•The traditional epidemiology of MRSA is blurring.•Genomic studies have helped in understanding the evolving epidemiology.•Genomic tools are useful in relation to epidemiology and outbreaks.
The ...evolution of meticillin-resistant Staphylococcus aureus (MRSA) from meticillin-susceptible S. aureus has been a result of the accumulation of genetic elements under selection pressure from antibiotics. The traditional classification of MRSA into healthcare-associated MRSA (HA-MRSA) and community-associated MRSA (CA-MRSA) is no longer relevant as there is significant overlap of identical clones between these groups, with an increasing recognition of human infection caused by livestock-associated MRSA (LA-MRSA). Genomic studies have enabled us to model the epidemiology of MRSA along these lines. In this review, we discuss the clinical relevance of genomic studies, particularly whole-genome sequencing, in the investigation of outbreaks. We also discuss the blurring of each of the three epidemiological groups (HA-MRSA, CA-MRSA and LA-MRSA), demonstrating the limited relevance of this classification.
Tau protein is found in the blood of 40 - 50% of patients in the acute phase of a stroke, as a result of the degradation of neurons and damage to the blood-brain barrier. The aim of the study was to ...assess the incidence of tau protein in the blood of stroke patients, as well as to evaluate the potential impact of tau protein presence in the blood of patients on their neurological state during the first 24 hours, and their functional condition three months after the stroke. Eighty-seven patients aged 39 - 99 (42 females and 45 males) diagnosed with stroke were enrolled in the prospective study (August 2014 - April 2015). The following parameters were analyzed in enrolled participants: the age at which first ischemic stroke occurred, neurological state during the first 24 hours (National Institutes of Health Stroke Scale - NIHSS), blood tau protein and brain derived neurotrophic factor (BDNF) concentrations on day 2 of stroke, the functional condition on day 90 after stroke onset (mRankin). A multifactorial analysis was carried out to establish independent factors for the presence of serum tau protein and to identify independent factors for poor prognosis. Eighty-seven patients of the mean age of 71.7 ± 11.8 years (median 74; min. 39 max. 99 years) took part in the study. The tau protein was found in the serum of 42 (48.27%) patients in the concentrations between 29.56 and 19 023.50 ng/ml. The female sex was the only independent factor for the presence of tau protein in blood (RR 4.49 (1.68 - 11.97), P = 0.003). The mean BDNF concentration in the evaluated group was: 9.96 ± 5.21; median 10.39. Three independent factors for poor functional condition of patients on day 90 after the stroke were identified: the presence of tau protein in blood (RR 3.90 (1.45 - 10.49), P = 0.007), BDNF concentration below the mean value for the study (RR 14.49 (4.60 - 45.45); P = 0.000) and NIHSS score > 4 during the first 24 hours of stroke (RR 1.14; 95% CI: 1.00 - 1.31; P = 0.027). The presence of the tau protein, low BDNF concentrations, and moderate/serious neurological state during the first 24 hours of stroke can be considered as negative prognosis for the patient's functional condition. The coincidence of high BDNF concentrations and absence of tau in blood during the acute phase of an ischemic stroke is a predictor of patient's good state in 3 months after stroke.
V-band waveguide components operating in 57–64 GHz ISM band is presented. Consumer-grade stereolithographic 3D printer is used to print these waveguide components with black-pigmented acrylate-based ...polymer. Electroless deposition of silver on these microwave components is achieved using an in-house system assembled with off-the-shelf components. This system is driven by a peristaltic pump, circling plating solution between silver bath and waveguide. Metal plated WR-15, 2-inch waveguide section offers average insertion coefficient of −0.35 dB. Trough waveguide section connected to rectangular waveguide through rectangular to trough waveguide transition is metal plated and offers average insertion coefficient of −1 dB. Silver deposited using the pump operated system offers potential of achieving comparable results as conventional dip coating technique.
A small renal mass is defined as a tumour <4cm. The standard treatment of choice for small renal masses is partial or radical nephrectomy, depending on the tumour anatomy, and has good overall and ...cancer-specific survival. Its association with lymph node metastasis and inferior vena cava (IVC) thrombus is very uncommon. We describe a case of a right small renal mass with a large metastatic paracaval lymph node with IVC level I thrombus who was treated with right radical nephrectomy with thrombus removal and lymph node excision.
Abstract Several guidelines have been published on the management of candidaemia. These guidelines vary in their recommendations, and the lack of consistency between the guidelines has implications ...for the management of candidaemia. We critiqued five guidelines, including the Infectious Diseases Society of America (IDSA) Guidelines for the Management of Candidiasis, the Canadian Clinical Practice Guidelines for Invasive Candidiasis in Adults, the Joint Recommendations of the German Speaking Mycological Society and the Paul-Ehrlich-Society for Chemotherapy, the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) Guideline for the Diagnosis and Management of Candida Diseases, and the Brazilian Guidelines for the Management of Candidiasis. The recommendations in these guidelines vary in all major areas of management, including choice of initial therapy, species-specific therapy ( Candida glabrata and Candida parapsilosis ), transition to oral therapy (3 days as per IDSA but 10 days as per ESCMID), catheter removal and specialty referrals. We found that too much emphasis has been placed on themes such as predicting the infecting species (and therefore fluconazole susceptibility) or the need for investigations such as echocardiography. We also stress that guidelines fail to provide adequate information (due to lack of evidence) on the most relevant issues that clinicians face when managing candidaemia, such as the place for fluconazole in the treatment of C. glabrata , the clinical relevance of dose-dependent susceptibility to fluconazole, and the timing of step-down therapy.
We aimed to describe bacterial co-infections and acute respiratory distress (ARDS) outcomes according to influenza type and subtype.
A retrospective observational study was conducted from 2012 to ...2016 in patients admitted to the respiratory intensive care unit (ICU) of Marseille university hospital for influenza-induced ARDS. Microbiological investigations, including multiplex molecular respiratory panel testing and conventional bacteriological cultures, were performed as part of the routine ICU care on the bronchoalveloar lavage collected at admission. Bacterial co-infections, ICU mortality and respiratory function were investigated according to virus type and subtype.
Among the 45 ARDS patients included, A(H1N1)pdm09 was the most frequent influenza virus identified (28/45 A(H1N1)pdm09, eight out of 45 A(H3N2) and nine out of 45 influenza B). Bacterial co-infections involving a total of 23 bacteria were diagnosed in 16/45 patients (36%). A(H1N1)pdm09 patients presented fewer bacterial co-infections (17.9% vs. 50.0% for A(H3N2) patients and 77.8% for B patients; p < 0.01). Overall, mortality at 90 days post admission was 33.3% (15/45), and there was no significant difference between influenza type and subtype. The need for extracorporeal membrane oxygenation was more frequent for A(H1N1)pdm2009 (20/28, 71.4%) and B patients (7/9, 77.8%) than the A(H3N2) subtype (1/8, 12.5%; p < 0.01). A(H1N1)pdm09-ARDS patients were associated with fewer ventilation-free days at day 28 (median (IQR): 0 (0–8) days) compared with other influenza–ARDS patients (15 (0–25) days, p < 0.05).
In a population of influenza-induced ARDS, A(H1N1)pdm09 was associated with fewer bacterial co-infections but poorer respiratory outcomes. These data underline the major role of A(H1N1)pdm09 subtype on influenza disease severity.
Abstract Knowledge distillation is a form of model compression that allows artificial neural networks of different sizes to learn from one another. Its main application is the compactification of ...large deep neural networks to free up computational resources, in particular on edge devices. In this article, we consider proton-proton collisions at the High-Luminosity Large Hadron Collider (HL-LHC) and demonstrate a successful knowledge transfer from an event-level graph neural network (GNN) to a particle-level small deep neural network (DNN). Our algorithm, DistillNet , is a DNN that is trained to learn about the provenance of particles, as provided by the soft labels that are the GNN outputs, to predict whether or not a particle originates from the primary interaction vertex. The results indicate that for this problem, which is one of the main challenges at the HL-LHC, there is minimal loss during the transfer of knowledge to the small student network, while improving significantly the computational resource needs compared to the teacher. This is demonstrated for the distilled student network on a CPU, as well as for a quantized and pruned student network deployed on an field programmable gate array. Our study proves that knowledge transfer between networks of different complexity can be used for fast artificial intelligence (AI) in high-energy physics that improves the expressiveness of observables over non-AI-based reconstruction algorithms. Such an approach can become essential at the HL-LHC experiments, e.g. to comply with the resource budget of their trigger stages.
Bacterial resistance to multiple antibiotics is a serious and emerging threat. Several measures have been proposed to curb this growing trend. These include prescribing restrictions, education, and ...infection control that target transmission, among several others. Antibiotic cycling has been a subject of debate, and although many investigators have studied the utility of antibiotic cycling with the help of theoretical models or as part of clinical investigations, several areas remain undefined and unclear. This review summarizes the available information on antibiotic heterogeneity (antibiotic cycling, antibiotic mixing, and other types of antibiotic protocols) with a critical analysis of the published studies.
Rice is the staple food and provides livelihood for smallholder farmers in the coastal delta regions of South and Southeast Asia. However, its productivity is often low because of several abiotic ...stresses including high soil salinity and waterlogging during the wet (monsoon) season and high soil and water salinity during the dry season. Development and dissemination of suitable rice varieties tolerant of these multiple stresses encountered in coastal zones are of prime importance for increasing and stabilizing rice productivity, however adoption of new varieties has been slow in this region. Here we implemented participatory varietal selection (PVS) processes to identify and understand smallholder farmers’ criteria for selection and adoption of new rice varieties in coastal zones. New breeding lines together with released rice varieties were evaluated in on-station and on-farm trials (researcher-managed) during the wet and dry seasons of 2008–2014 in the Indian Sundarbans region. Significant correlations between preferences of male and female farmers in most trials indicated that both groups have similar criteria for selection of rice varieties. However, farmers’ preference criteria were different from researchers’ criteria. Grain yield was important, but not the sole reason for variety selection by farmers. Several other factors also governed preferences and were strikingly different when compared across wet and dry seasons. For the wet season, farmers preferred tall (140–170cm), long duration (160–170 d), lodging resistant and high yielding rice varieties because these traits are required in lowlands where water stagnates in the field for about four months (July to October). For the dry season, farmers’ preferences were for high yielding, salt tolerant, early maturing (115–130 d) varieties with long slender grains and good quality for better market value. Pest and disease resistance was important in both seasons but did not rank high. When farmers ranked the two most preferred varieties, the ranking order was sometimes variable between locations and years, but when the top four varieties that consistently ranked high were considered, the variability was low. This indicates that at least 3–4 of the best-performing entries should be considered in succeeding multi-location and multi-year trials, thereby increasing the chances that the most stable varieties are selected. These findings will help improve breeding programs by providing information on critical traits. Selected varieties through PVS are also more likely to be adopted by farmers and will ensure higher and more stable productivity in the salt- and flood-affected coastal deltas of South and Southeast Asia.
PDF
