Characteristics of ESBL-producing Enterobacteriaceae and Methicillinresistant Staphylococcus aureus (MRSA) isolated from Swiss and imported raw poultry meat collected at retail level

This study was conducted to investigate the occurrence and genetic characteristics of extended spectrum β-lactamase (ESBL) and methicillin-resistant Staphylococcus aureus (MRSA) in 80 samples of Swiss (n=36) and imported (n=44) raw chicken meat collected at retail level. In addition, ESBL-producers were screened for the presence of the plasmid-mediated colistin resistance gene mcr-1. Countries of import included Argentina (n=2), Austria (n=1), Brazil (n=3), Denmark (n=5), France (n=1), Germany (n=13), Hungary (n=5), Italy (n=8), and Slovenia (n=6). Forty ESBL-producing E. coli strains were isolated from 33 (41.3%) of the 80 samples, comprising seven (19.4%) of the Swiss and 26 (59%) of the imported samples. The most common blaESBL among the isolates were blaCTX-M-1 (n=14) and blaSHV-12 (n=16). Other genes comprised blaTEM-52 (n=4), blaCTX-M-2 (n=3), blaCTX-M-8 (n=1), blaCTX-M-14 (n=1) and a novel blaCTX-M-14-like variant (n=1). Two ESBL-producers isolated from samples from Germany (n=1) and Italy (n=1) tested additionally positive for the plasmid-mediated colistin resistance gene mcr-1. Six (7.5%) samples, all imported from Germany, were found to contain MRSA. Three isolates belonged to the livestock-associated CC398-MRSA-V-t034, and 3 to CC9-MRSA-IV-t13177, described here for the first time in chicken meat

Band-Gap Nonlinearity in Lead Chalcogenide (PbQ, Q = Te, Se, S) Alloys

Narrow band-gap lead chalcogenides have been developed for several optical and electronic applications. However, band-gap energies of the ternary and quaternary alloys have received little attention compared with the parent binary phases. Here, we have fabricated single-phase ternary (PbTe)1−x(PbSe)x and quaternary (PbTe)0.9−y(PbSe)0.1(PbS)y and (PbTe)0.65−z(PbSe)0.35(PbS)z alloys and shown that although lattice parameters follow Vegard’s law as a function of composition, the bandgap energies exhibit a substantial bowing effect. The ternary (PbTe)1−x(PbSe)x system features a smaller bowing parameter predominantly due to the difference in electronegativity between Se and Te, whereas the larger bowing parameters in quaternary alloys are generated from a larger crystal lattice mismatch and larger miscibility gap. These findings can lead to further advances in tuning the band-gap and lattice parameters for optical and electronic applications of lead chalcogenides

Racial Disparities in Emergency General Surgery: Do Differences in Outcomes Persist Among Universally Insured Military Patients?

Research Objective: Described as one of the most serious health problems affecting the nation, racial disparities are estimated to account for \u3e83,000 deaths, \u3e$57 billion per year. They have been identified in multiple surgical settings, including differences in outcomes by race among emergency general surgery(EGS) patients. As many minority patients are uninsured, increasing access to care is thought to be a viable solution to mitigate inequities. The objectives of this study were to determine whether racial disparities in 30/90/180day outcomes exist within a universally-insured population of military/civilian-dependent EGS patients and whether differences in outcomes differentially persist in care received at military-vs-civilian hospitals and among sponsors who are enlisted-service members-vs-officers. It also considered longer-term outcomes of care. Study Design: Risk-adjusted survival analyses using Cox proportional-hazards models assessed race-based differences in mortality, major morbidity, and readmission from index-hospital admission (discharge for readmission) through 30/90/180days. Models accounted for hospital clustering and possible biases associated with missing race (reweighted-estimating equations). Sub-analyses considered effects restricted to operative interventions, stratified by 24 EGS-diagnostic categories defined by the American Association for the Surgery of Trauma(AAST), and effect modification related to rank (SES-proxy: officers-vs-enlisted-sponsors) and military-vs-civilian-hospital care. Population Studied: Five years of national TRICARE Prime/Prime-plus data, which provides insurance to active/reserve/retired members of the US Armed Services and dependents, were queried for adults (≥18y) with primary EGS conditions, defined by the AAST. Patients who did not have an index admission between 01/01/2006-01/07/2010 (minimum 180days follow-up) or who were not continuously enrolled in TRICARE for 180days were excluded. Non-surviving patients were retained while they survived. Principal Findings: A total of 101,011 patients were included: 73.5% White, 14.5% Black, 4.4% Asian, 7.7% other. Risk-adjusted analyses reported equivalent-or-better mortality and readmission outcomes among minority patients at 30/90/180days—even when restricted to civilian hospitals where studies suggest that EGS disparities are found. Readmissions within military hospitals were lower among minority patients. Major morbidity was higher among Black versus White patients (HR[95%CI]): 30day-1.23[1.13-1.35], 90day-1.18[1.09-1.28], 180day-1.15[1.07-1.24]—a finding driven by appendiceal disorders (HR:1.69-1.70). No other diagnostic category-based HR was significant. When considered by rank, significant effects were isolated to enlisted-service members. However, given the relatively small number of patients who were (dependents of) officers, it is difficult to determine whether rank-based findings are a result of social determinants or influenced by the limited number of minority patients. Conclusions: The first of its kind to examine racial disparities in longer-term outcomes of EGS care, this longitudinal analysis of military patients demonstrated apparent mitigation of racial disparities within a universally-insured health system when compared to the overall US health system. Efforts to explain findings based on consideration of care provided in military-vs-civilian hospitals, among specific EGS-diagnostic categories, and based on sponsor rank revealed modification of the association between race and outcomes to some extent for all three. Implications for Policy or Practice: The contrast between results for universally-insured military/civilian-dependent patients and reported disparities among all US civilian patients merits consideration. The data speak to the importance of insurance-coverage in the development of disparities interventions nationwide and will help to inform policy within the DoD

A review of the use of terrestrial laser scanning application for change detection and deformation monitoring of structures

Change detection and deformation monitoring is an active area of research within the field of engineering surveying as well as overlapping areas such as structural and civil engineering. The application of Terrestrial Laser Scanning (TLS) techniques for change detection and deformation monitoring of concrete structures has increased over the years as illustrated in the past studies. This paper presents a review of literature on TLS application in the monitoring of structures and discusses registration and georeferencing of TLS point cloud data as a critical issue in the process chain of accurate deformation analysis. Past TLS research work has shown some trends in addressing issues such as accurate registration and georeferencing of the scans and the need of a stable reference frame, TLS error modelling and reduction, point cloud processing techniques for deformation analysis, scanner calibration issues and assessing the potential of TLS in detecting sub-centimetre and millimetre deformations. However, several issues are still open to investigation as far as TLS is concerned in change detection and deformation monitoring studies such as rigorous and efficient workflow methodology of point cloud processing for change detection and deformation analysis, incorporation of measurement geometry in deformation measurements of high-rise structures, design of data acquisition and quality assessment for precise measurements and modelling the environmental effects on the performance of laser scanning. Even though some studies have attempted to address these issues, some gaps exist as information is still limited. Some methods reviewed in the case studies have been applied in landslide monitoring and they seem promising to be applied in engineering surveying to monitor structures. Hence the proposal of a three-stage process model for deformation analysis is presented. Furthermore, with technological advancements new TLS instruments with better accuracy are being developed necessitating more research for precise measurements in the monitoring of structures

Obeticholic acid for the treatment of non-alcoholic steatohepatitis: interim analysis from a multicentre, randomised, placebo-controlled phase 3 trial

BACKGROUND Non-alcoholic steatohepatitis (NASH) is a common type of chronic liver disease that can lead to cirrhosis. Obeticholic acid, a farnesoid X receptor agonist, has been shown to improve the histological features of NASH. Here we report results from a planned interim analysis of an ongoing, phase 3 study of obeticholic acid for NASH. METHODS In this multicentre, randomised, double-blind, placebo-controlled study, adult patients with definite NASH, non-alcoholic fatty liver disease (NAFLD) activity score of at least 4, and fibrosis stages F2-F3, or F1 with at least one accompanying comorbidity, were randomly assigned using an interactive web response system in a 1:1:1 ratio to receive oral placebo, obeticholic acid 10 mg, or obeticholic acid 25 mg daily. Patients were excluded if cirrhosis, other chronic liver disease, elevated alcohol consumption, or confounding conditions were present. The primary endpoints for the month-18 interim analysis were fibrosis improvement (≥1 stage) with no worsening of NASH, or NASH resolution with no worsening of fibrosis, with the study considered successful if either primary endpoint was met. Primary analyses were done by intention to treat, in patients with fibrosis stage F2-F3 who received at least one dose of treatment and reached, or would have reached, the month 18 visit by the prespecified interim analysis cutoff date. The study also evaluated other histological and biochemical markers of NASH and fibrosis, and safety. This study is ongoing, and registered with ClinicalTrials.gov, NCT02548351, and EudraCT, 20150-025601-6. FINDINGS Between Dec 9, 2015, and Oct 26, 2018, 1968 patients with stage F1-F3 fibrosis were enrolled and received at least one dose of study treatment; 931 patients with stage F2-F3 fibrosis were included in the primary analysis (311 in the placebo group, 312 in the obeticholic acid 10 mg group, and 308 in the obeticholic acid 25 mg group). The fibrosis improvement endpoint was achieved by 37 (12%) patients in the placebo group, 55 (18%) in the obeticholic acid 10 mg group (p=0·045), and 71 (23%) in the obeticholic acid 25 mg group (p=0·0002). The NASH resolution endpoint was not met (25 [8%] patients in the placebo group, 35 [11%] in the obeticholic acid 10 mg group [p=0·18], and 36 [12%] in the obeticholic acid 25 mg group [p=0·13]). In the safety population (1968 patients with fibrosis stages F1-F3), the most common adverse event was pruritus (123 [19%] in the placebo group, 183 [28%] in the obeticholic acid 10 mg group, and 336 [51%] in the obeticholic acid 25 mg group); incidence was generally mild to moderate in severity. The overall safety profile was similar to that in previous studies, and incidence of serious adverse events was similar across treatment groups (75 [11%] patients in the placebo group, 72 [11%] in the obeticholic acid 10 mg group, and 93 [14%] in the obeticholic acid 25 mg group). INTERPRETATION Obeticholic acid 25 mg significantly improved fibrosis and key components of NASH disease activity among patients with NASH. The results from this planned interim analysis show clinically significant histological improvement that is reasonably likely to predict clinical benefit. This study is ongoing to assess clinical outcomes. FUNDING Intercept Pharmaceuticals