Bangladesh, western Myanmar, and the Guangxi and Guangdong regions of China that may merit further investigation. As no extensive areas of new potential habitat were identified, we suggest that the priorities for the conservation of this species are habitat protection in important wintering and passage areas and reducing hunting pressure on birds at these sites.
Thalattosuchians are crocodylomorphs mainly known from marine strata of Early Jurassic to Early Cretaceous age. They represent the earliest crocodylomorph radiation to an aquatic habitat and their evolutionary history offers very few records from freshwater settings. Here, we report several exquisitely preserved thalattosuchian skulls attributed to a derived teleosaurid from a pedogenic horizon located at the base of a fluvial series of alternating silts and sandstones of the Phu Kradung Formation (Upper Jurassic) of northeastern Thailand. Using laser ablation multicollector inductively coupled mass spectrometry (MC-ICP-MS) on tooth enamel and dentine, we measured isotopic ratios of strontium (87Sr/86Sr) to test the habitat of these teleosaurids. In addition, Sr concentrations of the dental tissues were estimated from the calibrated signal intensities of the Sr isotope measurements. The dataset includes bioapatite (teeth or scales) of eight terrestrial and five aquatic vertebrates. Theropods exhibit lower Sr concentrations both in enamel and dentine compared to others groups, a pattern in accordance with the calcium biopurification process, which predicts that Sr concentrations in the body of vertebrates decrease up the trophic chain. It also excludes the possibility that diagenesis has completely overprinted the Sr isotope compositions of the fossil assemblage, which exhibits a homogeneous 87Sr/86Sr signature above the Late Jurassic seawater value. Values for teleosaurid teeth are in the range of other values for vertebrates in the continental assemblage and imply that these crocodylomorphs did not migrate between freshwater and marine habitats at least in the time constraint of the mineralizing tooth. This result represents the first demonstration that a population of teleosaurids was established for a prolonged time in a freshwater environment. Whether the ability of teleosaurids to inhabit freshwater habitats is a secondary adaptation or whether it is plesiomorphic and inherited from freshwater ancestors is discussed.
Newly hatched chicks may be held longer than 48 h and experience long periods of fasting in commercial hatcheries. Limited information is known about the physiological status of chicks in such situations, due to the difficulty of precisely recording time of hatch. This study investigated the effect of the time from hatch to pulling (holding period) on physiological measures/parameters in 109 broiler chicks. Fertile Ross 308 eggs were incubated in a custom built small-scale incubator. The individual hatching time of each focal chick was determined using eggshell temperature monitoring. At ‘pulling’ (512 h of incubation time), the quality of focal chicks was assessed using the chick scoring method and physiological parameters were measured including BW, organ (heart, liver and stomach) weights, blood values and plasma corticosterone level. The time from hatch to pulling varied from 7.58 to 44.97 h. Egg weight at setting was significantly correlated with chick BW and weight of organs at pulling, but had no effect on chick quality, blood values and plasma corticosterone. Relative BW at pulling was negatively associated with the duration of holding period (P=0.002). However, there was a positive correlation between relative stomach weight and the duration of the holding period (P<0.001). As the holding period duration increased, there was a trend that blood partial pressure of oxygen, haematocrit and haemoglobin also increased, and blood partial pressure of carbon dioxide, total carbon dioxide and bicarbonate decreased (P<0.05). A wide range of plasma corticosterone was observed from chicks that had experienced different durations of holding period. We conclude that shortening the hatch window and minimising the number of chicks that experience a long holding period before pulling may improve chick quality and physiological status, which may be due to unfavourable environmental conditions that include feed and water deprivation.
An unlinked anonymous study was conducted to estimate the prevalence of hepatitis C virus (HCV) infection in emergency department (ED) attendees at a London Hospital. Nine hundred and ninety-seven samples collected over a 12-day period were tested for HCV antibody (Ab) and reactive samples were further tested for HCV RNA. The HCV seroprevalence was 2·6% (26/997) with 1·2% (12/997) HCV RNA positive. A peak HCV RNA-positive prevalence of 4·8% (3/63) was found in males aged 35–44 years, this was compared to 0% (0/136) in males aged <35 years (P = 0·0614) and 1·4% (4/278) in males aged ⩾45 years (P = 0·2415). Assuming the cost for HCV Ab is £6 and HCV RNA is £40 per test, screening ED attendees aged 25–54 years would cost £360 per viraemic infection and identify 82% of those who were HCV RNA positive, yielding the most favourable cost/benefit ratio. HCV screening of ED attendees aged 25–54 years in this population could be an effective way of identifying patients and limit onward transmission.
Eggshell fragments attributed to large birds have been known from the Palaeogene of southern France for half a century, but reconstructing their original dimensions and identifying the birds that laid the eggs has been fraught with difficulties. On the basis of numerous newly collected specimens and using geometrical calculations, the original size of the thick-shelled eggs is reconstructed, showing that they were slightly larger than ostrich eggs, with a greatest length of 17.8 cm and a mean diameter of 12.0 cm in transversal section. The estimated volume is 1330.4 cm3. The fossil eggs from southern France are thus among the largest known avian eggs, being only surpassed by Aepyornis and some moas. Estimated egg mass is about 1.4 kg. On the basis of egg mass, the body mass of the parent bird is estimated at between 135.4 kg and 156.4 kg, assuming that the hatchlings were precocial. These calculations are in good agreement with the dimensions and mass estimates for the Palaeogene giant bird Gastornis, a probable anseriform, which lived in Europe at the time the eggs were laid. Other large Early Tertiary birds from Europe (Remiornis, Palaeotis) are too small to have laid these eggs. In all likelihood, the large eggs from the Palaeogene of southern France were laid by gastornithid birds.
Resistive switches are being explored as a candidate for ultra-dense memory as well as logic circuits. The advantages of the resistive switches include high switching speed and excellent scaling potential. Here, we report for the first time the switching behavior of anti-parallel connected resistive switches (APS), which is a composite device exhibiting bi-directional switching properties. Under the opposite voltage biases, the two anti-parallel cells are alternatively set and reset, rendering the APS switched in both directions. For appropriate ON resistance values and set and reset voltages the two anti-parallel switches can be both set in conductive states. An APS device can be realized in a single switch by two coexisting Cu and oxygen vacancy nanofilaments which are formed and ruptured under opposite voltage polarities. The described APS behavior is of interest to logic applications and in neural networks.
Poor weight gain is common in infants after Stage I Norwood operation and can negatively impact outcomes.
The purpose of this study was to examine the impact of feeding strategy on interstage weight gain.
In a multi-centre study, 158 infants discharged following the Norwood operation were enrolled prospectively. Weight and feeding data were obtained at 2-week intervals. Differences between feeding regimens in average daily weight gain and change in weight-for-age z-score between Stage I discharge and Stage II surgery were examined.
Discharge feeding regimens were oral only in 52%, oral with tube supplementation in 33%, and by nasogastric/gastrostomy tube only in 15%. There were significant differences in the average daily interstage weight gain among the feeding groups – oral only 25.0 grams per day, oral/tube 21.4 grams per day, and tube only 22.3 grams per day – p = 0.019. Tube-only-fed infants were significantly older at Stage II (p = 0.004) and had a significantly greater change in weight-for-age z-score (p = 0.007). The overall rate of weight gain was 16–32 grams per day, similar to infant norms. The rate of weight gain declined over time, with earlier decline observed for oral- and oral/tube-fed infants (less than 15 grams per day at 5.4 months) in comparison with tube-only-fed infants (less than 15 grams per day at 8.6 months).
Following Stage I Norwood, infants discharged on oral feeding had better average daily weight gain than infants with tube-assisted feeding. The overall weight gain was within the normal limits in all feeding groups, but the rate of weight gain decreased over time, with an earlier decline in infants fed orally.