A new method for normalized interpretation of antimicrobial resistance from disk test results for comparative purposes.

Objective To evaluate a calibration method for disk diffusion antibiotic susceptibility tests, using zone diameter values generated in the individual laboratory as the internal calibrator for combinations of antibiotic and bacterial species. Methods The high-zone side of zone histogram distributions was first analyzed by moving averages to determine the peak position of the susceptible population. The accumulated percentages of isolates for the high zone diameter values were calculated and converted into probit values. The normal distribution of the ideal population of susceptible strains was then determined by using the least-squares method for probit values against zone diameters, and the ideal population was thereby defined, including mean and standard deviation. Zone diameter values were obtained from laboratories at the Karolinska Hospital (KS) and Växjö Hospital (VX), and from two laboratories (LabA, LabB) in Argentina. The method relies on well standardized disk tests, but is independent of differences in MIC limits and zone breakpoints, and does not require the use of reference strains. Resistance was tentatively set at below 3 SD from the calculated, ideal mean zone diameter of the susceptible population. Results The method, called normalized interpretation of antimicrobial resistance, was tested on results from the KS and VX clinical microbiology laboratories, using the disk diffusion method for antimicrobial susceptibility tests, and for two bacterial species, Staphylococcus aureus and Escherichia coli. In total, 114 217 test results were included for the clinical isolates, and 3582 test results for control strains. The methodology at KS and VX followed the standard of the Swedish Reference Group for Antibiotics (SRGA). Zone diameter histograms for control strains were first analyzed to validate the procedure, and a comparison of actual means with the calculated means showed a correlation coefficient of r = 0.998. Results for clinical isolates at the two laboratories showed an excellent agreement for 54 of 57 combinations of antibiotic and bacterial species between normalized interpretations and the interpretations given by the laboratories. There were difficulties with E. coli and mecillinam, and S. aureus and tetracycline and rifampicin. The method was also tested on results from two laboratories using the NCCLS standard, and preliminary results showed very good agreement with quality-controlled laboratory interpretations. Conclusions The normalized resistance interpretation offers a new approach to comparative surveillance studies whereby the inhibition zone diameter results from disk tests in clinical laboratories can be used for calibration of the test

Interpretation of UV Absorption Lines in SN1006

We present a theoretical interpretation of the broad silicon and iron UV absorption features observed with the Hubble Space Telescope in the spectrum of the Schweizer-Middleditch star behind the remnant of Supernova 1006. These features are caused by supernova ejecta in SN1006. We propose that the redshifted SiII2 1260 A feature consists of both unshocked and shocked SiII. The sharp red edge of the line at 7070 km/s indicates the position of the reverse shock, while its Gaussian blue edge reveals shocked Si with a mean velocity of 5050 km/s and a dispersion of 1240 km/s, implying a reverse shock velocity of 2860 km/s. The measured velocities satisfy the energy jump condition for a strong shock, provided that all the shock energy goes into ions, with little or no collisionless heating of electrons. The line profiles of the SiIII and SiIV absorption features indicate that they arise mostly from shocked Si. The total mass of shocked and unshocked Si inferred from the SiII, SiIII and SiIV profiles is M_Si = 0.25 \pm 0.01 Msun on the assumption of spherical symmetry. Unshocked Si extends upwards from 5600 km/s. Although there appears to be some Fe mixed with the Si at lower velocities < 7070 km/s, the absence of FeII absorption with the same profile as the shocked SiII suggests little Fe mixed with Si at higher (before being shocked) velocities. The column density of shocked SiII is close to that expected for SiII undergoing steady state collisional ionization behind the reverse shock, provided that the electron to SiII ratio is low, from which we infer that most of the shocked Si is likely to be of a fairly high degree of purity, unmixed with other elements. We propose that the ambient interstellar density on the far side of SN1006 is anomalously low compared to the density around the rest of the remnant. ThisComment: 24 pages, with 8 figures included. Accepted for publication in the Astrophysical Journa

Liberal transfusion strategy improves survival in perioperative but not in critically ill patients. A meta-analysis of randomised trials

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