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Nosocomial outbreaks due to multidrug-resistant microorganisms in rehabilitation centers have rarely been reported. We report an outbreak of extended-spectrum beta-lactamase (ESBL)–producing Klebsiella pneumoniae (ESBL-K. pneumoniae) on a single ward in a rehabilitation center in Rotterdam, The Netherlands.
A 40-bed ward of a rehabilitation center in the Netherlands.
In October 2016, 2 patients were found to be colonized by genetically indistinguishable ESBL-K. pneumoniae isolates. Therefore, an outbreak management team was installed, by whom a contact tracing plan was made. In addition to general outbreak measures, specific measures were formulated to allow continuation of the rehabilitation process. Also, environmental cultures were taken. Multiple-locus variable-number tandem-repeat analysis and amplification fragment-length polymorphism were used to determine strain relatedness. Selected isolates were subjected to whole-genome multilocus sequence typing.
The outbreak lasted 8 weeks. In total, 14 patients were colonized with an ESBL-K. pneumoniae, of whom 11 patients had an isolate belonging to sequence type 307. Overall, 163 environmental cultures were taken. Several sites of a household washing machine were repeatedly found to be contaminated with the outbreak strain. This machine was used to wash lifting slings and patient clothing contaminated with feces. The outbreak was contained after taking the machine temporarily out of service and implementing a reinforced and adapted protocol on the use of this machine.
We conclude that in this outbreak, the route of transmission of the outbreak strain via the household washing machine played a major role.
GK Per, a classical nova system that erupted in 1901, is one of the more unusual examples of its type. It has the longest known orbital period for a classical nova (1.997d; Crampton, Cowley & Fisher 1986); and it contains a white dwarf primary with an evolved K2 sub-giant secondary. Most remarkably, the IRAS Sky Survey (1991) reveals that GK Per exhibits far-IR dust emission extending ~ 17′ to the NW and SE of the nova (Bode et al. 1987; Seaquist et al. 1989). We have re-analysed the IRAS data using maximum entropy reconstruction (Bontekoe et al. 1991; Bontekoe, Koper & Kester 1994) to resolve structures at a spatial resolution approaching the diffraction limit of IRAS, which is 1′ at 60 μm and 1.7′ at 100/μm.
Several years after outburst, extended optical emission can be seen around many classical novae. Common features include shells, polar ‘blobs’, equatorial rings and, at least in the case of DQ Her (1934), tropical rings above and below the ‘equator’. We present hydrodynamic calculations of the dynamical effects of the underlying binary system on the material ejected during outburst, and show that many of the features observed in the optical remnants of novae can be reproduced. Polar blobs, banded shells and spherical shells can all be obtained in the model, depending on the speed class of the nova.
We present MERLIN maps of V1016 Cyg at 6 cm, observed on 1992 July 21 and 1995 March 23. Previously discovered bipolar structure is resolved into three distinct peaks. Evolution and proper motion of these peaks has been measured.
Spectroscopy of the nebular (as opposed to the stellar) remnants of old novae can be a powerful diagnostic of physical conditions in, and mode of excitation of, nova shells. While optical spectroscopy of nova shells has been widely used in this way, few are sufficiently well resolved, and sufficiently bright, to be observed with IUE.
Combined optical and ultraviolet spectroscopy of only two nova remnants–those of GK Per and DQ Her–have been reported to date. Ferland et al. (1984) demonstrated that the shell of DQ Her is extremely cool (Te ≃ 500 K) and is excited by a hot central source. Bode et al. (1988) showed that the ultraviolet and optical lines in the spectrum of the GK Per nebula can best be understood in terms of shock excitation, consistent with its observed properties at radio wavelengths (Seaquist et al. 1989).
U Scorpii was observed in outburst for the tenth time in January 2010. We obtained optical and near-infrared spectroscopy from which we derive a helium abundance of N(He)/N(H) = 0.056±0.020 from the most reliable lines available; this is lower than most other estimates and indicates that the secondary is not helium-rich, as previous studies have suggested. Velocities are found to be up to 14,000 km s−1 in broad components and up to 1,800 km s−1 in narrow line components. The reddening of U Sco is found to be E(B-V) = 0.14 ± 0.12.
Thin films of CuInSe2, grown by coevaporation or by selenization of a Cu-In precursor, were analyzed in a scanning transmission electron microscope. While the coevaporated film shows clear evidence of second phases (Cu2Se) around the individual grains, no second phases could be found in the selenized material. Structural characterization also showed the presence of two ordered phases in the coevaporated films, the ordered-vacancy compound CuIn2Se3.5, and a CuPt-ordered phase of CuInSe2.
We examine the microstructure of short-period (14–31 Å) composition modulations in epitaxial ZnSel-xTex (email@example.com) films grown by molecular-beam epitaxy (MBE) on vicinal (001) GaAs. Transmission electron microscope (TEM) images of cross-sections reveal highly-periodic contrast along the growth direction throughout the full thicknesses of the films (over 2 μm) that corresponds to a nearly sinusoidal variation between Se- and Te-rich compositions. Growth of ZnSe1-xTex at 285°C on substrates tilted 4° toward [1111 maximizes the strength and regularity of the modulation. Using dynamical electron-diffraction simulations, we estimate a modulation amplitude of firstname.lastname@example.org(7) in a sample showing strong modulation. We assume a small amplitude of strain modulation to fit the experimental data.
One hundred and eighty-three patients suffering from functional psychoses were diagnosed according to ICD–8, RDC, and DSM–III criteria, and the concordance rates for the diagnoses compared. The heterogeneity of the diagnosis 'schizoaffective psychosis' as defined by these systems became clear. With respect to prognosis, the DSM–III diagnosis of schizophrenia was most closely related to poor outcome. Affective psychoses and schizoaffective psychoses, as well as DSM–III 'schizophreniform disorders', demonstrated a favourable prognosis.