Carbapenem-resistant
(CRE) represent a health threat, but effective control interventions remain unclear. Hospital wastewater sites are increasingly being highlighted as important potential ...reservoirs. We investigated a large
carbapenemase (KPC)-producing
outbreak and wider CRE incidence trends in the Central Manchester University Hospital NHS Foundation Trust (CMFT) (United Kingdom) over 8 years, to determine the impact of infection prevention and control measures. Bacteriology and patient administration data (2009 to 2017) were linked, and a subset of CMFT or regional hospital KPC-producing
isolates (
= 268) were sequenced. Control interventions followed international guidelines and included cohorting, rectal screening (
= 184,539 screens), environmental sampling, enhanced cleaning, and ward closure and plumbing replacement. Segmented regression of time trends for CRE detections was used to evaluate the impact of interventions on CRE incidence. Genomic analysis (
= 268 isolates) identified the spread of a KPC-producing
outbreak clone (strain A, sequence type 216 ST216;
= 125) among patients and in the environment, particularly on 2 cardiac wards (wards 3 and 4), despite control measures. ST216 strain A had caused an antecedent outbreak and shared its KPC plasmids with other
lineages and
species. CRE acquisition incidence declined after closure of wards 3 and 4 and plumbing replacement, suggesting an environmental contribution. However, ward 3/ward 4 wastewater sites were rapidly recolonized with CRE and patient CRE acquisitions recurred, albeit at lower rates. Patient relocation and plumbing replacement were associated with control of a clonal KPC-producing
outbreak; however, environmental contamination with CRE and patient CRE acquisitions recurred rapidly following this intervention. The large numbers of cases and the persistence of
in
, including pathogenic lineages, are of concern.
The Argentine stem weevil, Listronotus bonariensis (Kuschel) (Coleoptera: Curculionidae), is an important introduced pasture pest in New Zealand. In this study geographical populations of this ...species were analysed using polymerase chain reaction-based randomly amplified polymorphic DNA (RAPD), in an attempt to determine the geographical origin of the pest. Morphologically indistinguishable individuals were collected from nine South American, five New Zealand and one Australian populations. Ten primers were screened for usefulness, two of which revealed significant, scorable polymorphisms between these populations. The results indicated that the sampled New Zealand L. bonariensis populations originated from the east coast of South America.
Twenty nine young children with severe recurrent asthma were given nebulised beclomethasone dipropionate or normal saline in a double blind manner over a six month period. Progress was monitored ...using diary score cards. Those receiving beclomethasone had lower symptom scores, had more symptom free days, and required less additional treatment with bronchodilator agents. The code needed to be broken more frequently if normal saline was used. Over the study period height and weight increases in the two groups were similar, and no serious side effects were noted.
In England and Wales hospital admissions for childhood asthma almost trebled over the period 1975-81. This may have reflected a true increase in the incidence of acute asthma, a swing from primary to ...hospital care, or both. The trend was not due to a change in diagnostic fashion. Monthly admissions showed a pronounced seasonal variation with fewest admissions in winter, rising in spring and early summer to peak in the autumn. A deep admission trough was present in August. The monthly admission profile was very similar throughout England and Wales, suggesting that major "trigger" factors were responsible.
Territorial male red-winged blackbirds from five locations in the United States and Canada were genotyped using a suite of six microsatellite loci. Each population possessed unique alleles, but ...numbers of alleles per locus (range = 7.3-8.8) and expected multilocus heterozygosities (range = 0.76-0.80) were similar in all populations. Significant overall allele frequency differences were detected between some population pairs, and some pairwise Fst values were significant (but small). However, Fst among populations, although significant, was also small (0.009). Despite revealing low levels of population structure, the high multilocus polymorphism indicates these loci will be valuable in the genetic analysis of behavior and reproductive strategies in this species.
Eight South American geographical populations of the parasitoid Microctonus hyperodae Loan were collected in South America (Argentina, Brazil, Chile and Uruguay) and released in New Zealand for ...biological control of the weevil Listronotus bonariensis (Kuschel), a pest of pasture grasses and cereals. DNA sequencing (16S, COI, 28S, ITS1, beta-tubulin), RAPD, AFLP, microsatellite, SSCP and RFLP analyses were used to seek markers for discriminating between the South American populations. All of the South American populations were more homogeneous than expected. However, variation in microsatellites and 16S gene sequences corroborated morphological, allozyme and other phenotypic evidence of trans-Andes variation between the populations. The Chilean populations were the most genetically variable, while the variation present on the eastern side of the Andes mountains was a subset of that observed in Chile.
Proline-rich proteins (PRPs) constitute a group of unusual salivary proteins encoded by tissue-specific multigene families which can be dramatically induced (20- to 70-fold) in vivo in rats, mice and ...hamsters by treatment with the beta-agonist isoproterenol. Addition of dibutyryl cyclic AMP (dbcAMP) or forskolin to hamster parotid gland primary cultures resulted in a large increase (15- to 30-fold) in PRP mRNA levels. The same time-course and levels of induction of PRP mRNA by dbcAMP and isoproterenol were found in primary cultures, indicating that both effectors act through the same mechanism. Induction by isoproterenol, but not by dbcAMP or forskolin, was blocked by the beta-antagonist propranolol. Incorporation of 3Hproline into PRPs was stimulated in primary cultures by all three effectors. The greatest increase in proline incorporation was in the 3HPRPs recovered in the culture medium of induced cells. These studies demonstrate that cAMP or agents which increase intracellular cAMP levels increase PRP gene expression in primary cultures of parotid glands. Pretreatment of the cells with cycloheximide blocked the induction of PRP mRNAs which indicates that the synthesis of a trans-acting factor may be necessary for transcriptional activation of the PRP genes. alpha-Amylase mRNA, another tissue-specific gene product, was not significantly affected by cycloheximide treatment.
The electromagnetic radiation (EMR) signals collected by satellites in the solar spectrum are modified by scattering and absorption by gases and aerosols while traveling through the atmosphere from ...the Earth's surface to the sensor. When and how to correct the atmospheric effects depend on the remote sensing and atmospheric data available, the information desired, and the analytical methods used to extract the information. In many applications involving classification and change detection, atmospheric correction is unnecessary as long as the training data and the data to be classified are in the same relative scale. In other circumstances, corrections are mandatory to put multitemporal data on the same radiometric scale in order to monitor terrestrial surfaces over time. A multitemporal dataset consisting of seven Landsat 5 Thematic Mapper (TM) images from 1988 to 1996 of the Pearl River Delta, Guangdong Province, China was used to compare seven absolute and one relative atmospheric correction algorithms with uncorrected raw data. Based on classification and change detection results, all corrections improved the data analysis. The best overall results are achieved using a new method which adds the effect of Rayleigh scattering to conventional dark object subtraction. Though this method may not lead to accurate surface reflectance, it best minimizes the difference in reflectances within a land cover class through time as measured with the Jeffries–Matusita distance. Contrary to expectations, the more complicated algorithms do not necessarily lead to improved performance of classification and change detection. Simple dark object subtraction, with or without the Rayleigh atmosphere correction, or relative atmospheric correction are recommended for classification and change detection applications.
There is poor agreement on definitions of different phenotypes of preschool wheezing disorders. The present Task Force proposes to use the terms episodic (viral) wheeze to describe children who ...wheeze intermittently and are well between episodes, and multiple-trigger wheeze for children who wheeze both during and outside discrete episodes. Investigations are only needed when in doubt about the diagnosis. Based on the limited evidence available, inhaled short-acting beta(2)-agonists by metered-dose inhaler/spacer combination are recommended for symptomatic relief. Educating parents regarding causative factors and treatment is useful. Exposure to tobacco smoke should be avoided; allergen avoidance may be considered when sensitisation has been established. Maintenance treatment with inhaled corticosteroids is recommended for multiple-trigger wheeze; benefits are often small. Montelukast is recommended for the treatment of episodic (viral) wheeze and can be started when symptoms of a viral cold develop. Given the large overlap in phenotypes, and the fact that patients can move from one phenotype to another, inhaled corticosteroids and montelukast may be considered on a trial basis in almost any preschool child with recurrent wheeze, but should be discontinued if there is no clear clinical benefit. Large well-designed randomised controlled trials with clear descriptions of patients are needed to improve the present recommendations on the treatment of these common syndromes.
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