117 research outputs found

    Curbing methicillin-resistant Staphylococcus aureus in 38 French hospitals through a 15-year institutional control program

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    BACKGROUND: The Assistance Publique-Hôpitaux de Paris (AP-HP) institution administers 38 teaching hospitals (23 acute care and 15 rehabilitation and long-term care hospitals; total, 23 000 beds) scattered across Paris and surrounding suburbs in France. In the late 1980s, the proportion of methicillin resistance among clinical strains of Staphylococcus aureus (MRSA) reached approximately 40% at AP-HP.METHODS: A program aimed at curbing the MRSA burden was launched in 1993, based on passive and active surveillance, barrier precautions, training, and feedback. This program, supported by the strong commitment of the institution, was reinforced in 2001 by a campaign promoting the use of alcohol-based hand-rub solutions. An observational study on MRSA rate was prospectively carried out from 1993 onwards. RESULTS: There was a significant progressive decrease in MRSA burden (-35%) from 1993 to 2007, whether recorded as the proportion (expressed as percentage) of MRSA among S aureus strains (41.0% down to 26.6% overall; 45.3% to 24.2% in blood cultures) or incidence of MRSA cases (0.86 down to 0.56 per 1000 hospital days). The MRSA burden decreased more markedly in intensive care units (-59%) than in surgical (-44%) and medical (-32%) wards. The use of ABHR solutions (in liters per 1000 hospital days) increased steadily from 2 L to 21 L (to 26 L in acute care hospitals and to 10 L in rehabilitation and long-term care hospitals) following the campaign. CONCLUSION: A sustained reduction of MRSA burden can be obtained at the scale of a large hospital institution with high endemic MRSA rates, providing that an intensive program is maintained for a long period

    3D flow in the venom channel of a spitting cobra: do the ridges in the fangs act as fluid guide vanes?

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    The spitting cobra Naja pallida can eject its venom towards an offender from a distance of up to two meters. The aim of this study was to understand the mechanisms responsible for the relatively large distance covered by the venom jet although the venom channel is only of micro-scale. Therefore, we analysed factors that influence secondary flow and pressure drop in the venom channel, which include the physical-chemical properties of venom liquid and the morphology of the venom channel. The cobra venom showed shear-reducing properties and the venom channel had paired ridges that span from the last third of the channel to its distal end, terminating laterally and in close proximity to the discharge orifice. To analyze the functional significance of these ridges we generated a numerical and an experimental model of the venom channel. Computational fluid dynamics (CFD) and Particle-Image Velocimetry (PIV) revealed that the paired interior ridges shape the flow structure upstream of the sharp 90° bend at the distal end. The occurrence of secondary flow structures resembling Dean-type vortical structures in the venom channel can be observed, which induce additional pressure loss. Comparing a venom channel featuring ridges with an identical channel featuring no ridges, one can observe a reduction of pressure loss of about 30%. Therefore it is concluded that the function of the ridges is similar to guide vanes used by engineers to reduce pressure loss in curved flow channels

    A combined numerical and experimental study of the 3D tumble structure and piston boundary layer development during the intake stroke of a gasoline engine

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    Due to its positive effect on flame propagation in the case of a well-defined breakdown, the formation of a large-scale tumble motion is an important goal in engine development. Cycle-to-cycle variations (CCV) in the tumble position and strength however lead to a fluctuating tumble breakdown in space and time and therefore to combustion variations, indicated by CCV of the peak pressure. This work aims at a detailed investigation of the large-scale tumble motion and its interaction with the piston boundary layer during the intake stroke in a state-of-the-art gasoline engine. To allow the validation of the flow near the piston surface obtained by simulation, a new measurement technique called “Flying PIV” is applied. A detailed comparison between experimental and simulation results is carried out as well as an analysis of the obtained flow field. The large-scale tumble motion is investigated based on numerical data of multiple highly resolved intake strokes obtained using scale-resolving simulations. A method to detect the tumble center position within a 3D flow field, as an extension of previously developed 2D and 3D algorithms, is presented and applied. It is then used to investigate the phase-averaged tumble structure, its characteristics in terms of angular velocity and the CCV between the individual intake strokes. Finally, an analysis is presented of the piston boundary layer and how it is influenced by the tumble motion during the final phase of the intake stroke

    SDHA gain-of-function engages inflammatory mitochondrial retrograde signaling via KEAP1-Nrf2.

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    Whether screening the metabolic activity of immune cells facilitates discovery of molecular pathology remains unknown. Here we prospectively screened the extracellular acidification rate as a measure of glycolysis and the oxygen consumption rate as a measure of mitochondrial respiration in B cells from patients with primary antibody deficiency. The highest oxygen consumption rate values were detected in three study participants with persistent polyclonal B cell lymphocytosis (PPBL). Exome sequencing identified germline mutations in SDHA, which encodes succinate dehydrogenase subunit A, in all three patients with PPBL. SDHA gain-of-function led to an accumulation of fumarate in PPBL B cells, which engaged the KEAP1-Nrf2 system to drive the transcription of genes encoding inflammatory cytokines. In a single patient trial, blocking the activity of the cytokine interleukin-6 in vivo prevented systemic inflammation and ameliorated clinical disease. Overall, our study has identified pathological mitochondrial retrograde signaling as a disease modifier in primary antibody deficiency

    International Migration with Heterogeneous Agents: Theory and Evidence

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    Zwei verwirrende Fakten der internationalen Wanderung sind, dass nur ein kleiner Teil der Bevölkerung der Auswanderungsländer emigriert und dass die Migrationsquoten mit der Zeit kleiner werden. Der Beitrag untersucht dieses Phänomen unter Zuhilfenahme eines Migrationsmodells mit heterogenen Agenten für die temporäre Migration. Im Gleichgewicht existiert eine positive Relation zwischen der Anzahl der Migranten und dem Einkommensdifferential, während der Nettomigrationsfluss versiegt. Infolge dessen sind empirische Migrationsmodelle, die sich auf Nettomigrationsflüsse anstatt auf den Bestand an Migranten beziehen, missspezifiziert. Diese Vermutung scheint sich durch die empirische Untersuchung der Kointegrationsbeziehungen von Fluss- und Bestands-Migrationsmodellen zu bestätigen

    European economic integration and migration in Romania

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    Considering the recent debates on the benefits of European economic integration, the purpose of this paper is to assess the impact of EU membership on the migration process in the case of Romania. The paper focussed on two directions of research: comparisons with neighbouring countries that are not member or candidates for EU and the explanation of the remittances based on the economic situation in the destination countries. The approach based on comparisons used difference-in-difference estimator as quantitative method, while the approach based on economic factors in destination countries employed mixed-effects models. The results based on these two approaches indicated that Romania did not send more migrants abroad in the period 2002–2017 compared to Ukraine and Republic of Moldova due its EU membership. On the other hand, Romania gained around 2.5 percentage points more remittances due its EU membership compared to Republic of Moldova and Ukraine. However, the unemployment and the GDP per capita in the destination countries are more important determinants of remittances rather than EU membership in the period 2010–2017. The results reveal that the remittances of Romanian migrants are conditioned by labour market issues in the destination countries, the unemployment in host country having a greater impact on remittances compared to GDP per capita and EU membership. It is expected that a future economic crisis will reduce remittances gained by Romania from other EU countries
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