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Between December 2010 and August 2011 an outbreak of measles occurred in Serbia with 363 reported cases. Sera and/or nose/throat swabs were collected from 193 patients and tested for measles-specific IgM antibodies by ELISA and viral RNA by RT–PCR, respectively. Epidemiological data were obtained from the surveillance database of the Institute of Public Health of Serbia. Of the 363 cases involved in the outbreak, 113 were laboratory confirmed. More than one third of the patients were hospitalized (n = 130, 35·8%) and for 15 (4·1% of the reported outbreak cases) the infection was complicated by pneumonia. Mostly pre-school children aged ⩽4 years (37·8%) and adults aged ⩾30 years (27·3%) were affected. The majority of patients belonged to the Roma population with a preponderance of female cases (57·0%). Nearly 94% of the patients were either unvaccinated or of unknown vaccination status. The main outbreak virus was the D4-Hamburg strain. The outbreak in Serbia occurred after several years of very low measles incidence despite a high routine immunization coverage in the general population, suggesting that special efforts to identify and vaccinate susceptible population groups are required even in countries with apparently good disease control.
To determine whether implementation of a multifaceted intervention would significantly reduce the incidence of central line–associated bloodstream infections.
Prospective cohort collaborative.
SETTING AND PARTICIPANTS
Intensive care units of the Abu Dhabi Health Services Company hospitals in the Emirate of Abu Dhabi.
A bundled intervention consisting of 3 components was implemented as part of the program. It consisted of a multifaceted approach that targeted clinician use of evidence-based infection prevention recommendations, tools that supported the identification of local barriers to these practices, and implementation ideas to help ensure patients received the practices. Comprehensive unit-based safety teams were created to improve safety culture and teamwork. Finally, the measurement and feedback of monthly infection rate data to safety teams, senior leaders, and staff in participating intensive care units was encouraged. The main outcome measure was the quarterly rate of central line–associated bloodstream infections.
Eighteen intensive care units from 7 hospitals in Abu Dhabi implemented the program and achieved an overall 38% reduction in their central line–associated bloodstream infection rate, adjusted at the hospital and unit level. The number of units with a quarterly central line–associated bloodstream infection rate of less than 1 infection per 1,000 catheter-days increased by almost 40% between the baseline and postintervention periods.
A significant reduction in the global morbidity and mortality associated with central line–associated bloodstream infections is possible across intensive care units in disparate settings using a multifaceted intervention.
Infect. Control Hosp. Epidemiol. 2015;36(7):816–822
A theoretical investigation of the propagation of a relativistic electron (or positron) particle beam in an overdense magnetoactive plasma is carried out within a fluid plasma model, taking into account the individual quantum properties of beam particles. It is demonstrated that the collective character of the particle beam manifests mostly through the self-consistent macroscopic plasma wakefield created by the charge and the current densities of the beam. The transverse dynamics of the beam–plasma system is governed by the Schrödinger equation for a single-particle wavefunction derived under the Hartree mean field approximation, coupled with a Poisson-like equation for the wake potential. These two coupled equations are subsequently reduced to a nonlinear, non-local Schrödinger equation and solved in a strongly non-local regime. An approximate Glauber solution is found analytically in the form of a Hermite–Gauss ring soliton. Such non-stationary (‘breathing’ and ‘wiggling’) coherent structure may be parametrically unstable and the corresponding growth rates are estimated analytically.
Over a 9-day period in February 1995, 16 newborn babies (age range 2–11 days) and 3 infants (24, 47 and 180 days of age) in a neonatal nursery ward developed diarrhoea accompanied by pyrexia and weight loss. Known enteropathogens were not detected in their stools but Escherichia coli displaying aggregative adherence to HEp-2 cells (enteroaggregative E. coli) were found in 12 (63%) ill infants and in none of 5 well neonates (P = 0·02). The illness lasted 3–9 days (mean 5·2) in 16 babies, whereas in 3 neonates it showed a protracted course of 18–20 days. The source of infection and the mode of transmission remained unclear. The outbreak isolates manifested properties common in this new group of diarrhoeagenic E. coli: mannose-resistant haemagglutination, haemolysis on blood agar, and clump formation in liquid culture medium. They belonged to the O4 E. coli serogroup and expressed multiple antibiotic resistance.
A kinetic theory of nonlinear currents, quasi-stationary electric and magnetic fields and the ponderomotive effect of high-frequency electromagnetic radiation on a collisionless plasma is developed. General expressions for nonlinear current densities, fields and ponderomotive forces that are applicable in a broad range of space-time scales, characteristie of low-frequency motion in plasma, are obtained. These expressions are compared with the results of previous papers.
Cerebral small vessel disease is rarely described in association with pseudoxanthoma elasticum (PXE), a hereditary connective tissue disorder with skin, eye and vascular manifestations. This autosomally inherited elastic tissue disease has been attributed to mutations in the ABCC6 gene located on chromosome 16p13.1. Different stroke mechanisms are suggested in PXE patients, arterial hypertension and accelerated atherosclerosis being the leading ones.
Case 1: A 49-year-old man with history of mild hypertension presented with recurrent transient ischemic attacks. At the age of 42, evaluation for progressive visual loss and skin changes led to diagnosis of PXE. Brain magnetic resonance imaging (MRI) disclosed multiple lacunar infarctions and confluent periventricular white matter lesions (WML). Case 2: A 71-year-old woman with history of mild hypertension suffered right-sided stroke. Diagnosis of PXE was made at the age of 48 due to severe visual loss and skin changes. Brain MRI revealed multiple lacunar infarctions and subcortical ischemic leukoencephalopathy. Case 3: A 47-year-old woman with prominent skin changes and bilateral amblyopia developed right-sided weakness. Skin biopsy confirmed PXE. Several lacunar infarcts in deep white matter and pons were revealed on MRI. Discussion: We present three patients with clinical and histopathological features of PXE who presented with multiple lacunar strokes, two with extensive confluent WML. These cases illustrate that PXE is a rare but significant risk factor for small vessel disease and stroke in patients of all age groups. Occlusive small vessel disease and subsequent lacunar infarcts and WML represent important PXE manifestations.
Nonstationarity of stimulated Raman backscattering in a finite homogeneous plasma slab is examined. Slowly varying envelope equations are analyzed taking into account a damping and a convection of an electron plasma wave, with a nonzero source boundary condition assumed. The linear analysis method is used for examination of stability of saturated stationary amplitude solutions. When linear wave damping is sufficiently small or absent, these solutions are spatially periodic and appear linearly unstable to small perturbations. However, a direct numerical simulation of the backscattering process in a lossless case shows that the system tends to quasistationary state with maximum reflectivity (R → 1). If the electron plasma wave damping exceeds a certain critical value, a spatially aperiodic solution raises and the Raman backscattering process becomes stable.
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