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Candida auris (CA) is an emerging multidrug-resistant pathogen associated with increased mortality. The environment may play a role, but transmission dynamics remain poorly understood. We sought to limit environmental and patient CA contamination following a sustained unsuspected exposure.
A 528-bed teaching hospital.
The index case patient and 17 collocated ward mates.
Immediately after confirmation of CA in the bloodstream and urine of a patient admitted 6 days previously, active surveillance, enhanced transmission-based precautions, environmental cleaning with peracetic acid-hydrogen peroxide and ultraviolet light, and patient relocation were undertaken. Pre-existing agreements and foundational relationships among internal multidisciplinary teams and external partners were leveraged to bolster detection and mitigation efforts and to provide genomic epidemiology.
Candida auris was isolated from 3 of 132 surface samples on days 8, 9, and 15 of ward occupancy, and from no patient samples (0 of 48). Environmental and patient isolates were genetically identical (4–8 single-nucleotide polymorphisms [SNPs]) and most closely related to the 2013 India CA-6684 strain (~200 SNPs), supporting the epidemiological hypothesis that the source of environmental contamination was the index case patient, who probably acquired the South Asian strain from another New York hospital. All isolates contained a mutation associated with azole resistance (K163R) found in the India 2105 VPCI strain but not in CA-6684. The index patient remained colonized until death. No surfaces were CA-positive 1 month later.
Compared to previous descriptions, CA dissemination was minimal. Immediate access to rapid CA diagnostics facilitates early containment strategies and outbreak investigations.
This study assessed the strength of the association between socioeconomic status (SES) and low birth weight (LBW) and preterm birth (PTB) in Southwestern Ontario. Utilizing perinatal and neonatal databases at the London Health Science Centre, maternal postal codes were entered into a Geographic Information System to determine home neighbourhoods. Neighbourhoods were defined by dissemination areas (DAs). Median household income for each DA was extracted from the latest Canadian Census and linked to each mother. All singleton infants born between February 2009 and February 2014 were included. Of 26,654 live singleton births, 6.4% were LBW and 9.7% were PTB. Top risk factors for LBW were: maternal amphetamine use, chronic hypertension and maternal marijuana use (OR respectively: 17.51, 3.18, 2.72); previously diagnosed diabetes, maternal narcotic use and insulin-controlled gestational diabetes predicted PTB (OR respectively: 17.95, 2.69, 2.42). Overall, SES had little impact on adverse birth outcomes, although low maternal education increased the likelihood of a LBW neonate (OR: 1.01).
Mental health services are increasingly supporting recovery-oriented practice as a basis for service delivery. There is considerable overlap between the values and approaches associated with recovery-based practice and those already endorsed as good psychiatric practice. However, these agreed principles may not be consistently applied and further steps may be needed if the reorientation of the relationship between psychiatrists and people using psychiatric services is to fully reflect recovery principles. This article describes ways in which psychiatric practice could develop, including conceptualising medication as one of many possible recovery tools that a person can actively use to support their well-being, and a range of practices available to professionals to support people in taking up an active stance in relation to medication. It also identifies recovery-supportive practices for when someone is unable to fully participate in decision-making, owing to crisis, loss of capacity or concerns about safety.
Extreme impacts can result from extreme weather and climate events, but can also occur without extreme events. This chapter examines two broad categories of impacts on human and ecological systems, both of which are influenced by changes in climate, vulnerability, and exposure: first, the chapter primarily focuses on impacts that result from extreme weather and climate events, and second, it also considers extreme impacts that are triggered by less-than-extreme weather or climate events. These two categories of impacts are examined across sectors, systems, and regions. Extreme events can have positive as well as negative impacts on ecosystems and human activities.
Economic losses from weather- and climate-related disasters have increased, but with large spatial and interannual variability (high confidence, based on high agreement, medium evidence). Global weather- and climate-related disaster losses reported over the last few decades reflect mainly monetized direct damages to assets, and are unequally distributed. Estimates of annual losses have ranged since 1980 from a few US$ billion to above 200 billion (in 2010 dollars), with the highest value for 2005 (the year of Hurricane Katrina). In the period 2000 to 2008, Asia experienced the highest number of weather- and climate-related disasters. The Americas suffered the most economic loss, accounting for the highest proportion (54.6%) of total loss, followed by Asia (27.5%) and Europe (15.9%). Africa accounted for only 0.6% of global economic losses. Loss estimates are lower bound estimates because many impacts, such as loss of human lives, cultural heritage, and ecosystem services, are difficult to value and monetize, and thus they are poorly reflected in estimates of losses. [4.5.1, 126.96.36.199, 188.8.131.52]
Carbapenem-resistant Enterobacteriaceae (CRE) are rapidly emerging in hospitals in the United States and are posing a significant threat. To better understand the transmission dynamics and the acquisition of resistant strains, a thorough analysis of epidemiologic and molecular characteristics was performed.
CRE isolated at Detroit Medical Center were analyzed from September 2008 to September 2009. blaKPC genes were investigated by polymerase chain reaction (PCR), and repetitive extragenic palindromic PCR (rep-PCR) was used to determine genetic similarity among strains. Epidemiologic and outcomes analyses were performed.
Ninety-two unique patient CRE isolates were recovered. Sixty-eight strains (74%) were Klebsiella pneumoniae, 7 were Klebsiella oxytoca, 15 were Enterobacter species, and 2 were Escherichia coli. Fifteen isolates (16%) were resistant to Colistin, 14 (16%) were resistant to tigecycline, and 2 were resistant to all antimicrobials tested. The mean ± standard deviation age of patients was 63 ± 2 years. Sixty patients (68%) were admitted to the hospital from long-term care facilities. Only 70% of patients received effective antimicrobial therapy when infection was suspected, with a mean time to appropriate therapy of 120 ± 23 hours following sample culturing. The mean length of hospitalization after sample culturing was 18.6 ± 2.5 days. Of 57 inpatients, 18 (32%) died in the hospital. Independent predictors for mortality were intensive care unit stay (odds ratio [OR], 15.8; P = .003) and co-colonization with CRE and either Acinetobacter baumannii or Pseudomonas aeruginosa (OR, 17.2; P = .006). Among K. pneumoniae CRE, rep-PCR revealed 2 genetically related strains that comprised 70% and 20% of isolates, respectively.
In this large U.S. cohort of patients with CRE infection, which reflects the modern continuum of medical care, co-colonization with CRE and A. baumannii or P. aeruginosa was associated with increased mortality. Two predominant clones of K. pneumoniae accounted for the majority of cases of CRE infection.
The development of periodic nanostructures fabricated by self-assembly of surfactants and block co-polymers has opened up the possibility of generating periodic magnetic nanostructures of types not accessible by self-assembly of nano-particles. The fabrication of mesoporous silica thin films around self-assembled block co-polymers is well established. Common structures for such films are SBA-15 which consists of hexagonal arrays of cylindrical pores and SBA-16 which has face centered arrays of spherical voids. These pores are connected by 1-2 nm thick flaws in the continuous silica phase producing an effectively continuous porous phase. After removal of the block co-polymer template, electrodeposition into the mesoporous silica thin films produces arrays of 5-10 nm diameter nano-wires and nano-particles. We have demonstrated that such materials can be fabricated on a wide range of metal substrates. Characterization by Scanning Electron Microscopies shows that the mesoporous silica is well ordered over micron scale areas. Grazing Incidence Small Angle X-ray Scattering (GISAXS) studies shows diffraction spots, consistent with the entire film being well ordered. GISAXS also shows that the mesoporous silica films survive removal of the template and electrodeposition of nickel and cobalt into the mesoporous silica films. Such films are of interest for their magnetic properties, as the nanophase and scale can be independently varied. Further, the presence of nanowires inside an insulator suggests that these films might also be of interest as the current confining element for Confined Current Path-Current Perpendicular to Plane GMR sensors.
The extremely high surface areas required for supercapacitors has limited the use of metal based electrodes, despite the other advantages such electrodes might have. Self-assembling surfactants and block co-polymers can be used as templates to produce nanostructured thin films that readily give 60-140 fold increases in surface area on both planar and three-dimensional substrates. However, even when relatively high surface area porous metal substrates such as nickel foam are used as a starting point, the resultant material still has surface area density well short of that available in other types of materials. Micro-emulsions offer a method of generating microstructure that bridges the gap between the 100 micron scale structures of foamed metals and the 10-50 nm scale structure of self-assembling block co-polymers. Electrodeposition of nickel and cobalt from micro-emulsions of Tween surfactants gives rise to structure on the 0.1-10 micron length scale. The scale of the microstructure is strongly influenced by the metal ion concentration and the potential at which the electrodeposition. The nature of the metal ion also strongly effects the ease with which the microstructure can be generated and the distribution of the microstructured film on foamed nickel electrodes. For microstructured nickel films ten fold surface area increases can be achieved. The microstructured films are expected to be compatible with a number of the nanostructuring methods to yield cumulative surface area increases of 1000-2000 fold.
MOS capacitors were fabricated from MOCVD HfO2 and HfxSiyO gate dielectrics with ALD TaN / PVD Ta metal electrodes. Dielectrics with 1.8 to 2.6 nm capacitance equivalent thickness (CET) were investigated with gate leakage (Jg) of 1×10−7 to 1×10−3 A/cm2 at Vg = Vfb−1V in accumulation. In addition to the C-V and I-V characterization of the MOSCAPs, XPS physical characterization was performed on monitor wafers to determine composition and physical thickness. From the combined results of the electrical and physical characterization, the relative dielectric constants of the Hf-Si-O films and the metal electrode work functions are determined, and simple models for the compositional dependence of the dielectric constant are formulated. Capacitors with the same dielectric composition and thickness exhibited 100 mV Vfb change when the thickness of the ALD TaN electrode layer was changed from 40-80Å. This change is attributed to a change in the work function of the aggregate TaN / Ta metal electrode. Workfunctions were found to be located near middle of the Si band gap, with workfunctions of 4.6 eV to 4.7 eV.
Maternal nutrition and growth hormone (GH) treatment during early- to mid-pregnancy can each alter the subsequent growth and differentiation of muscle in progeny. We have investigated the effects of varying maternal nutrition and maternal treatment with porcine (p) GH during the second quarter of pregnancy in gilts on semitendinosus muscle cross-sectional area and fibre composition of progeny, and relationships between maternal and progeny measures and progeny muscularity. Fifty-three Large White×Landrace gilts, pregnant to Large White×Duroc boars, were fed either 2·2 kg (about 35 % ad libitum intake) or 3·0 kg commercial ration (13·5 MJ digestible energy, 150 g crude protein (N×6·25)/kg DM)/d and injected with 0, 4 or 8 mg pGH/d from day 25 to 50 of pregnancy, then all were fed 2·2 kg/d for the remainder of pregnancy. The higher maternal feed allowance from day 25 to 50 of pregnancy increased the densities of total and secondary fibres and the secondary:primary fibre ratio in semitendinosus muscles of their female progeny at 61 d of age postnatally. The densities of secondary and total muscle fibres in semitendinosus muscles of progeny were predicted by maternal weight before treatment and maternal plasma insulin-like growth factor-II during treatment. Maternal pGH treatment from day 25 to day 50 of pregnancy did not alter fibre densities, but increased the cross-sectional area of the semitendinosus muscle; this may be partially explained by increased maternal plasma glucose. Thus, maternal nutrition and pGH treatment during the second quarter of pregnancy in pigs independently alter muscle characteristics in progeny.
In this work, we studied the electrical and thermal stability of Ru and RuO2 electrode on Y-silicate dielectrics in contrast to ZrO2 and Al2O3 dielectrics. Very low resistivity Ru and rutile stoichiometric RuO2 films, deposited via reactive sputtering, were evaluated as gate electrodes on ultrathin Y-silicate, ZrO2 and Al2O3 films for Si-MOS devices. Thermal and chemical stability of the electrodes was studied at annealing temperatures up to 800°C in N2 and subsequently forming gas anneal. XRD and XPS were measured to study grain structure and interface reactions. The morphology of the films was tested by atomic force microscopy (AFM). Electrical properties were evaluated via MOS capacitors. The role of oxygen inside dielectrics was studied by comparing equivalent oxide thickness change as a function of annealing temperature for capacitors with Y-silicate, ZrO2and Al2O3 dielectrics. Good stability of Ru and RuO2 gate electrodes on all dielectrics studied was found. Flatband voltage and gate current as a function of annealing temperature was also studied. It was found that capacitors with Y-silicate after high-temperature anneal had less positive flatband voltage shift than ZrO2 and Al2O3. For capacitors with Ru gate electrode, the significant flatband voltage shift after high temperature anneal could be partially removed by a forming gas anneal.
Investigation of the geographical distribution of schizophrenia and its relationship to socio-demographic factors is useful for planning services.
Individuals with schizophrenia (n=980) were identified by key informants within an inner London borough and point prevalence calculated for broad, Feighner and DSM–III–R schizophrenia. The distribution of cases was tested for significant variation using the Poisson process model. Regression models using the Jarman-8 score and its component variables were tested for their ability to predict the prevalence of schizophrenia.
A high point prevalence of schizophrenia (5.3 per 1000 resident population) was demonstrated. Case distribution showed a marked and significant variation associated with socio-demographic factors. The prediction of prevalence was more accurate for broad than for narrower definitions of schizophrenia; unemployment rate performed best.
Unemployment rates and Jarman-8 scores may provide crude estimates for resource allocation in planning mental health services, highlighting the need for additional services in deprived inner city areas.
The South Camden Schizophrenia Survey was started in 1985 with Regional Funding through the Locally Organised Research Scheme. Its overall aim is to explore the disabilities and needs of those individuals recognised by the services within an inner-city area as suffering from schizophrenia. The survey has also been the first step towards setting up a computerised case monitoring system, named ‘Safety Net’, which is being developed as a means of keeping track of the needs and progress of these vulnerable individuals. This enterprise will develop a community-wide perspective directed at targetting the deployment of services to those most in need. This article gives a preliminary account of the progress so far and highlights our experience of carrying out research within the community.
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