Molecular epidemiology of endemic Clostridium difficile infection

This is the first study to provide a comprehensive insight into the molecular epidemiology of endemic Clostridium difficile and particularly that associated with a recently recognized epidemic strain. We DNA fingerprinted all C. difficile isolates from the stools of patients with symptomatic antibiotic-associated diarrhoea and from repeated samples of the inanimate ward environment on two elderly medicine hospital wards over a 22-month period. Notably, C. difficile was not recoverable from either ward immediately before opening, but was found on both wards within 1–3 weeks of opening, and the level of environmental contamination rose markedly during the first 6 months of the study period. C. difficile infection (CDI) incidence data correlated significantly with the prevalence of environmental C. difficile on ward B (r = 0·76, P 0·05). We found that RAPD and RS–PCR typing had similar discriminatory power, although, despite fingerprinting over 200 C. difficile isolates, we identified only six distinct types. Only two distinct C. difficile strains were identified as causing both patient infection and ward contamination. Attempts to determine whether infected patients or contaminated environments are the prime source for cross-infection by C. difficile had limited success, as over 90% of C. difficile isolates were the UK epidemic clone. However, a non-epidemic strain caused a cluster of six cases of CDI, but was only isolated from the environment after the sixth patient became symptomatic. The initial absence of this strain from the environment implies patient-to-patient and/or staff-to-patient spread. In general, routine cleaning with detergent was unsuccessful at removing C. difficile from the environment. Understanding the epidemiology and virulence of prevalent strains is important if CDI is to be successfully controlled

Japan reenters the foreign exchange market

From 1999 to 2004 Japan unilaterally sold a combined, and unprecedented, 500 billion dollars of yen.Foreign exchange market ; Japan

Capital controls by any other name

The embrace of ad hoc capital controls to address temporary market inefficiencies on a case-by-case basis, while pragmatic, perpetuates the view that each capital crisis is an isolated example of failed financial institutions.Capital market

Mexico's oportunidades program fails to make the grade in NYC

A program that pays poor, rural Mexican families to keep their children in school didn't translate well to New York City. The latter's version will end this summer.Education ; Mexico ; New York (N.Y.)

Why "fixing" China's currency is no quick fix

Even if China does revalue its currency, jobs aren’t likely to come flooding back to the United States. Much of what China exports to the U.S. originates in other Asian countries.Foreign exchange rates ; International finance ; China

Why health care matters and the current debt does not

All of the attention given to raising the debt ceiling this past summer might lead some to believe that spending by the federal government only recently became unsustainable. Hardly. We've been on this path a long time.Health care reform ; Debt

Monetary policy and asset prices

The housing market crisis is the latest reminder that asset prices can and do run wild at rates capable of negative effects on real economic activity. Not surprisingly, this has reinvigorated debate over whether central banks should respond to asset price bubbles.Monetary policy ; Asset pricing

Food prices and inflation in emerging markets

The experience of the past decade illustrates the sensitivity of inflation in emerging markets to rapidly rising food prices.Inflation (Finance) ; Food prices ; Emerging markets

Commodity price gains: speculation vs. fundamentals

Commodities of all sorts have risen in price over the past few years. Some say that the prices reflect a bubble, driven by low interest rates and excessive speculation. Others say the price gains can be fully explained by supply and demand.Inflation (Finance) ; Food prices

Unemployment and the role of monetary policy

On balance, the figure suggests that structural unemployment during economic downturns has increased since 1991.Monetary policy - United States ; Unemployment