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Clinical Enterobacteriacae isolates with a colistin minimum inhibitory concentration (MIC) ≥4 mg/L from a United States hospital were screened for the mcr-1 gene using real-time polymerase chain reaction (RT-PCR) and confirmed by whole-genome sequencing. Four colistin-resistant Escherichia coli isolates contained mcr-1. Two isolates belonged to the same sequence type (ST-632). All subjects had prior international travel and antimicrobial exposure.
The purpose of this study is to identify characterize and quantify local, regional and remote effects of snow cover on western U. S. climate and water resources. An ensemble of predictability and sensitivity studies was made with the U.S. National Center for Atmospheric Research (NCAR) Community Climate Model, version 3 (CCM3) to investigate the relative roles of snow-cover anomalies and initial atmospheric states in the subsequent accumulation and ablation seasons. The suite of model experiments focuses on the direct effect of snow on regional climate anomalies and ultimately will be used to examine the lagged effect of anomalous snow cover on the climate. The set of ensemble simulations presented here looks at the climate-system response to anomalously high and low snow cover at the start of the ablation season over the western U.S.A. These current results suggest that the initial state of snow cover is more important than the initial state of the atmosphere or of sea-surface temperatures because of direct thermal effects on the surface and subsequent indirect, dynamical effects on the atmospheric circulation.
To assess relationships between mothers’ feeding practices (food as a reward, food for emotion regulation, modelling of healthy eating) and mothers’ willingness to purchase child-marketed foods and fruits/vegetables (F&V) requested by their children during grocery co-shopping.
Cross-sectional. Mothers completed an online survey that included questions about feeding practices and willingness (i.e. intentions) to purchase child-requested foods during grocery co-shopping. Feeding practices scores were dichotomized at the median. Foods were grouped as nutrient-poor or nutrient-dense (F&V) based on national nutrition guidelines. Regression models compared mothers with above-the-median v. at-or-below-the-median feeding practices scores on their willingness to purchase child-requested food groupings, adjusting for demographic covariates.
Participants completed an online survey generated at a public university in the USA.
Mothers (n 318) of 2- to 7-year-old children.
Mothers who scored above-the-median on using food as a reward were more willing to purchase nutrient-poor foods (β=0·60, P<0·0001), mothers who scored above-the-median on use of food for emotion regulation were more willing to purchase nutrient-poor foods (β=0·29, P<0·0031) and mothers who scored above-the-median on modelling of healthy eating were more willing to purchase nutrient-dense foods (β=0·22, P<0·001) than were mothers with at-or-below-the-median scores, adjusting for demographic covariates.
Mothers who reported using food to control children’s behaviour were more willing to purchase child-requested, nutrient-poor foods. Parental feeding practices may facilitate or limit children’s foods requested in grocery stores. Parent–child food consumer behaviours should be investigated as a route that may contribute to children’s eating patterns.
To determine the scope, source, and mode of transmission of a multifacility outbreak of extensively drug-resistant (XDR) Acinetobacter baumannii.
SETTING AND PARTICIPANTS
Residents and patients in skilled nursing facilities, long-term acute-care hospital, and acute-care hospitals.
A case was defined as the incident isolate from clinical or surveillance cultures of XDR Acinetobacter baumannii resistant to imipenem or meropenem and nonsusceptible to all but 1 or 2 antibiotic classes in a patient in an Oregon healthcare facility during January 2012–December 2014. We queried clinical laboratories, reviewed medical records, oversaw patient and environmental surveillance surveys at 2 facilities, and recommended interventions. Pulsed-field gel electrophoresis (PFGE) and molecular analysis were performed.
We identified 21 cases, highly related by PFGE or healthcare facility exposure. Overall, 17 patients (81%) were admitted to either long-term acute-care hospital A (n=8), or skilled nursing facility A (n=8), or both (n=1) prior to XDR A. baumannii isolation. Interfacility communication of patient or resident XDR status was not performed during transfer between facilities. The rare plasmid-encoded carbapenemase gene blaOXA-237 was present in 16 outbreak isolates. Contact precautions, chlorhexidine baths, enhanced environmental cleaning, and interfacility communication were implemented for cases to halt transmission.
Interfacility transmission of XDR A. baumannii carrying the rare blaOXA-237 was facilitated by transfer of affected patients without communication to receiving facilities.
We have developed a physically-based parameterization for snow albedo, for the visible and near-infrared spectral regions used in general circulation models (GCMs). Snow albedo depends primarily on snow grain size, and also on solar zenith angle, snow thickness, impurity content, and atmospheric transmittance. This parameterization is now available as a Fortran subroutine. Simpler, but less accurate, parameterizations have also been developed which depend only on grain size or thickness. Since GCMs do not compute snow grain size, we also developed a method to estimate grain size based on the air temperature and the snow age.
Our parameterization for snow albedo is being incorporated in the NCAR Community Climate Model (CCM) in place of the existing empirical parameterization for snow albedo, to determine the effect of this improvement on the model's performance, and the results will be discussed. However, additional aspects of the treatment of the radiative properties of snow and ice were also capable of improvement and are being changed in the CCM. In particular, it is important to recognize that sea ice is often snow-covered and in that case has an albedo as high as that of snow, and that southern hemisphere sea ice is nearly always snow-covered, even through the melting season. The surface albedo for the Antarctic ice sheet should be about 0.83, but it had been set to 0.71 in the CCM, The CCM has been calculating temperatures too warm over Antarctica, and this low albedo contributed to that error.
A key measure of our understanding of polar glaciation is the ability to
model the initiation, maintenance, and elimination of glaciation over
Antarctica and high-latitude land masses in the Northern Hemisphere. Studies
that address questions of Cenozoic Antarctic glaciation, as well as studies
that address questions of Pleistocene glaciation in the Northern Hemisphere,
are described in some detail. The intention is to emphasize and discuss
issues that are important in modeling these types of glacial events as much
as to present specific results.
Fontan survivors have depressed cardiac index that worsens over time. Serum biomarker measurement is minimally invasive, rapid, widely available, and may be useful for serial monitoring. The purpose of this study was to identify biomarkers that correlate with lower cardiac index in Fontan patients.
Methods and results
This study was a multi-centre case series assessing the correlations between biomarkers and cardiac magnetic resonance-derived cardiac index in Fontan patients ⩾6 years of age with biochemical and haematopoietic biomarkers obtained ±12 months from cardiac magnetic resonance. Medical history and biomarker values were obtained by chart review. Spearman’s Rank correlation assessed associations between biomarker z-scores and cardiac index. Biomarkers with significant correlations had receiver operating characteristic curves and area under the curve estimated. In total, 97 cardiac magnetic resonances in 87 patients met inclusion criteria: median age at cardiac magnetic resonance was 15 (6–33) years. Significant correlations were found between cardiac index and total alkaline phosphatase (−0.26, p=0.04), estimated creatinine clearance (0.26, p=0.02), and mean corpuscular volume (−0.32, p<0.01). Area under the curve for the three individual biomarkers was 0.63–0.69. Area under the curve for the three-biomarker panel was 0.75. Comparison of cardiac index above and below the receiver operating characteristic curve-identified cut-off points revealed significant differences for each biomarker (p<0.01) and for the composite panel [median cardiac index for higher-risk group=2.17 L/minute/m2 versus lower-risk group=2.96 L/minute/m2, (p<0.01)].
Higher total alkaline phosphatase and mean corpuscular volume as well as lower estimated creatinine clearance identify Fontan patients with lower cardiac index. Using biomarkers to monitor haemodynamics and organ-specific effects warrants prospective investigation.
In the United States alone, ∼14,000 children are hospitalised annually with acute heart failure. The science and art of caring for these patients continues to evolve. The International Pediatric Heart Failure Summit of Johns Hopkins All Children’s Heart Institute was held on February 4 and 5, 2015. The 2015 International Pediatric Heart Failure Summit of Johns Hopkins All Children’s Heart Institute was funded through the Andrews/Daicoff Cardiovascular Program Endowment, a philanthropic collaboration between All Children’s Hospital and the Morsani College of Medicine at the University of South Florida (USF). Sponsored by All Children’s Hospital Andrews/Daicoff Cardiovascular Program, the International Pediatric Heart Failure Summit assembled leaders in clinical and scientific disciplines related to paediatric heart failure and created a multi-disciplinary “think-tank”. The purpose of this manuscript is to summarise the lessons from the 2015 International Pediatric Heart Failure Summit of Johns Hopkins All Children’s Heart Institute, to describe the “state of the art” of the treatment of paediatric cardiac failure, and to discuss future directions for research in the domain of paediatric cardiac failure.
To examine the use of vitamin D supplements during infancy among the participants in an international infant feeding trial.
Information about vitamin D supplementation was collected through a validated FFQ at the age of 2 weeks and monthly between the ages of 1 month and 6 months.
Infants (n 2159) with a biological family member affected by type 1 diabetes and with increased human leucocyte antigen-conferred susceptibility to type 1 diabetes from twelve European countries, the USA, Canada and Australia.
Daily use of vitamin D supplements was common during the first 6 months of life in Northern and Central Europe (>80 % of the infants), with somewhat lower rates observed in Southern Europe (>60 %). In Canada, vitamin D supplementation was more common among exclusively breast-fed than other infants (e.g. 71 % v. 44 % at 6 months of age). Less than 2 % of infants in the USA and Australia received any vitamin D supplementation. Higher gestational age, older maternal age and longer maternal education were study-wide associated with greater use of vitamin D supplements.
Most of the infants received vitamin D supplements during the first 6 months of life in the European countries, whereas in Canada only half and in the USA and Australia very few were given supplementation.
The recording and analysis of a burnt mound and adjacent palaeochannel deposits on the floodplain of the River Soar in Leicestershire revealed that the burnt mound was in use, possibly for a number of different purposes, at the transition from the Neolithic to the Bronze Age. An extensive radiocarbon dating programme indicated that the site was revisited. Human remains from the palaeochannel comprised the remains of three individuals, two of whom pre-dated the burnt mound by several centuries while the partial remains of a third, dating from the Late Bronze Age, provided evidence that this individual had met a violent death. These finds, along with animal bones dating to the Iron Age, and the remains of a bridge from the early medieval period, suggest that people were drawn to this location over a long period of time.
Auxinic herbicides, such as 2,4-D and dicamba, that act as plant growth regulators are commonly used for broadleaf weed control in cereal crops (e.g., wheat, barley), grasslands, and noncroplands. If applied at late growth stages, while cereals are developing reproductive parts, the herbicides can reduce seed production. We tested whether growth regulators have this same effect on the invasive annual grass Japanese brome. The herbicides 2,4-D, dicamba, and picloram were applied at typical field use rates to Japanese brome at various growth stages in a greenhouse. Picloram reduced seed production nearly 100% when applied at the internode elongation, boot, or heading stages of growth, whereas dicamba appeared to be slightly less effective and 2,4-D was much less effective. Our results indicate it may be possible to control Japanese brome by using growth regulator herbicides to reduce its seed production, thereby depleting its short-lived seed bank.
To evaluate the impact of serial interventions on the incidence of methicillin-resistant Staphylococcus aureus (MRSA).
Longitudinal observational study before and after interventions.
The Alfred Hospital is a 350-bed tertiary referral hospital with a 35-bed intensive care unit (ICU).
A series of interventions including the introduction of an antimicrobial hand-hygiene gel to the intensive care unit and a hospitalwide MRSA surveillance feedback program that used statistical process control charts but not active surveillance cultures.
Serial interventions were introduced between January 2003 and May 2006. The incidence and rates of new patients colonized or infected with MRSA and episodes of MRSA bacteremia in the intensive care unit and hospitalwide were compared between the preintervention and intervention periods. Segmented regression analysis was used to calculate the percentage reduction in new patients with MRSA and in episodes of MRSA bacteremia hospitalwide in the intervention period.
The rate of new patients with MRSA in the ICU was 6.7 cases per 100 patient admissions in the intervention period, compared with 9.3 cases per 100 patient admissions in the preintervention period (P = .047). The hospitalwide rate of new patients with MRSA was 1.7 cases per 100 patient admissions in the intervention period, compared with 3.0 cases per 100 patient admissions in the preintervention period (P < .001). By use of segmented regression analysis, the maximum and conservative estimates for percentage reduction in the rate of new patients with MRSA were 79.5% and 42.0%, respectively, and the maximum and conservative estimates for percentage reduction in the rate of episodes of MRSA bacteremia were 87.4% and 39.0%, respectively.
A sustained reduction in the number of new patients with MRSA colonization or infection has been demonstrated using minimal resources and a limited number of interventions.
The 2005 Workshop for Department Chairs was dedicated to discussing
the legal issues that face department chairs. Themes included sexual and
racial harassment, tenure, and hiring. APSA's Departmental Services
Committee (DSC) sponsored the workshop and Edie N. Goldenberg (University
of Michigan), a member of the DSC, moderated the panel. American
University Counsel Hisham Khalid, Loyola University Chicago's Susan
Gluck Mezey, and retired Wheaton College President Dale Rogers Marshall
were also part of the panel. The Workshop drew 75 attendees to hear the
four presentations and to consider how to deal with legal issues. The 2006
Workshop for Department Chairs is “Planning for Assessment &
Accountability Issues”—more information will follow in the