Nasal decolonization of Staphylococcus aureus with mupirocin: strengths, weaknesses and future prospects

Staphylococcus aureus in the nose is a risk factor for endogenous staphylococcal infection. UK guidelines recommend the use of mupirocin for nasal decolonization in certain groups of patients colonized with methicillin-resistant S. aureus (MRSA). Mupirocin is effective at removing S. aureus from the nose over a few weeks, but relapses are common within several months. There are only a few prospective randomized clinical trials that have been completed with sufficient patients, but those that have been reported suggest that clearance of S. aureus from the nose is beneficial in some patient groups for the reduction in the incidence of nosocomial infections. There is no convincing evidence that mupirocin treatment reduces the incidence of surgical site infection. New antibiotics are needed to decolonize the nose because bacterial resistance to mupirocin is rising, and so it will become less effective. Furthermore, a more bactericidal antibiotic than mupirocin is needed, on the grounds that it might reduce the relapse rate, and so clear the patient of MRSA for a longer period of time than mupirocin

Worldwide time and frequency synchronization by planned VLBI networks

Accurate baseline determinations and clock synchronization results obtained from the Quasar Patrol observations at X band with the Goldstone-Haystack baseline are presented. In addition, data from stations at Greenbank, West Virginia, and Onsala, Sweden were used. It was estimated that clock accuracy was on the order of 16 cm

SuperNeurons: Dynamic GPU Memory Management for Training Deep Neural Networks

Going deeper and wider in neural architectures improves the accuracy, while the limited GPU DRAM places an undesired restriction on the network design domain. Deep Learning (DL) practitioners either need change to less desired network architectures, or nontrivially dissect a network across multiGPUs. These distract DL practitioners from concentrating on their original machine learning tasks. We present SuperNeurons: a dynamic GPU memory scheduling runtime to enable the network training far beyond the GPU DRAM capacity. SuperNeurons features 3 memory optimizations, \textit{Liveness Analysis}, \textit{Unified Tensor Pool}, and \textit{Cost-Aware Recomputation}, all together they effectively reduce the network-wide peak memory usage down to the maximal memory usage among layers. We also address the performance issues in those memory saving techniques. Given the limited GPU DRAM, SuperNeurons not only provisions the necessary memory for the training, but also dynamically allocates the memory for convolution workspaces to achieve the high performance. Evaluations against Caffe, Torch, MXNet and TensorFlow have demonstrated that SuperNeurons trains at least 3.2432 deeper network than current ones with the leading performance. Particularly, SuperNeurons can train ResNet2500 that has $10^4$ basic network layers on a 12GB K40c.Comment: PPoPP '2018: 23nd ACM SIGPLAN Symposium on Principles and Practice of Parallel Programmin

Cassini CAPS-ELS observations of negative ions in Titan's ionosphere: trends of density with altitude

Observations with the Electron Spectrometer sensor of the Cassini Plasma Spectrometer (CAPS-ELS) have revealed the existence of negative ions in Titan's ionosphere. Negative ions are observed during encounters whenever the instrument points in the ram direction at altitudes 950–1400 km. Complex hydrocarbon and nitrile chemical processes are believed to take place which play a role in haze formation. The heaviest ions observed so far have masses up to 13,800 amu/q. Using data from 34 Titan encounters, we show for the first time negative ion density trends of different mass groups, including total densities, with altitude. We determine peak densities and the associated altitudes at which they are observed and the highest altitudes at which individual mass groups are found

Women's experiences of induction of labour: Qualitative systematic review and thematic synthesis

OBJECTIVES: To explore and synthesise evidence of women's experiences of induction of labour (IoL). DESIGN: Systematic review and thematic synthesis of peer-reviewed qualitative evidence. Relevant databases were searched from inception to the present day. Study quality was appraised using the Critical Appraisal Skills Programme (CASP) qualitative research appraisal tool. SETTING AND PARTICIPANTS: Low and high risk women who had experienced IoL in an inpatient or outpatient setting. FINDINGS: Eleven papers (representing 10 original studies) published between 2010 and 2018 were included for thematic synthesis. Four key analytical themes were identified: ways in which decisions regarding induction were made; women's ownership of the process; women's social needs when undergoing IoL; and the importance of place in the induction process. The review indicates that IoL is a challenging experience for women, which can be understood in terms of the gap between women's needs and the reality of their experience concerning information and decision-making, support, and environment. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Providing good quality appropriately timed information and supporting women's self-efficacy to be involved in decision-making around IoL may benefit women by facilitating a sense of ownership or control of labour. Compassionate support from significant others and healthcare professionals in a comfortable, private and safe environment should be available to all women

Fast and Slow Water Ion Populations in the Enceladus Plume

Ion velocities have been measured during the Enceladus E3 and E5 flybys using the Cassini Plasma Spectrometer (CAPS) instrument on the Cassini spacecraft. Data from three sensors in the CAPS instrument have been examined from two flybys that occurred during 2008. Positive ion measurements from the CAPS Ion Beam Spectrometer and Ion Mass Spectrometer have been used to measure positive ion velocities. The CAPS Electron Spectrometer has been used to complement the positive ion findings with measurements of negative ion velocities. Two velocities for the positive ions are found, with the fast ions (2.3–5.8 km/s) originating from the high‐speed neutral gas emission and slow ions (0.2–2.2 km/s) associated with the low‐speed thermal gas emission from Enceladus. Negative ions were found to be near stationary or northerly traveling, implying a deceleration mechanism within the plume. A tentative detection of fast negative ions was also recorded for one of the flybys. These findings will aid in future modeling of plume dynamics

A Unified Account of the Moral Standing to Blame

Recently, philosophers have turned their attention to the question, not when a given agent is blameworthy for what she does, but when a further agent has the moral standing to blame her for what she does. Philosophers have proposed at least four conditions on having “moral standing”: 1. One’s blame would not be “hypocritical”. 2. One is not oneself “involved in” the target agent’s wrongdoing. 3. One must be warranted in believing that the target is indeed blameworthy for the wrongdoing. 4. The target’s wrongdoing must some of “one’s business”. These conditions are often proposed as both conditions on one and the same thing, and as marking fundamentally different ways of “losing standing.” Here I call these claims into question. First, I claim that conditions (3) and (4) are simply conditions on different things than are conditions (1) and (2). Second, I argue that condition (2) reduces to condition (1): when “involvement” removes someone’s standing to blame, it does so only by indicating something further about that agent, viz., that he or she lacks commitment to the values that condemn the wrongdoer’s action. The result: after we clarify the nature of the non-hypocrisy condition, we will have a unified account of moral standing to blame. Issues also discussed: whether standing can ever be regained, the relationship between standing and our "moral fragility", the difference between mere inconsistency and hypocrisy, and whether a condition of standing might be derived from deeper facts about the "equality of persons"

New treatments for breast cancer: Breakthroughs for patient care or just steps in the right direction?

Three areas of clinical research in breast cancer treatment led to news breaking presentations at the American Society of Clinical Oncology (ASCO) meeting, 1998, in Los Angeles. All three subjects represent important advances in cancer medicine. Prevention: Two related drugs, tamoxifen and raloxifene, were found in placebo controlled trials to significantly reduce the incidence of breast cancer for women at increased risk of developing the disease. Patterns of relapse showed that the reduced rate of breast cancer was exclusively observed for tumors expressing estrogen receptors, while the rate of tumors classified as estrogen-receptor negative was similar for the treatment and the control groups. This may indicate that the observed reduction in breast cancer incidence is due to a treatment effect on occult disease rather than its prevention. We certainly have no adequate information on mortality prevention. Adjuvant therapies: Taxol given every three weeks for four courses following an adjuvant treatment with four courses of doxorubicin and cyclophosphamide (AC) combination was found to be superior to not adding treatment after the four courses of AC in a trial involving 3170 patients. At 22 months of median follow-up, the quoted P-values were P = 0.0077 for disease-free survival and P = 0.039 for overall survival, but these did not cross the prospectively defined interim analysis boundaries for statistical significance at the 0.05 level. The difference was observed early during follow-up, and was exclusively seen in the 40% of patients who had ER-negative primaries and, therefore, did not receive tamoxifen following chemotherapy. One may thus argue that the early difference observed was primarily due to differences in the duration of the treatment regimens in the two groups and the early entry into the trial of patients with particularly aggressive neoplasia (e.g., ER-negative primaries) who would have benefited from a longer duration treatment. Treatment of advanced disease: The use of monoclonal antibodies to c-erb-B2 was found to induce responses in metastatic breast cancer. Patients with tumors expressing c-erb-B2 responded to weekly infusions of this biological agent. It was particularly impressive that the response rate for patients receiving infusion of the monoclonal antibodies together with the cytotoxics was superior to that with chemotherapy alone in a randomized trial. It is important to note that only patients with tumors overexpressing c-erbB-2 (the overall incidence is about 20%) were tested. It must still be demonstrated that the effect of these monoclonal antibodies is indeed confined to cells overexpressing c-erbB-2. Treatment related cardiac tox-icity remains a problem, and the effects of treatment in various subsets of patients need to be defined before starting investigations in the adjuvant setting, which is a clear further objective of this specific research. The significant findings from clinical research opened several new questions, which must be answered before allowing them to be employed in routine patient car

Achieving minimal disease activity in psoriatic arthritis predicts meaningful improvements in patients’ health-related quality of life and productivity

Background Although psoriatic arthritis is complex and involves multiple domains, recent advances in treatments have made remission or near-remission of most symptoms a potentially achievable goal for many patients. We sought to evaluate whether achieving minimal disease activity (MDA) criteria represented meaningful improvement from the patient perspective. Methods Data were combined from two randomized, multinational, 24 week clinical studies of ixekizumab, a high-affinity monoclonal antibody selectively targeting interleukin-17A, in biological drug-naïve or experienced adults. MDA required 5 of 7 of: tender joint count ≤1; swollen joint count ≤1; Psoriasis Area and Severity Index total score ≤ 1 or body surface area ≤ 3%; patient’s assessment of pain visual analogue scale (VAS) ≤15; patient’s global assessment of disease activity VAS ≤20; Health Assessment Questionnaire Disability Index ≤0.5; and tender entheseal points ≤ 1. MDA responders and non-responders were compared for mean change from baseline on the 36-Item Short Form Health Survey (SF-36), European Quality of Life 5 Dimension 5 Level Health Questionnaire (EQ-5D-5 L); EQ-5D-5 L VAS; and Work Productivity and Activity Impairment–Specific Health Problem (WPAI-SHP) questionnaire. Results MDA responders had significantly greater improvements versus non-responders in each SF-36 domain and in the SF-36 physical summary score; improvements were also greater in the EQ-5D-5 L and EQ-5D-5 L VAS, and in 3 of the 4 WPAI-SHP domains. MDA responders were more likely to achieve minimal clinically important differences than non-responders. Conclusion These findings support MDA response as being strongly associated with achieving improved disease status based on measures of patient reported health-related quality of life and productivity. Trial registration SPIRIT-P1, NCT01695239, First Posted: September 27, 2012; and SPIRIT-P2, NCT02349295, First Posted: January 28, 2015