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Background: Weekly surveillance to identify neonatal intensive care unit (NICU) infants with methicillin-resistant S. aureus (MRSA) nasal colonization was performed using Remel Spectra MRSA chromogenic media. An increased MRSA colonization rate from baseline was detected in 2019, prompting additional review of all positive MRSA NICU screening cultures from 2019. Methods: A subset of 23 positive cultures were interrogated in detail. Species-level identification was confirmed using matrix-assisted laser desorption/ionization-time of flight (MALDI-TOF) with a Bruker Biotyper. Penicillin-binding protein 2a (PBP2a) testing was performed using the Alere culture colony test, and cefoxitin and oxacillin susceptibility were assessed via Kirby-Bauer disk-diffusion methods (for the purpose of this analysis, oxacillin zone sizes 18 mm were considered susceptible). Molecular detection of mecA and mecC genes using PCR was performed. Results: All 23 isolates in the subset group were confirmed as S. aureus based on MALDI-TOF testing. Moreover, 8 isolates (35%) were confirmed as MRSA based on cefoxitin susceptibility, positive rapid PBP2a testing, and mecA PCR results. Overall, 15 isolates (65%) tested cefoxitin-susceptible and PBP2a negative with negative mecA and mecC gene testing. Of these, 1 (7%) tested oxacillin-susceptible based on disk-diffusion testing, consistent with methicillin-susceptible S. aureus (MSSA). The remaining 14 isolates (93%) tested oxacillin resistant based on oxacillin zone size. Conclusions: Our findings indicate the detection of mecA/mecC negative S. aureus isolates demonstrating oxacillin resistance and growth on Remel Spectra MRSA chromogenic media. These results have important implications for infection prevention surveillance efforts to detect MRSA and raise questions regarding optimal antibiotic therapy in patients with isolates displaying this phenotype.
Biomagnetic field sensors based on AlN/FeCoSiB magnetoelectric (ME) composites desire a resonant frequency that can be precisely tuned to match the biomagnetic signal of interest. A tunable mechanical resonant frequency is achieved when ME composites are integrated onto shape memory alloy (SMA) thin films. Here, high-quality c-axis growth of AlN is obtained on (111) Pt seed layers on both amorphous and crystallized TiNiCu SMA thin films on Si substrates. These composites show large piezoelectric coefficients as high as d33,f= 6.4 pm/V ± 0.2 pm/V. Annealing the AlN/Pt/Ta/amorphous TiNiCu/Si composites to 700 °C to crystallize TiNiCu promoted interdiffusion of Ti into the Ta/Pt layers, leading to an enhanced conductivity in AlN. Depositing AlN onto already crystalline TiNiCu films with low surface roughness resulted in the best piezoelectric films and hence is found to be a more desirable processing route for ME composite applications.
This chapter begins by describing some of the main lines of influence on Coetzee, including major literary figures, philosophical and theological traditions, and a range of South African writers and thinkers. It distinguishes the psychoanalytic and philosophical registers in which the concept of intertextuality has been discussed by such figures as Roland Barthes and Julia Kristeva, as well as (more implicitly) by writers including Fyodor Dostoevsky and Samuel Beckett. Most broadly, it develops an argument that Coetzee was not simply influenced by this way of thinking about the nature and value of literature. Instead, his fiction can be understood as a complex engagement with both the imaginative power and the moral problems that it generates.
We propose the concept of the “Fish Revolution” to demarcate the dramatic increase in North Atlantic fisheries after AD 1500, which led to a 15-fold increase of cod (Gadus morhua) catch volumes and likely a tripling of fish protein to the European market. We consider three key questions: (1) What were the environmental parameters of the Fish Revolution? (2) What were the globalising effects of the Fish Revolution? (3) What were the consequences of the Fish Revolution for fishing communities? While these questions would have been considered unknowable a decade or two ago, methodological developments in marine environmental history and historical ecology have moved information about both supply and demand into the realm of the discernible. Although much research remains to be done, we conclude that this was a major event in the history of resource extraction from the sea, mediated by forces of climate change and globalisation, and is likely to provide a fruitful agenda for future multidisciplinary research.
Angiostrongylus cantonensis (rat lungworm), a parasitic nematode, is expanding its distribution. Human infection, known as angiostrongyliasis, may manifest as eosinophilic meningitis, an emerging infectious disease. The range and incidence of this disease are expanding throughout the tropics and subtropics. Recently, the Hawaiian Islands have experienced an increase in reported cases. This study addresses factors affecting the parasite's distribution and projects its potential future distribution, using Hawaii as a model for its global expansion. Specimens of 37 snail species from the Hawaiian Islands were screened for the parasite using PCR. It was present on five of the six largest islands. The data were used to generate habitat suitability models for A. cantonensis, based on temperature and precipitation, to predict its potential further spread within the archipelago. The best current climate model predicted suitable habitat on all islands, with greater suitability in regions with higher precipitation and temperatures. Projections under climate change (to 2100) indicated increased suitability in regions with estimated increased precipitation and temperatures, suitable habitat occurring increasingly at higher elevations. Analogously, climate change could facilitate the spread of A. cantonensis from its current tropical/subtropical range into more temperate regions of the world, as is beginning to be seen in the continental USA.
ONE OF THE FOUNDING CONCEPTS in modern autobiography is the understanding that autobiographical truth is connected to the ideal of sincerity. So much in modern autobiography has its origins in Rousseau's Confessions, particularly through the idea that autobiographical writing is fundamentally an act of persuasion, one that persuades an audience that it embodies a sincere realization of the self. “Rousseau's interest,” Jean Starobinski has argued, “begins with the question: Why does this inner feeling … not find its echo in the according of immediate recognition?” And Rousseau's text, Starobinski continues, therefore must convey a voice “supple enough and varied enough to tell the diversity, the contradictions, the slight details, the miniscule nuances, the interlocking of tiny perceptions whose tissue constitutes the unique existence of Jean-Jacques.” There is much that distances Rousseau from contemporary autobiographical writing, and there are of course very different ways of interpreting Rousseau's significance as a confessional writer. But the notion that the task of autobiography is to establish a written presence capable of winning recognition as uniquely his or her own finds its equivalent in the injunction repeatedly made by life-writing instructors on MFAs to “find your voice,” to create the persona that is you. As Vivian Gornick explains in The Situation and the Story, a how-to guide that accompanies her MFA course, successful autobiographies derive from “an insight that organized the writing, and in each case a persona had been created to serve the insight.”
The challenge to this assumption dates back almost as far as the Confessions themselves. Examples of an “other tradition,” to borrow John Ashbery's phrase, that connects autobiographical truth with the capacity to shake off the voice of sincerity and treat the self ironically as a fiction, can be found throughout modern literature, in texts as diverse as Thomas Carlyle's Sartor Resartus (1833) and James Joyce's Portrait of the Artist (1916). Indeed, as I will argue, this “other tradition” dates back to what Simon Critchley has defined as the first modern avantgarde, the group of writers and philosophers who gathered at Jena in Germany, including such figures as Friedrich Schlegel and Novalis, and who first articulated the theory of romantic irony.
A biomarker is an objectively measured and evaluated characteristic which is an indicator of normal biologic processes, pathogenic processes, or pharmacologic responses to a therapeutic intervention (Group,2001). Physicians in clinical practice routinely use biomarkers to diagnose and assess disease severity, assist in disease prognosis, and evaluate treatment efficacy. Generally, injury and/or cell death results in increased concentrations of a given biomarker, either due to the release of that biomarker from the injured cell (e.g. creatine phosphokinase (CPK) in patients with myocardial infarction) or the lack of excretion of a normally excreted chemical which results in its accumulation (e.g. blood urea nitrogen in patients with renal failure). In some cases, however, a decrease in biomarker concentrations indicates pathology (e.g. haptoglobin in patients with hemolytic anemia).
Development of a clinically acceptable “brain” biomarker has proven much more difficult than the development of biomarkers for other organs. The difficulty is likely due to a combination of anatomic, physiologic, and technical issues. The complexity of the brain and the concomitant complexity of its response to injury have been barriers to development of sensitive and specific brain biomarkers. The presence of the blood–brain barrier which limits the amount and size of the biomarkers that can cross into the serum has also been an important issue. Until recently, technical difficulties had hindered the ability to identify novel candidate biomarkers using proteomics and, as a result, the number of potential biomarkers has been limited.
This case report describes a patient with reportedly new onset of tics, beginning at 21 years of age, in the context of posttraumatic stress disorder (PTSD) and comorbid alcohol abuse, with no known head injury. The setting is an American Society of Addiction Medicine intensive outpatient substance abuse rehabilitation program in an United States Army Medical Center. The patient is a 22-year-old male diagnosed with alcohol abuse and delayed PTSD who presented to the program's medical officer due to insomnia. We discovered he had a reportedly new ocular tic of ∼9 months duration, which he claimed developed at 21 years of age soon after returning from 1 year of combat duty. The patient was thoroughly evaluated, and we surmised the tic was a symptom of PTSD. After achieving full remission from alcohol, the tic persisted. However, as his PTSD symptoms remitted, so did his tic symptoms. At 6-month follow-up, the patient reported he was essentially free from PTSD symptoms, and his tic was significantly reduced.