Molecular epidemiological investigation of multidrug-resistant Acinetobacter baumannii strains in four Mediterranean countries with a multilocus sequence typing scheme

Thirty-five multidrug-resistant Acinetobacter baumannii strains, representative of 28 outbreaks involving 484 patients from 20 hospitals in Greece, Italy, Lebanon and Turkey from 1999 to 2009, were analysed by multilocus sequence typing. Sequence type (ST)2, ST1, ST25, ST78 and ST20 caused 12, four, three, three and two outbreaks involving 227, 93, 62, 62 and 31 patients, respectively. The genes bla oxa-58, bla oxa-23 and bla oxa-72 were found in 27, two and one carbapenem-resistant strain, respectively. In conclusion, A. baumannii outbreaks were caused by the spread of a few strains

Carbapenem resistance in Acinetobacter baumannii: the molecular epidemic features of an emerging problem in health care facilities

Acinetobacter baumannii is an opportunistic gram-negative pathogen with increasing relevance in a variety of nosocomial infections especially among intensive-care-unit (ICU) patients. Carbapenems have been widely used to treat serious multidrug-resistant A. baumannii infections; however, incidences of carbapenem-resistant A. baumannii are rising in several parts of the world and large and sustained outbreaks caused by such bacteria have been described. Carbapenem-resistant A. baumannii epidemics are sustained by clusters of highly similar strains that successfully spread among different cities and countries; their resistance phenotype is mainly due to the acquisition of carbapenem-hydrolyzing class D β-lactamase (CHDL) genes flanked by insertion sequence (IS) elements. Multi-facility outbreaks can be also sustained by inter-hospital transfer of colonized patients. Here, we review the global epidemiology of carbapenem-resistant A. baumannii, with the emphasis on the molecular epidemiology and genetic characterization of carbapenem resistance in epidemic strains

A cell type-specific cortico-subcortical brain circuit for investigatory and novelty-seeking behavior

INTRODUCTION: Motivational drives are internal states that can be different even in similar interactions with external stimuli. Curiosity as the motivational drive for novelty-seeking and investigating the surrounding environment is for survival as essential and intrinsic as hunger. Curiosity, hunger, and appetitive aggression drive three different goal-directed behaviors—novelty seeking, food eating, and hunting—but these behaviors are composed of similar actions in animals. This similarity of actions has made it challenging to study novelty seeking and distinguish it from eating and hunting in nonarticulating animals. The brain mechanisms underlying this basic survival drive, curiosity, and novelty-seeking behavior have remained unclear. RATIONALE: In spite of having well-developed techniques to study mouse brain circuits, there are many controversial and different results in the field of motivational behavior. This has left the functions of motivational brain regions such as the zona incerta (ZI) still uncertain. Not having a transparent, nonreinforced, and easily replicable paradigm is one of the main causes of this uncertainty. Therefore, we chose a simple solution to conduct our research: giving the mouse freedom to choose what it wants—double free-access choice. By examining mice in an experimental battery of object free-access double-choice (FADC) and social interaction tests—using optogenetics, chemogenetics, calcium fiber photometry, multichannel recording electrophysiology, and multicolor mRNA in situ hybridization—we uncovered a cell type–specific cortico-subcortical brain circuit of the curiosity and novelty-seeking behavior. RESULTS: We analyzed the transitions within action sequences in object FADC and social interaction tests. Frequency and hidden Markov model analyses showed that mice choose different action sequences in interaction with novel objects and in early periods of interaction with novel conspecifics compared with interaction with familiar objects or later periods of interaction with conspecifics, which we categorized as deep and shallow investigation, respectively. This finding helped us to define a measure of depth of investigation that indicates how much a mouse prefers deep over shallow investigation and reflects the mouse’s motivational level to investigate, regardless of total duration of investigation. Optogenetic activation of inhibitory neurons in medial ZI (ZIm), ZImGAD2 neurons, showed a dramatic increase in positive arousal level, depth of investigation, and duration of interaction with conspecifics and novel objects compared with familiar objects, crickets, and food. Optogenetic or chemogenetic deactivation of these neurons decreased depth and duration of investigation. Moreover, we found that ZImGAD2 neurons are more active during deep investigation as compared with during shallow investigation. We found that activation of prelimbic cortex (PL) axons into ZIm increases arousal level, and chemogenetic deactivation of these axons decreases the duration and depth of investigation. Calcium fiber photometry of these axons showed no difference in activity between shallow and deep investigation, suggesting a nonspecific motivation. Optogenetic activation of ZImGAD2 axons into lateral periaqueductal gray (lPAG) increases the arousal level, whereas chemogenetic deactivation of these axons decreases duration and depth of investigation. Calcium fiber photometry of these axons showed high activity during deep investigation and no significant activity during shallow investigation, suggesting a thresholding mechanism. Last, we found a new subpopulation of inhibitory neurons in ZIm expressing tachykinin 1 (TAC1) that monosynaptically receive PL inputs and project to lPAG. Optogenetic activation and deactivation of these neurons, respectively, increased and decreased depth and duration of investigation. CONCLUSION: Our experiments revealed different action sequences based on the motivational level of novelty seeking. Moreover, we uncovered a new brain circuit underlying curiosity and novelty-seeking behavior, connecting excitatory neurons of PL to lPAG through TAC1+ inhibitory neurons of ZIm

Acinetobacter baumannii clonal lineages I and II harboring different carbapenem-hydrolyzing-β-lactamase genes are widespread among hospitalized burn patients in Tehran

The aim of this study was to analyze antimicrobial resistance patterns and their encoding genes and genotypic diversity of Acinetobacter baumannii isolated from burn patients in Tehran, Iran. The presence of extended-spectrum beta-lactamase- and blaOXA-encoding genes among 37 multidrug resistant (MDR) A. baumannii strains isolated from patients hospitalized in a teaching hospital in Tehran was evaluated. Susceptibility to 7 antibiotics was tested by disk agar diffusion and to polymyxin B and colistin was tested by E-test, according to CLSI guidelines. All isolates were then analyzed by PCR for the presence of blaIMP, blaVIM, blaSIM blaOXA-23, blaOXA-24, and blaOXA-58-like carbapenemase genes, and blaOXA-51-like, blaTEM, blaSHV, blaPER, blaVEB, and blaGIM genes. Genotyping of A. baumannii strains was performed by repetitive sequence-based (REP)-PCR and cluster analysis of REP-PCR profiles. A. baumannii isolates were assigned to international clones by multiplex PCR sequence group analysis. Twenty-five A. baumannii isolates were classified as MDR, and 12 were classified as extensively drug resistant. All isolates were susceptible to colistin and polymyxin B. Eighty-one percent of the isolates was resistant to imipenem or meropenem and harbored at least one or both of the blaOXA-23-like or blaOXA-24-like carbapenemase genes. Co-existence of different resistance genes was found among carbapenem-resistant isolates. Multiplex PCR sequence group analysis most commonly assigned A. baumannii isolates to international clones I (18/37; 48.6) and II (18/37; 48.6). An alarming increase in resistance to carbapenems and the spread of blaOXA-23-like and/or blaOXA-24-like carbapenemase genes was observed among A. baumannii strains belonging to clonal lineages I and II, isolated from burn patients in Tehran. © 2015 King Saud Bin Abdulaziz University for Health Sciences

Perception of Symmetries in Drawings of Graphs

Symmetry is an important factor in human perception in general, as well as in the visualization of graphs in particular. There are three main types of symmetry: reflective, translational, and rotational. We report the results of a human subjects experiment to determine what types of symmetries are more salient in drawings of graphs. We found statistically significant evidence that vertical reflective symmetry is the most dominant (when selecting among vertical reflective, horizontal reflective, and translational). We also found statistically significant evidence that rotational symmetry is affected by the number of radial axes (the more, the better), with a notable exception at four axes.Comment: Appears in the Proceedings of the 26th International Symposium on Graph Drawing and Network Visualization (GD 2018

MOBIlity assessment with modern TEChnology in older patients' real-life by the General Practitioner: The MOBITEC-GP study protocol

Background: Mobility limitations in older adults are associated with poor clinical outcomes including higher mortality and disability rates. A decline in mobility (including physical function and life-space) is detectable and should be discovered as early as possible, as it can still be stabilized or even reversed in early stages by targeted interventions. General practitioners (GPs) would be in the ideal position to monitor the mobility of their older patients. However, easy-to-use and valid instruments for GPs to conduct mobility assessment in the real-life practice setting are missing. Modern technologies such as the global positioning system (GPS) and inertial measurement units (IMUs) - nowadays embedded in every smartphone - could facilitate monitoring of different aspects of mobility in the GP's practice. Methods: This project's aim is to provide GPs with a novel smartphone application that allows them to quantify their older patients' mobility. The project consists of three parts: development of the GPS- and IMU-based application, evaluation of its validity and reliability (Study 1), and evaluation of its applicability and acceptance (Study 2). In Study 1, participants (target N = 72, aged 65+, ≥2 chronic diseases) will perform a battery of walking tests (varying distances; varying levels of standardization). Besides videotaping and timing (gold standard), a high-end GPS device, a medium-accuracy GPS/IMU logger and three different smartphone models will be used to determine mobility parameters such as gait speed. Furthermore, participants will wear the medium-accuracy GPS/IMU logger and a smartphone for a week to determine their life-space mobility. Participants will be re-assessed after 1 week. In Study 2, participants (target N = 60, aged 65+, ≥2 chronic diseases) will be instructed on how to use the application by themselves. Participants will perform mobility assessments independently at their own homes. Aggregated test results will also be presented to GPs. Acceptance of the application will be assessed among patients and GPs. The application will then be finalized and publicly released. Discussion: If successful, the MOBITEC-GP application will offer health care providers the opportunity to follow their patients' mobility over time and to recognize impending needs (e.g. for targeted exercise) within pre-clinical stages of decline

Nano-Tubular Cellulose for Bioprocess Technology Development

Delignified cellulosic material has shown a significant promotional effect on the alcoholic fermentation as yeast immobilization support. However, its potential for further biotechnological development is unexploited. This study reports the characterization of this tubular/porous cellulosic material, which was done by SEM, porosimetry and X-ray powder diffractometry. The results showed that the structure of nano-tubular cellulose (NC) justifies its suitability for use in “cold pasteurization” processes and its promoting activity in bioprocessing (fermentation). The last was explained by a glucose pump theory. Also, it was demonstrated that crystallization of viscous invert sugar solutions during freeze drying could not be otherwise achieved unless NC was present. This effect as well as the feasibility of extremely low temperature fermentation are due to reduction of the activation energy, and have facilitated the development of technologies such as wine fermentations at home scale (in a domestic refrigerator). Moreover, NC may lead to new perspectives in research such as the development of new composites, templates for cylindrical nano-particles, etc

The My Active and Healthy Aging (My-AHA) ICT platform to detect and prevent frailty in older adults: Randomized control trial design and protocol

[EN] Introduction Frailty increases the risk of poor health outcomes, disability, hospitalization, and death in older adults and affects 7%¿12% of the aging population. Secondary impacts of frailty on psychological health and socialization are significant negative contributors to poor outcomes for frail older adults. Method The My Active and Healthy Aging (My-AHA) consortium has developed an information and communications technology¿based platform to support active and healthy aging through early detection of prefrailty and provision of individually tailored interventions, targeting multidomain risks for frailty across physical activity, cognitive activity, diet and nutrition, sleep, and psychosocial activities. Six hundred adults aged 60 years and older will be recruited to participate in a multinational, multisite 18-month randomized controlled trial to test the efficacy of the My-AHA platform to detect prefrailty and the efficacy of individually tailored interventions to prevent development of clinical frailty in this cohort. A total of 10 centers from Italy, Germany, Austria, Spain, United Kingdom, Belgium, Sweden, Japan, South Korea, and Australia will participate in the randomized controlled trial. Results Pilot testing (Alpha Wave) of the My-AHA platform and all ancillary systems has been completed with a small group of older adults in Europe with the full randomized controlled trial scheduled to commence in 2018. Discussion The My-AHA study will expand the understanding of antecedent risk factors for clinical frailty so as to deliver targeted interventions to adults with prefrailty. Through the use of an information and communications technology platform that can connect with multiple devices within the older adult's own home, the My-AHA platform is designed to measure an individual's risk factors for frailty across multiple domains and then deliver personalized domain-specific interventions to the individual. The My-AHA platform is technology-agnostic, enabling the integration of new devices and sensor platforms as they emerge.This project has received funding from the European Union's Horizon 2020 research and innovation program under grant agreement No 689582 and the Australian National Health and Medical Research Council (NHRMC) European Union grant scheme (1115818). M.J.S. reports personal fees from Eli Lilly (Australia) Pty Ltd and grants from Novotech Pty Ltd, outside the submitted work. All other authors report nothing to disclose.Summers, MJ.; Rainero, I.; Vercelli, AE.; Aumayr, GA.; De Rosario Martínez, H.; Mönter, M.; Kawashima, R. (2018). The My Active and Healthy Aging (My-AHA) ICT platform to detect and prevent frailty in older adults: Randomized control trial design and protocol. Alzheimer's and Dementia: Translational Research and Clinical Interventions. 4:252-262. https://doi.org/10.1016/j.trci.2018.06.004S2522624Blair, S. N. (1995). Changes in Physical Fitness and All-Cause Mortality. JAMA, 273(14), 1093. doi:10.1001/jama.1995.03520380029031Fried, L. P., Ferrucci, L., Darer, J., Williamson, J. D., & Anderson, G. (2004). Untangling the Concepts of Disability, Frailty, and Comorbidity: Implications for Improved Targeting and Care. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 59(3), M255-M263. doi:10.1093/gerona/59.3.m255Gillick, M. (2001). Guest Editorial: Pinning Down Frailty. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 56(3), M134-M135. doi:10.1093/gerona/56.3.m134Hamerman, D. (1999). Toward an Understanding of Frailty. Annals of Internal Medicine, 130(11), 945. doi:10.7326/0003-4819-130-11-199906010-00022Fried, L. P., Tangen, C. M., Walston, J., Newman, A. B., Hirsch, C., Gottdiener, J., … McBurnie, M. A. (2001). Frailty in Older Adults: Evidence for a Phenotype. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 56(3), M146-M157. doi:10.1093/gerona/56.3.m146Panza, F., Solfrizzi, V., Barulli, M. R., Santamato, A., Seripa, D., Pilotto, A., & Logroscino, G. (2015). Cognitive Frailty: A Systematic Review of Epidemiological and Neurobiological Evidence of an Age-Related Clinical Condition. Rejuvenation Research, 18(5), 389-412. doi:10.1089/rej.2014.1637Soong, J., Poots, A., Scott, S., Donald, K., Woodcock, T., Lovett, D., & Bell, D. (2015). Quantifying the prevalence of frailty in English hospitals. BMJ Open, 5(10), e008456. doi:10.1136/bmjopen-2015-008456Varadhan, R., Walston, J., Cappola, A. R., Carlson, M. C., Wand, G. S., & Fried, L. P. (2008). Higher Levels and Blunted Diurnal Variation of Cortisol in Frail Older Women. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 63(2), 190-195. doi:10.1093/gerona/63.2.190BROWN, I., RENWICK, R., & RAPHAEL, D. (1995). Frailty. International Journal of Rehabilitation Research, 18(2), 93-102. doi:10.1097/00004356-199506000-00001Buchner, D. M., & Wagner, E. H. (1992). Preventing Frail Health. Clinics in Geriatric Medicine, 8(1), 1-18. doi:10.1016/s0749-0690(18)30494-4Kojima, G., Iliffe, S., Jivraj, S., & Walters, K. (2016). Association between frailty and quality of life among community-dwelling older people: a systematic review and meta-analysis. Journal of Epidemiology and Community Health, 70(7), 716-721. doi:10.1136/jech-2015-206717Ory, M. G., Schechtman, K. B., Miller, J. P., Hadley, E. C., Fiatarone, M. A., … Province, M. A. (1993). Frailty and Injuries in Later Life: The FICSIT Trials. Journal of the American Geriatrics Society, 41(3), 283-296. doi:10.1111/j.1532-5415.1993.tb06707.xShamliyan, T., Talley, K. M. C., Ramakrishnan, R., & Kane, R. L. (2013). Association of frailty with survival: A systematic literature review. Ageing Research Reviews, 12(2), 719-736. doi:10.1016/j.arr.2012.03.001Woodhouse, K. W., & O’Mahony, M. S. (1997). Frailty and ageing. Age and Ageing, 26(4), 245-246. doi:10.1093/ageing/26.4.245CAMPBELL, A. J., & BUCHNER, D. M. (1997). Unstable disability and the fluctuations of frailty. Age and Ageing, 26(4), 315-318. doi:10.1093/ageing/26.4.315Drey, M., Pfeifer, K., Sieber, C. C., & Bauer, J. M. (2011). The Fried Frailty Criteria as Inclusion Criteria for a Randomized Controlled Trial: Personal Experience and Literature Review. Gerontology, 57(1), 11-18. doi:10.1159/000313433Albert, M. S., DeKosky, S. T., Dickson, D., Dubois, B., Feldman, H. H., Fox, N. C., … Phelps, C. H. (2011). The diagnosis of mild cognitive impairment due to Alzheimer’s disease: Recommendations from the National Institute on Aging-Alzheimer’s Association workgroups on diagnostic guidelines for Alzheimer’s disease. Alzheimer’s & Dementia, 7(3), 270-279. doi:10.1016/j.jalz.2011.03.008Petersen, R. C., Smith, G. E., Waring, S. C., Ivnik, R. J., Tangalos, E. G., & Kokmen, E. (1999). Mild Cognitive Impairment. Archives of Neurology, 56(3), 303. doi:10.1001/archneur.56.3.303Winblad, B., Palmer, K., Kivipelto, M., Jelic, V., Fratiglioni, L., Wahlund, L.-O., … Petersen, R. C. (2004). Mild cognitive impairment - beyond controversies, towards a consensus: report of the International Working Group on Mild Cognitive Impairment. Journal of Internal Medicine, 256(3), 240-246. doi:10.1111/j.1365-2796.2004.01380.xDubois, B., Hampel, H., Feldman, H. H., Scheltens, P., Aisen, P., … Andrieu, S. (2016). Preclinical Alzheimer’s disease: Definition, natural history, and diagnostic criteria. Alzheimer’s & Dementia, 12(3), 292-323. doi:10.1016/j.jalz.2016.02.002Moher, D., Hopewell, S., Schulz, K. F., Montori, V., Gotzsche, P. C., Devereaux, P. J., … Altman, D. G. (2010). CONSORT 2010 Explanation and Elaboration: updated guidelines for reporting parallel group randomised trials. BMJ, 340(mar23 1), c869-c869. doi:10.1136/bmj.c869Gray, L. C., Bernabei, R., Berg, K., Finne-Soveri, H., Fries, B. E., Hirdes, J. P., … Ariño-Blasco, S. (2008). Standardizing Assessment of Elderly People in Acute Care: The interRAI Acute Care Instrument. Journal of the American Geriatrics Society, 56(3), 536-541. doi:10.1111/j.1532-5415.2007.01590.xRadloff, L. S. (1977). The CES-D Scale. Applied Psychological Measurement, 1(3), 385-401. doi:10.1177/014662167700100306Guralnik, J. M., Simonsick, E. M., Ferrucci, L., Glynn, R. J., Berkman, L. F., Blazer, D. G., … Wallace, R. B. (1994). A Short Physical Performance Battery Assessing Lower Extremity Function: Association With Self-Reported Disability and Prediction of Mortality and Nursing Home Admission. Journal of Gerontology, 49(2), M85-M94. doi:10.1093/geronj/49.2.m85Powell, L. E., & Myers, A. M. (1995). The Activities-specific Balance Confidence (ABC) Scale. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 50A(1), M28-M34. doi:10.1093/gerona/50a.1.m28Kendzierski, D., & DeCarlo, K. J. (1991). Physical Activity Enjoyment Scale: Two Validation Studies. Journal of Sport and Exercise Psychology, 13(1), 50-64. doi:10.1123/jsep.13.1.50Folstein, M. F., Folstein, S. E., & McHugh, P. R. (1975). «Mini-mental state». Journal of Psychiatric Research, 12(3), 189-198. doi:10.1016/0022-3956(75)90026-6Brandt, J. (1991). The hopkins verbal learning test: Development of a new memory test with six equivalent forms. Clinical Neuropsychologist, 5(2), 125-142. doi:10.1080/13854049108403297Lubben, J. E. (1988). Assessing social networks among elderly populations. Family & Community Health, 11(3), 42-52. doi:10.1097/00003727-198811000-00008Russell, D., Peplau, L. A., & Cutrona, C. E. (1980). The revised UCLA Loneliness Scale: Concurrent and discriminant validity evidence. Journal of Personality and Social Psychology, 39(3), 472-480. doi:10.1037/0022-3514.39.3.472De Vries, O. J., Peeters, G. M. E. E., Lips, P., & Deeg, D. J. H. (2013). Does frailty predict increased risk of falls and fractures? A prospective population-based study. Osteoporosis International, 24(9), 2397-2403. doi:10.1007/s00198-013-2303-zTheou, O., Stathokostas, L., Roland, K. P., Jakobi, J. M., Patterson, C., Vandervoort, A. A., & Jones, G. R. (2011). The Effectiveness of Exercise Interventions for the Management of Frailty: A Systematic Review. Journal of Aging Research, 2011, 1-19. doi:10.4061/2011/569194Cadore, E. (2014). Strength and Endurance Training Prescription in Healthy and Frail Elderly. Aging and Disease, 5(3), 183. doi:10.14336/ad.2014.0500183Cadore, E. L., Rodríguez-Mañas, L., Sinclair, A., & Izquierdo, M. (2013). Effects of Different Exercise Interventions on Risk of Falls, Gait Ability, and Balance in Physically Frail Older Adults: A Systematic Review. Rejuvenation Research, 16(2), 105-114. doi:10.1089/rej.2012.1397Gardner, M. M. (2001). Practical implementation of an exercise-based falls prevention programme. Age and Ageing, 30(1), 77-83. doi:10.1093/ageing/30.1.77Eng, J. J. (2010). Fitness and Mobility Exercise Program for Stroke. Topics in Geriatric Rehabilitation, 26(4), 310-323. doi:10.1097/tgr.0b013e3181fee736Wadlinger, H. A., & Isaacowitz, D. M. (2008). Looking happy: The experimental manipulation of a positive visual attention bias. Emotion, 8(1), 121-126. doi:10.1037/1528-3542.8.1.121MacLeod, C. (2012). Cognitive bias modification procedures in the management of mental disorders. Current Opinion in Psychiatry, 25(2), 114-120. doi:10.1097/yco.0b013e32834fda4aMensink, R. P., & Katan, M. B. (1989). Effect of a Diet Enriched with Monounsaturated or Polyunsaturated Fatty Acids on Levels of Low-Density and High-Density Lipoprotein Cholesterol in Healthy Women and Men. New England Journal of Medicine, 321(7), 436-441. doi:10.1056/nejm19890817321070