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To describe the genomic analysis and epidemiologic response related to a slow and prolonged methicillin-resistant Staphylococcus aureus (MRSA) outbreak.
Prospective observational study.
Neonatal intensive care unit (NICU).
We conducted an epidemiologic investigation of a NICU MRSA outbreak involving serial baby and staff screening to identify opportunities for decolonization. Whole-genome sequencing was performed on MRSA isolates.
A NICU with excellent hand hygiene compliance and longstanding minimal healthcare-associated infections experienced an MRSA outbreak involving 15 babies and 6 healthcare personnel (HCP). In total, 12 cases occurred slowly over a 1-year period (mean, 30.7 days apart) followed by 3 additional cases 7 months later. Multiple progressive infection prevention interventions were implemented, including contact precautions and cohorting of MRSA-positive babies, hand hygiene observers, enhanced environmental cleaning, screening of babies and staff, and decolonization of carriers. Only decolonization of HCP found to be persistent carriers of MRSA was successful in stopping transmission and ending the outbreak. Genomic analyses identified bidirectional transmission between babies and HCP during the outbreak.
In comparison to fast outbreaks, outbreaks that are “slow and sustained” may be more common to units with strong existing infection prevention practices such that a series of breaches have to align to result in a case. We identified a slow outbreak that persisted among staff and babies and was only stopped by identifying and decolonizing persistent MRSA carriage among staff. A repeated decolonization regimen was successful in allowing previously persistent carriers to safely continue work duties.
Disadvantages of intravenous therapeutic unfractionated heparin, the first-line anti-coagulant agent in children with complex congenital heart disease, include unpredictable pharmacokinetics requiring frequent phlebotomies and the need for continuous intravenous access.
To compare efficacy and safety of low-molecular-weight heparin administered by a subcutaneous indwelling catheter with intravenous unfractionated heparin.
Materials and methods:
Clinical data from 31 inpatients prospectively enrolled to receive subcutaneous low-molecular-weight heparin were compared with those from a historical group of 44 inpatients receiving intravenous unfractionated heparin. Investigation of parents’ satisfaction by telephone survey.
The percentage of anti-factor Xa levels outside therapeutic range was lower in the subcutaneous low-molecular-weight heparin group compared with the percentage of activated partial thromboplastin times outside therapeutic range in the intravenous unfractionated heparin group (40% versus 90%, p < 0.001). Neither group had a major complication. Transient local reactions occurred in 19% of patients of the subcutaneous low-molecular-weight heparin group. The number of needle punctures and that of placement of indwelling catheters were significantly lower in the subcutaneous low-molecular-weight heparin compared with the intravenous unfractionated heparin group (p < 0.001). In total, 84.2% of parents in the subcutaneous low-molecular-weight heparin group reported a positive experience when asked about comparison with prior intravenous unfractionated heparin treatment.
Subcutaneous low-molecular-weight heparin offers a safe anti-coagulation regimen for children with complex congenital heart disease providing more efficient therapeutic anti-coagulation and a reduction in needle punctures, thus causing less pain and anxiety in this children.
Comparing knowledge with belief can go wrong in two dimensions: If the authors employ a wider notion of knowledge, then they do not compare like with like because they assume a narrow notion of belief. If they employ only a narrow notion of knowledge, then their claim is not supported by the evidence. Finally, we sketch a superior teleological view.
Green and Tao famously proved in 2005 that any subset of the primes of fixed positive density contains arbitrarily long arithmetic progressions. Green had previously shown that, in fact, any subset of the primes of relative density tending to zero sufficiently slowly contains a three-term progression. This was followed by work of Helfgott and de Roton, and Naslund, who improved the bounds on the relative density in the case of three-term progressions. The aim of this note is to present an analogous result for longer progressions by combining a quantified version of the relative Szemerédi theorem given by Conlon, Fox and Zhao with Henriot's estimates of the enveloping sieve weights.
The Taipan galaxy survey (hereafter simply ‘Taipan’) is a multi-object spectroscopic survey starting in 2017 that will cover 2π steradians over the southern sky (δ ≲ 10°, |b| ≳ 10°), and obtain optical spectra for about two million galaxies out to z < 0.4. Taipan will use the newly refurbished 1.2-m UK Schmidt Telescope at Siding Spring Observatory with the new TAIPAN instrument, which includes an innovative ‘Starbugs’ positioning system capable of rapidly and simultaneously deploying up to 150 spectroscopic fibres (and up to 300 with a proposed upgrade) over the 6° diameter focal plane, and a purpose-built spectrograph operating in the range from 370 to 870 nm with resolving power R ≳ 2000. The main scientific goals of Taipan are (i) to measure the distance scale of the Universe (primarily governed by the local expansion rate, H0) to 1% precision, and the growth rate of structure to 5%; (ii) to make the most extensive map yet constructed of the total mass distribution and motions in the local Universe, using peculiar velocities based on improved Fundamental Plane distances, which will enable sensitive tests of gravitational physics; and (iii) to deliver a legacy sample of low-redshift galaxies as a unique laboratory for studying galaxy evolution as a function of dark matter halo and stellar mass and environment. The final survey, which will be completed within 5 yrs, will consist of a complete magnitude-limited sample (i ⩽ 17) of about 1.2 × 106 galaxies supplemented by an extension to higher redshifts and fainter magnitudes (i ⩽ 18.1) of a luminous red galaxy sample of about 0.8 × 106 galaxies. Observations and data processing will be carried out remotely and in a fully automated way, using a purpose-built automated ‘virtual observer’ software and an automated data reduction pipeline. The Taipan survey is deliberately designed to maximise its legacy value by complementing and enhancing current and planned surveys of the southern sky at wavelengths from the optical to the radio; it will become the primary redshift and optical spectroscopic reference catalogue for the local extragalactic Universe in the southern sky for the coming decade.
This survey looks at some recent applications of relative entropy in additive combinatorics. Specifically, we examine to what extent entropy-increment arguments can replace or even outperform more traditional energy-increment strategies or alternative approximation arguments based on the Hahn-Banach theorem.
Entropy has a long history as a tool in combinatorics. Starting with a well-known estimate for the sum of the first few binomial coefficients, some of the classical applications include Spencer's theorem that six standard deviations suffice, which states that given n finite sets, there exists a two-colouring of the elements such that all sets have discrepancy at most; a proof of the Loomis-Whitney inequality, which gives an upper bound on the volume of an n-dimensional body in Euclidean space in terms of its (n - 1)-dimensional projections; or Radhakrishnans proof  of Bregman's theorem on the maximum permanent of a 0/1 matrix with given row sums. For a beautiful introduction to these fascinating applications, as well as an extensive annotated bibliography, see .
There are other more recent results in additive combinatorics in particular where the concept of entropy has played a crucial role. Notable examples include Fox's improvement  of the bounds in the graph removal lemma (see also , which appeared in the proof-reading stages of this article); Szegedy's information-theoretic approach  to Sidorenko's conjecture (see also the blog post  by Gowers); Tao's solution  to the Erds discrepancy problem (see the discussion  on Tao's blog).
Since the above developments appear to be well captured by discussions online, we shall not cover them in any detail here. Instead we shall focus on a particular strand of recent results in additive combinatorics that could all be described as “approximation theorems” of a certain kind.
The text naturally splits into five parts. To start with we give a very brief introduction to the concept of entropy and its variants, in particular relative entropy (also known as Kullback-Leibler divergence). In Section 3, we state and prove a rather general sparse approximation theorem due to Lee .
To understand the evolution and morphology of planetary nebulae, a detailed knowledge of their central stars is required. Central stars that exhibit emission lines in their spectra, indicating stellar mass-loss allow to study the evolution of planetary nebulae in action. Emission line central stars constitute about 10 % of all central stars. Half of them are practically hydrogen-free Wolf-Rayet type central stars of the carbon sequence, [WC], that show strong emission lines of carbon and oxygen in their spectra. In this contribution we address the weak emission-lines central stars (wels). These stars are poorly analyzed and their hydrogen content is mostly unknown. We obtained optical spectra, that include the important Balmer lines of hydrogen, for four weak emission line central stars. We present the results of our analysis, provide spectral classification and discuss possible explanations for their formation and evolution.
The purpose of this study was to determine the factors which influence advance directive (AD) completion among older adults.
Direct interviews of hospitalized and community-dwelling cognitively intact patients >65 years of age were conducted in three tertiary teaching settings in New York. Analysis of AD completion focused on its correlation with demographics, personal beliefs, knowledge, attitudes, and exposure to educational media initiatives. We identified five variables with loadings of at least 0.30 in absolute value, along with five demographic variables (significant in the univariate analyses) for multiple logistic regression. The backward elimination method was used to select the final set of jointly significant predictor variables.
Of the 200 subjects consenting to an interview, 125 subjects (63%) had completed ADs. In comparing groups with and without ADs, gender (p < 0.0002), age (p < 0.0161), race (p < 0.0001), education (p < 0.0039), and religion (p < 0.0104) were significantly associated with having an AD. Factors predicting AD completion are: thinking an AD will help in the relief of suffering at the end of life, (OR 76.3, p < 0.0001), being asked to complete ADs/ or receiving explanation about ADs (OR 55.2, p < 0.0001), having undergone major surgery (OR 6.3, p < 0.0017), female gender (OR 11.1, p < 0.0001) and increasing age (76–85 vs. 59–75: OR 3.4, p < 0.0543; <85 vs. 59–75: OR 6.3, p < 0.0263).
Significance of results:
This study suggests that among older adults, the probability of completing ADs is related to personal requests by health care providers, educational level, and exposure to advance care planning media campaigns.
Bacterial protein synthesis is the target for several classes
of established antibiotics. This report describes the
characterization of a novel translation inhibitor produced by
the soil bacterium Flexibacter. The dipeptide antibiotic
TAN1057 A/B was synthesized and designated GS7128. As reported
previously, TAN1057 inhibits protein synthesis in both
Escherichia coli and Staphylococcus aureus,
leaving transcription unaffected. Cell-free translation systems
from E. coli were used to further dissect the mechanism
of translational inhibition. Binding of mRNA to ribosomes was
unaffected by the drug, whereas the initiation reaction was
reduced. Elongation of translation was completely inhibited
by GS7128. Detailed analysis showed that the peptidyl transferase
reaction was strongly inhibited, whereas tRNA binding to both
A- and P-site was unaffected. Selection and analysis of
drug-resistant mutants of S. aureus suggests that drug
uptake may be mediated by a dipeptide transport mechanism.