To send content items to your account,
please confirm that you agree to abide by our usage policies.
If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account.
Find out more about sending content to .
To send content items to your Kindle, first ensure firstname.lastname@example.org
is added to your Approved Personal Document E-mail List under your Personal Document Settings
on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part
of your Kindle email address below.
Find out more about sending to your Kindle.
Note you can select to send to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi.
‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
Describe the epidemiological and molecular characteristics of an outbreak of Klebsiella pneumoniae carbapenemase (KPC)–producing organisms and the novel use of a cohorting unit for its control.
A 566-room academic teaching facility in Milwaukee, Wisconsin.
Solid-organ transplant recipients.
Infection control bundles were used throughout the time of observation. All KPC cases were intermittently housed in a cohorting unit with dedicated nurses and nursing aids. The rooms used in the cohorting unit had anterooms where clean supplies and linens were placed. Spread of KPC-producing organisms was determined using rectal surveillance cultures on admission and weekly thereafter among all consecutive patients admitted to the involved units. KPC-positive strains underwent pulsed-field gel electrophoresis and whole-genome sequencing.
A total of 8 KPC cases (5 identified by surveillance) were identified from April 2016 to April 2017. After the index patient, 3 patients acquired KPC-producing organisms despite implementation of an infection control bundle. This prompted the use of a cohorting unit, which immediately halted transmission, and the single remaining KPC case was transferred out of the cohorting unit. However, additional KPC cases were identified within 2 months. Once the cohorting unit was reopened, no additional KPC cases occurred. The KPC-positive species identified during this outbreak included Klebsiella pneumoniae, Enterobacter cloacae complex, and Escherichia coli. blaKPC was identified on at least 2 plasmid backbones.
A complex KPC outbreak involving both clonal and plasmid-mediated dissemination was controlled using weekly surveillances and a cohorting unit.
Measurements in the infrared wavelength domain allow direct assessment of the physical state and energy balance of cool matter in space, enabling the detailed study of the processes that govern the formation and evolution of stars and planetary systems in galaxies over cosmic time. Previous infrared missions revealed a great deal about the obscured Universe, but were hampered by limited sensitivity.
SPICA takes the next step in infrared observational capability by combining a large 2.5-meter diameter telescope, cooled to below 8 K, with instruments employing ultra-sensitive detectors. A combination of passive cooling and mechanical coolers will be used to cool both the telescope and the instruments. With mechanical coolers the mission lifetime is not limited by the supply of cryogen. With the combination of low telescope background and instruments with state-of-the-art detectors SPICA provides a huge advance on the capabilities of previous missions.
SPICA instruments offer spectral resolving power ranging from R ~50 through 11 000 in the 17–230 μm domain and R ~28.000 spectroscopy between 12 and 18 μm. SPICA will provide efficient 30–37 μm broad band mapping, and small field spectroscopic and polarimetric imaging at 100, 200 and 350 μm. SPICA will provide infrared spectroscopy with an unprecedented sensitivity of ~5 × 10−20 W m−2 (5σ/1 h)—over two orders of magnitude improvement over what earlier missions. This exceptional performance leap, will open entirely new domains in infrared astronomy; galaxy evolution and metal production over cosmic time, dust formation and evolution from very early epochs onwards, the formation history of planetary systems.
Studies have consistently shown that subthreshold depression is associated with an increased risk of developing major depression. However, no study has yet calculated a pooled estimate that quantifies the magnitude of this risk across multiple studies.
We conducted a systematic review to identify longitudinal cohort studies containing data on the association between subthreshold depression and future major depression. A baseline meta-analysis was conducted using the inverse variance heterogeneity method to calculate the incidence rate ratio (IRR) of major depression among people with subthreshold depression relative to non-depressed controls. Subgroup analyses were conducted to investigate whether IRR estimates differed between studies categorised by age group or sample type. Sensitivity analyses were also conducted to test the robustness of baseline results to several sources of study heterogeneity, such as the case definition for subthreshold depression.
Data from 16 studies (n = 67 318) revealed that people with subthreshold depression had an increased risk of developing major depression (IRR = 1.95, 95% confidence interval 1.28–2.97). Subgroup analyses estimated similar IRRs for different age groups (youth, adults and the elderly) and sample types (community-based and primary care). Sensitivity analyses demonstrated that baseline results were robust to different sources of study heterogeneity.
The results of this study support the scaling up of effective indicated prevention interventions for people with subthreshold depression, regardless of age group or setting.
This study evaluated the relationship between radiation and Eustachian tube dysfunction, and examined the radiation dose required to induce otitis media with effusion.
The function of 36 Eustachian tubes in 18 patients with head and neck cancer were examined sonotubometrically before, during, and 1, 2 and 3 months after, intensity-modulated radiotherapy. Patients with an increase of 5 dB or less in sound pressure level (dB) during swallowing were categorised as being in the dysfunction group. Additionally, radiation dose distributions were assessed in all Eustachian tubes using three dose–volume histogram parameters.
Twenty-two of 25 normally functioning Eustachian tubes before radiotherapy (88.0 per cent) shifted to the dysfunction group after therapy. All ears that developed otitis media with effusion belonged to the dysfunction group. The radiation dose threshold evaluation revealed that ears with otitis media with effusion received significantly higher doses to the Eustachian tubes.
The results indicate a relationship between radiation dose and Eustachian tube dysfunction and otitis media with effusion.
IR spectroscopy in the range 12–230 μm with the SPace IR telescope for Cosmology and Astrophysics (SPICA) will reveal the physical processes governing the formation and evolution of galaxies and black holes through cosmic time, bridging the gap between the James Webb Space Telescope and the upcoming Extremely Large Telescopes at shorter wavelengths and the Atacama Large Millimeter Array at longer wavelengths. The SPICA, with its 2.5-m telescope actively cooled to below 8 K, will obtain the first spectroscopic determination, in the mid-IR rest-frame, of both the star-formation rate and black hole accretion rate histories of galaxies, reaching lookback times of 12 Gyr, for large statistically significant samples. Densities, temperatures, radiation fields, and gas-phase metallicities will be measured in dust-obscured galaxies and active galactic nuclei, sampling a large range in mass and luminosity, from faint local dwarf galaxies to luminous quasars in the distant Universe. Active galactic nuclei and starburst feedback and feeding mechanisms in distant galaxies will be uncovered through detailed measurements of molecular and atomic line profiles. The SPICA’s large-area deep spectrophotometric surveys will provide mid-IR spectra and continuum fluxes for unbiased samples of tens of thousands of galaxies, out to redshifts of z ~ 6.
We estimate the column density of the Galactic foreground interstellar medium (GFISM) in the direction of extragalactic sources. All-sky AKARI FIS infrared sky survey data might be used to trace the GFISM with a resolution of 2 arcminutes. The AKARI based GFISM hydrogen column density estimates are compared with similar quantities based on HI 21cm measurements of various resolution and of Planck results. High spatial resolution observations of the GFISM may be important recalculating the physical parameters of gamma-ray burst (GRB) host galaxies using the updated foreground parameters.
Cognitive–behavioral therapy (CBT) is thought to be useful for chronic pain, with the pathology of the latter being closely associated with cognitive–emotional components. However, there are few resting-state functional magnetic resonance imaging (R-fMRI) studies. We used the independent component analysis method to examine neural changes after CBT and to assess whether brain regions predict treatment response.
We performed R-fMRI on a group of 29 chronic pain (somatoform pain disorder) patients and 30 age-matched healthy controls (T1). Patients were enrolled in a weekly 12-session group CBT (T2). We assessed selected regions of interest that exhibited differences in intrinsic connectivity network (ICN) connectivity strength between the patients and controls at T1, and compared T1 and T2. We also examined the correlations between treatment effects and rs-fMRI data.
Abnormal ICN connectivity of the orbitofrontal cortex (OFC) and inferior parietal lobule within the dorsal attention network (DAN) and of the paracentral lobule within the sensorimotor network in patients with chronic pain normalized after CBT. Higher ICN connectivity strength in the OFC indicated greater improvements in pain intensity. Furthermore, ICN connectivity strength in the dorsal posterior cingulate cortex (PCC) within the DAN at T1 was negatively correlated with CBT-related clinical improvements.
We conclude that the OFC is crucial for CBT-related improvement of pain intensity, and that the dorsal PCC activation at pretreatment also plays an important role in improvement of clinical symptoms via CBT.
To describe the investigation and control of a rare cluster of Klebsiella pneumoniae carbapenemase–producing Citrobacter freundii in a hospital in southern Florida.
An epidemiologic investigation, review of infection prevention procedures, and molecular studies including whole genome sequencing were conducted.
An outbreak of K. pneumoniae carbapenemase–3-producing C. freundii was identified at a tertiary hospital in Florida in 2014. Of the 6 cases identified, 3 occurred in the same intensive care unit and were caused by the same clone. For 2 of the 3 remaining cases, the isolates had low carbapenem minimum inhibitory concentrations and were unrelated by whole genome sequencing. As a response to the outbreak, supplementary environmental cleaning was implemented, including closure and terminal cleaning of the unit where the 3 cases clustered, in addition to the infection control bundle already in place at the time. No further cases were identified after these additional interventions.
Although C. freundii is not a species that commonly demonstrates carbapenem resistance, our findings suggest that carbapenemase-producing C. freundii may be underdetected even when active surveillance is in place and has a potential to cause hospital outbreak.
Various transmission routes contribute to spread of carbapenem-resistant Klebsiella pneumoniae (CRKP) in hospitalized patients. Patients with readmissions during which CRKP is again isolated (“CRKP readmission”) potentially contribute to transmission of CRKP.
To evaluate CRKP readmissions in the Consortium on Resistance against Carbapenems in K. pneumoniae (CRaCKLe).
Cohort study from December 24, 2011, through July 1, 2013.
Multicenter consortium of acute care hospitals in the Great Lakes region.
All patients who were discharged alive during the study period were included. Each patient was included only once at the time of the first CRKP-positive culture.
All readmissions within 90 days of discharge from the index hospitalization during which CRKP was again found were analyzed. Risk factors for CRKP readmission were evaluated in multivariable models.
Fifty-six (20%) of 287 patients who were discharged alive had a CRKP readmission. History of malignancy was associated with CRKP readmission (adjusted odds ratio [adjusted OR], 3.00 [95% CI, 1.32–6.65], P<.01). During the index hospitalization, 160 patients (56%) received antibiotic treatment against CRKP; the choice of regimen was associated with CRKP readmission (P=.02). Receipt of tigecycline-based therapy (adjusted OR, 5.13 [95% CI, 1.72–17.44], using aminoglycoside-based therapy as a reference in those treated with anti-CRKP antibiotics) was associated with CRKP readmission.
Hospitalized patients with CRKP—specifically those with a history of malignancy—are at high risk of readmission with recurrent CRKP infection or colonization. Treatment during the index hospitalization with a tigecycline-based regimen increases this risk.
Infect. Control Hosp. Epidemiol. 2016;37(3):281–288
We present a systematic review providing estimates of the overall and regional burden of infectious complications following prostate biopsy. A directly standardized prevalence estimate was used because it reflects the burden of disease more explicitly. Complications included sepsis, hospitalization, bacteraemia, bacteriuria, and acute urinary retention after biopsy. There were 165 articles, comprising 162 577 patients, included in the final analysis. Our findings demonstrate that transrectal biopsy was associated with a higher burden of hospitalization (1·1% vs. 0·9%) and sepsis (0·8% vs. 0·1%) compared to transperineal biopsy, while acute urinary retention was more prevalent after transperineal than transrectal biopsy (4·2% vs. 0·9%). The differences were statistically non-significant because of large heterogeneity across countries. We also demonstrate and discuss regional variations in complication rates, with Asian studies reporting higher rates of sepsis and hospitalization.
The nearby radio galaxy M87 offers a unique opportunity for exploring the connection between γ-ray production and jet formation at an unprecedented linear resolution. However, the origin and location of the γ-rays in this source is still elusive. Based on previous radio/TeV correlation events, the unresolved jet base (radio core) and the peculiar knot HST-1 at >120 pc from the nucleus are proposed as candidate site(s) of γ-ray production. Here we report our intensive, high-resolution radio monitoring observations of the M87 jet with the VLBI Exploration of Radio Astrometry (VERA) and the European VLBI Network (EVN) from February 2011 to October 2012. During this period, an elevated level of the M87 flux is reported at TeV with VERITAS. We detected a remarkable flux increase in the radio core with VERA at 22/43 GHz coincident with the VHE activity. Meanwhile, HST-1 remained quiescent in terms of its flux density and structure at radio. These results strongly suggest that the TeV γ-ray activity in 2012 originates in the jet base within 0.03 pc (projected) from the central supermassive black hole.
The “pad-in-a-bottle” (PIB) approach to planarization is a non-traditional chemical mechanical polishing (CMP) process in which slurry containing polymer beads is used. The approach is hypothesized to be able to perform polishing by mixing polymer beads with similar chemical and mechanical properties as pad asperities into the slurry to provide force application and polishing contacts, so that a traditional CMP pad is not needed. Pad-in-a-bottle could provide predictable and controllable mechanical contacts through bead size control, which could substantially reduce process variability. Pad-in-a-bottle also has the potential to reduce the CMP consumable cost. In this work, we propose a physical model to understand the behavior of the pad-in-a-bottle approach and estimate the relationship of applied pressure and material removal rate in this variant of CMP. Two specific cases of polymer bead formation are considered in our modeling work, bead packing and bead stacking. Model prediction shows that the two bead formation cases generate distinctly different polishing mechanisms: material removal is applied pressure driven in bead packing, but contact event driven in bead stacking. The physical model suggests that in future experiments or applications of pad-in-a-bottle, a polymer bead size distribution or shape variation may be needed to achieve efficient material removal.
A Compact Planar Magnetron Plasma Sputtering Deposition Device (CPM-PSDD) has been used to deposit TiO2 on silicon, glass and cotton cloth. An 80 mm diameter Ti target was placed at the cathode and was sputtered by argon-oxygen plasma with 10-20 mA discharge current and -300 V to -450 V discharge potential. Reactive oxygen gas fed into the system at 13:1 Ar:O2 sccm ratio for the deposition durations between one to four hours. The deposited films exhibited both anatase and rutile phases. Cotton cloths were dipped in methyl blue to evaluate the photocatalytic activity of the film.
We report the growth of single crystals by a flux method in ambient pressure and tri-axial orientation under modulated rotation magnetic fields (MRFs) on REBa2Cu4O8 (RE124, RE; rare earth elements) compounds. RE124 crystals were grown for RE = Y, Sm, Eu, Gd, Dy, Ho, Er, Tm, and Yb through appropriate choice of source compounds. All the obtained RE124 powders were tri-axially aligned in MRF of 10T, whereas magnetization axes depended on the type of RE. Moreover, it was found from the changes in the degrees of c-axis and inplane orientation that tri-axial magnetic anisotropies of RE124 also depended on the type of RE. This indicates that it appropriate choice of RE is important for the fabrication of tri-axial oriented ceramics in lower magnetic field conditions.
We present VLBI maps of the 6.7 GHz methanol maser emission in 32 sources obtained using the Japanese VLBI Network (JVN) and the East-Asian VLBI Network (EAVN). All of the observed sources provide new VLBI maps, and the spatial morphologies have been classified into five categories similar to the results obtained from European VLBI Network observations (Bartkiewicz et al. 2009). The 32 methanol sources are being monitored to measure the relative proper motions of the methanol maser spots.
Although aim of the environmental protection is conservation of ecosystem, there are only a few studies focusing on the effect of radiation on ecosystem. To understand the ecological effect of irradiation, microbial ecosystem, “microcosm”, which contains minimum components of ecosystem such as producer, consumer and decomposer, is useful because the natural ecosystem is too complex. The microcosm consists of three species, i.e. Euglena (producer), Tetrahymena (consumer), and E. coli (decomposer). The mathematical model and computer simulation model were also developed to understand the mechanism of ecological interaction using the results of acute exposure experiments of the microcosm, and we predicted Tetrahymena, which is the most radio-resistant among the constituent species, would be most sensitive in the chronically irradiated microcosm as a result of an indirect effect due to population decrease in E. coli. Recently we started chronic exposure experiments. The microcosms were irradiated with γ-rays at dose rate of 1.2Gy/day, 5Gy/day, 10Gy/day and 23Gy/day. From preliminary results, we found that the prediction from the models was different from the experimental results. Therefore, in this study, we improved our mathematical model and discuss the difference between the model and experiments.
We studied X-ray Fourier transform holography using separated holography-mask and sample geometry. The method was successfully applied to the imaging of the magnetic nanostructure using soft X-ray in addition to the cross-sectional imaging of Cu interconnect lines using hard X-ray.