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Determining infectious cross-transmission events in healthcare settings involves manual surveillance of case clusters by infection control personnel, followed by strain typing of clinical/environmental isolates suspected in said clusters. Recent advances in genomic sequencing and cloud computing now allow for the rapid molecular typing of infecting isolates.
To facilitate rapid recognition of transmission clusters, we aimed to assess infection control surveillance using whole-genome sequencing (WGS) of microbial pathogens to identify cross-transmission events for epidemiologic review.
Clinical isolates of Staphylococcus aureus, Enterococcus faecium, Pseudomonas aeruginosa, and Klebsiella pneumoniae were obtained prospectively at an academic medical center, from September 1, 2016, to September 30, 2017. Isolate genomes were sequenced, followed by single-nucleotide variant analysis; a cloud-computing platform was used for whole-genome sequence analysis and cluster identification.
Most strains of the 4 studied pathogens were unrelated, and 34 potential transmission clusters were present. The characteristics of the potential clusters were complex and likely not identifiable by traditional surveillance alone. Notably, only 1 cluster had been suspected by routine manual surveillance.
Our work supports the assertion that integration of genomic and clinical epidemiologic data can augment infection control surveillance for both the identification of cross-transmission events and the inclusion of missed and exclusion of misidentified outbreaks (ie, false alarms). The integration of clinical data is essential to prioritize suspect clusters for investigation, and for existing infections, a timely review of both the clinical and WGS results can hold promise to reduce HAIs. A richer understanding of cross-transmission events within healthcare settings will require the expansion of current surveillance approaches.
Efforts to address health disparities and achieve health equity are critically dependent on the development of a diverse research workforce. However, many researchers from underrepresented backgrounds face challenges in advancing their careers, securing independent funding, and finding the mentorship needed to expand their research.
Faculty from the University of Maryland at College Park and the University of Wisconsin-Madison developed and evaluated an intensive week-long research and career-development institute—the Health Equity Leadership Institute (HELI)—with the goal of increasing the number of underrepresented scholars who can sustain their ongoing commitment to health equity research.
In 2010-2016, HELI brought 145 diverse scholars (78% from an underrepresented background; 81% female) together to engage with each other and learn from supportive faculty. Overall, scholar feedback was highly positive on all survey items, with average agreement ratings of 4.45-4.84 based on a 5-point Likert scale. Eighty-five percent of scholars remain in academic positions. In the first three cohorts, 73% of HELI participants have been promoted and 23% have secured independent federal funding.
HELI includes an evidence-based curriculum to develop a diverse workforce for health equity research. For those institutions interested in implementing such an institute to develop and support underrepresented early stage investigators, a resource toolbox is provided.
The discovery of the fully developed Formative sites of Cotocallao (ca. 3750-2350 cal. B.P.) in the Quito Basin and La Chimba (ca. 2650-1700 cal. B.P.) in the northern highlands of Ecuador has raised questions about their cultural antecedents, which have not been resolved despite decades of archaeological work in the region. Paleoenvironmental coring investigations were conducted at Lake San Pablo in northern highland Ecuador to determine the date for the onset of prehistoric maize farming in the temperate highland valleys of this region. The investigations included analysis of lake sediments for pollen, phytoliths, diatoms, and tephra. Maize pollen was identified as early as 4900 cal. B.P., while maize phytoliths dated even earlier, to 6200 or 6600 cal. B.P. These results demonstrate a long history of maize farming in valleys around Lake San Pablo, but in the context of a punctuated record of major and minor volcanic eruptions. It is concluded that early horticultural sites predating Cotocallao and La Chimba must exist, but to find such sites, archaeologists will have to locate and study deeply buried A-horizon soils.
In the quarter plane, five lattice path models with unit steps have resisted the otherwise general approach featured in recent works by Fayolle, Kurkova and Raschel. Here we consider these five models, called the singular models, and prove that the univariate generating functions marking the number of walks of a given length are not D-finite. Furthermore, we provide exact and asymptotic enumerative formulas for the number of such walks, and describe an efficient algorithm for exact enumeration.
The presence or absence of dwarf galaxies with Mr' > -14 in low-density volumes correlates with dark matter halos and how they affect galaxy formation. We are conducting a redshifted Hα imaging survey for dwarf galaxies with Mr' > -13 in the heart of the well-defined voids FN2 and FN8 using the KPNO 4m Mayall telescope and Mosaic Imager. These data have furnished over 600 strong candidates in a four square degree area. Follow-up spectra finding none of these candidates to be within the void volumes will constrain the dwarf population there to be 2 to 8% of the cosmic mean. Conversely, finding even one Hα dwarf in the void heart will challenge several otherwise successful theories of large-scale structure formation.
Emergency department (ED) patients with symptoms of cardiac ischemia often require a second cardiac troponin (cTn) measurement to rule out non–ST elevation myocardial infarction. We measured the total turnaround time and the component event times following the ordering of the second cTn level to ED discharge to identify root causes of delays.
We reviewed a random sample of ED discharges following a second normal cTn measurement and recorded associated event times. The central tendency of time intervals is reported as median and mean number of minutes with interquartile ranges (IQRs) and 95% confidence intervals, respectively.
From 9,656 eligible cases, we randomly selected 226 for data collection. The median number of minutes for each event are as follows: from ordering the second cTn measurement to the time of ED discharge was 90 minutes (IQR 65–120); for blood collection from the time the collection was ordered for was 0 minutes (IQR 212–0); from blood collection to the time the blood was transported to the laboratory was 9 minutes (IQR 2–19); laboratory process duration was 44 minutes (IQR 39–52); from when the results were available to the time the patient was discharged was 30 minutes (IQR 15–52).
For ED patients discharged following two normal cTn levels, the laboratory processing time and time from the result being available to the time of ED discharge represent the longest modifiable time periods to reduce ED length of stay.
Anti-Wolbachia therapy delivers safe macrofilaricidal activity with superior therapeutic outcomes compared to all standard anti-filarial treatments, with the added benefit of substantial improvements in clinical pathology. These outcomes can be achieved, in principle, with existing registered drugs, e.g. doxycycline, that are affordable, available to endemic communities and have well known, albeit population-limiting, safety profiles. The key barriers to using doxycycline as an mass drug administration (MDA) strategy for widespread community-based control are the logistics of a relatively lengthy course of treatment (4–6 weeks) and contraindications in children under eight years and pregnancy. Therefore, the primary goal of the anti-Wolbachia (A·WOL) consortium is to find drugs and regimens that reduce the period of treatment from weeks to days (7 days or less), and to find drugs which would be safe in excluded target populations (pregnancy and children). A secondary goal is to refine regimens of existing antibiotics suitable for a more restricted use, prior to the availability of a regimen that is compatible with MDA usage. For example, for use in the event of the emergence of drug-resistance, in individuals with high loiasis co-infection and at risk of severe adverse events (SAE) to ivermectin, or in post-MDA ‘endgame scenarios’, where test and treat strategies become more cost effective and deliverable.
The population-based Northern Survey of Twin and Multiple Pregnancy (NorSTAMP, formerly the Multiple Pregnancy Register) has collected data since 1998 on all multiple pregnancies in North of England (UK) from the earliest point of ascertainment in pregnancy. This paper updates recent developments to the NorSTAMP and presents some early mortality data from the first 10 years of data collection (1998–2007). Since 2005, mothers have been asked to give explicit consent for their identifiable data to be held by the survey, in line with changing guidance and legal frameworks for identifiable data. In 2009, regional standards of care for multiple pregnancies were developed, agreed, and disseminated. During 1998–2007, 4,865 twin maternities (pregnancies with at least one live birth or stillbirth) were registered, with an average twinning rate of 14.9 per 1,000 maternities. The overall stillbirth and neonatal mortality rates in twins were 18.0/1,000 births and 23.0/1,000 live births respectively. Stillbirth and neonatal mortality rates were significantly higher in monochorionic than dichorionic twins: 44.4 versus 12.2 per 1,000 births (relative risk [RR] 3.6, 95% Confidence Intervals [CI] 2.6–5.1), and 32.4 versus 21.4 per 1,000 live births (RR 1.5, 95% CI 1.04–2.2) respectively. There was no significant improvement during this period in either stillbirth or neonatal mortality rates in either chorionicity group. This population-based survey is an important source of data on multiple pregnancies, which allows monitoring of trends in multiple birth rates and pregnancy losses, providing essential information to support improvements in clinical care and for epidemiological research.
This case report describes carbon monoxide toxicity from prolonged shisha (water-pipe) smoking. The evidence base for the source and pathway of toxicity is discussed. This practice has been increasing in the UK in recent years, and emergency physicians need to be aware of the high levels of CO, with the consequent risk of clinical poisoning from water-pipe smoking.
ClarkeSFJ, StephensC, FarhanM, WardP, KeshishianC, MurrayV, ZennerD. Multiple Patients with Carbon Monoxide Toxicity from Water-Pipe Smoking. Prehosp Disaster Med. 2012;27(6):1-3.
We tested the hypothesis that the conophagous Douglas-fir cone gall midge,
Contarinia oregonensis Foote (Diptera: Cecidomyiidae),
responds to infrared (IR) radiation and other electromagnetic wavelengths
associated with cones of Douglas-fir, Pseudotsuga menziesii
(Mirbel) Franco (Pinaceae). Early-season (March–April) thermographic images
showed that cone orientation (upright, horizontal, pendant) and cone colour
(green, purple, green/purple) did not affect apparent cone temperature
(inferred from thermographic images). Tree components significantly differed
in apparent temperature with foliage being coolest and branches warmest.
There was no significant difference in the number of larvae in cones of
different colours, and adult midges were equally attracted to traps painted
green or purple, suggesting that cone colour does not affect oviposition
decisions by gravid females. Adult midges were more strongly attracted to
warm traps with IR frequency emissions higher than the background than to
cold traps with IR frequency emissions lower than the background. They were
also more strongly attracted to warm branch-shaped traps than to warm
can-shaped traps. Collectively, these data indicate that the shape and IR
attributes of Douglas-fir branches may serve as foraging cues for C.
Herbicides are the foundation of weed control in commercial crop-production systems. However, herbicide-resistant (HR) weed populations are evolving rapidly as a natural response to selection pressure imposed by modern agricultural management activities. Mitigating the evolution of herbicide resistance depends on reducing selection through diversification of weed control techniques, minimizing the spread of resistance genes and genotypes via pollen or propagule dispersal, and eliminating additions of weed seed to the soil seedbank. Effective deployment of such a multifaceted approach will require shifting from the current concept of basing weed management on single-year economic thresholds.