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Identifying routes of transmission among hospitalized patients during a healthcare-associated outbreak can be tedious, particularly among patients with complex hospital stays and multiple exposures. Data mining of the electronic health record (EHR) has the potential to rapidly identify common exposures among patients suspected of being part of an outbreak.
We retrospectively analyzed 9 hospital outbreaks that occurred during 2011–2016 and that had previously been characterized both according to transmission route and by molecular characterization of the bacterial isolates. We determined (1) the ability of data mining of the EHR to identify the correct route of transmission, (2) how early the correct route was identified during the timeline of the outbreak, and (3) how many cases in the outbreaks could have been prevented had the system been running in real time.
Correct routes were identified for all outbreaks at the second patient, except for one outbreak involving >1 transmission route that was detected at the eighth patient. Up to 40 or 34 infections (78% or 66% of possible preventable infections, respectively) could have been prevented if data mining had been implemented in real time, assuming the initiation of an effective intervention within 7 or 14 days of identification of the transmission route, respectively.
Data mining of the EHR was accurate for identifying routes of transmission among patients who were part of the outbreak. Prospective validation of this approach using routine whole-genome sequencing and data mining of the EHR for both outbreak detection and route attribution is ongoing.
We report new results from a program which is aimed at obtaining deep CCD photometry for a sample of relatively nearby globular clusters having a wide range of metallicities. The CCD cameras on the CFHT 3.6 m, CTIO 4 m and KPNO 4 m telescopes have been used over the past 4 years to obtain deep exposures in regions of a number of clusters. In order to avoid the severest crowding, all of our observations have been obtained at distances of greater than ~ 5 core radii from the cluster centers. The images have been analysed by using the DAOPHOT point-spread-function fitting routines.
Scanning acoustic microscopy (SAM), when applied to biological samples has the potential to resolve the longitudinal acoustic wave speed and hence stiffness of discrete tissue components. The heterogeneity of biological materials combined with the action of cryosectioning and rehydrating can, however, create variations in section topography. Here, we set out to determine how variations in specimen thickness influence apparent acoustic wave speed measurements
Cryosections (5μm nominal thickness) of human skin biopsies were adhered to glass slides before washing and rehydrating in water. Multiple regions (200x200 μm; n = 3) were imaged by SAM to generate acoustic wave speed maps. Subsequently co-localised 30x30 μm sub-regions were imaged by atomic force microscopy (AFM) in fluid. The images were then registered using Image J. Each pixel was allocated both a height and wave speed value before their relationship was then plotted on a scattergram. The mean section thickness measured by AFM was 3.48 ± 1.12 (SD) μm. Regional height variations influenced apparent wave speed measurements. A 3.5 μm height difference was associated with a 400 ms-1 increase in wave speed. In the present study we show that local variations in specimen thickness influence apparent wave speed. We also show that a true measure of wave speed can be calculated if the thickness of the specimen is known at each sampling point.
Recent applications of the “Atom Location by Channelling Enhanced Microanalysis” (ALCHEMI) are summarised. This is a quantitative method for determining the sites of impurity atoms in crystals using an electron microscope and X-ray analysis system. Since the fractional site occupancies are given in terms of measured X-ray counts alone, it involves no adjustable parameters. New experiments have been performed on the temperature dependence of characteristic X-ray production under channelling conditions for InP and GaAs. We conclude that low temperatures will give more accurate results for “ALCHEMI” in some materials due to the reduction in diffuse inelastic phonon scattering, and that the study of this temperature dependence may provide new information from small areas or particles on the correlations amongst atom motions due to thermal vibration.
Three models were used to look at the Southern Ocean Ross Sea sector circulation and hydrography. Two were climate models of low (1°) to intermediate resolution (1/3°), and one was an operational high resolution (1/10°) ocean model. Despite model differences (including physics and forcing), mean and monthly variability aspects of off-shelf circulation are consistently represented, and could imply bathymetric constraints. Western and eastern cyclonic gyral systems separated by shallow bathymetry around 180°E redistributing water between the wider Southern Ocean and the Ross Sea are found. Some model seasonal gyral transports increase as the Antarctic Circumpolar Current transport decreases. Model flows at 900 m at the gyral eastern end compare favourably with float data. On-shelf model depth-averaged west–east flow is relatively consistent with that reconstructed from longline fishing records. These flows have components associated with isopycnal gradients in both light and dense waters. The climate models reproduce characteristic isopycnal layer inflections (‘V’s) associated with the observed Antarctic Slope Front and on-shelf deep water formation, and these models transport some 4 Sv of this bottom water northwards across the outer 1000 m shelf isobath. Overall flow complexity suggests care is needed to force regional Ross Sea models.
Using the Hilbert Uniqueness Method, we study the problem of exact controllability in Neumann boundary conditions for problems of transmission of the wave equation. We prove that this system is exactly controllable for all initial states in L2(Ω)×(H1(Ω))′.
One method of finding non-parametric hypersurfaces of prescribed mean curvature which span a given curve in Rn is to find a function which minimizes a particular integral amongst all smooth functions satisfying certain boundary conditions. A new problem can be considered by changing the integral slightly and then minimizing over a larger class of functions. It is possible to show that a solution to this new problem exists under very general conditions and it is usually known as the generalized solution. In this paper we show that the two problems are equivalent in the sense that the least value for the original minimization problem and the generalized problem are the same even though no solution may exist. The case where the surfaces are constrained to lie above an obstacle is also considered.