Presence of Legionellaceae in warm water supplies and typing of strains by polymerase chain reaction

Outbreaks of Legionnaire's disease present a public health challenge especially because fatal outcomes still remain frequent. The aim of this study was to describe the abundance and epidemiology of Legionellaceae in the human-made environment. Water was sampled from hot-water taps in private and public buildings across the area of Göttingen, Germany, including distant suburbs. Following isolation, we used polymerase chain reaction in order to generate strain specific banding profiles of legionella isolates. In total, 70 buildings were examined. Of these 18 (26%) had the bacterium in at least one water sample. Legionella pneumophila serogroups 1, 4, 5 and 6 could be identified in the water samples. Most of the buildings were colonized solely by one distinct strain, as proven by PCR. In three cases equal patterns were found in separate buildings. There were two buildings in this study where isolates with different serogroups were found at the same time

In-Situ Far-Field Calibration of Multibeam Sonar Arrays for Precise Backscatter Imagery

Calibration of large hull-mounted sonar transducer arrays is usually done by measuring the performance of individual components in a test tank. Multiple transducer element beam patterns are superimposed and combined with window attenuation and other partial measurements to give an approximation of the total beam pattern. This process often ignores or fails to accurately model factors such as mounting hardware, array misalignment, reflections from the hull structure and other real world absorbers, reflectors and attenuators which can have significant effect on the actual beam pattern. This paper describes an application of a novel technique for in-situ measurement of the far-field beam pattern of an entire installed hydrophone array using an ROV to carry a calibrated reference transducer. Thesonar array is part of a Simrad EM-121 multibeam sonar system installed aboard the Navy\u27s new survey ship the USNS SUMNER TAGS-61. Test tank measurements of individual hydrophone transducer packages were available and a composite array beam pattern was computed from this data. Direct at-sea measurement of the far-field beam pattern was then made by placing a reference transducer on an ROV and navigating it through an are in the far field of the shipboard array. These two sets of beam patterns are compared. Backscattered signals in a multibeam sonar system can be the basis for characterization of seafloor morphology in terms of mud, clay, silt, sand, gravel, rocks, etc. The degree of differentiation between bottom types, or the number of bottom types which can be differentiated, depends on how accurately the signal strength is calibrated. Factors which affect this measurement include the sonar transmitter electrical output, projector efficiency, projector array beam pattern, spreading loss and attenuation in the water column, losses at the bottom reflection, hydrophonearray beam pattern, hydrophone sensitivity and receiver gains. The degree of improvement in seafloor characterization resulting from the in-situ hydrophone array calibration are examine

Economic Issues in Tariffication: An Overview

Tariffication is an effort to convert all existing agricultural nontariff barriers (NTBs) to trade into bound tariffs and to reduce these tariffs over time. The main economic issues that arise with tariffication stem from the nonequivalence of tariffs in NTBs in a number of scenarios. This paper analyzes nonequivalence arising from the existence of imperfect competition in importing countries, price instability in importing and exporting countries, and inefficient allocation of quantitative restrictions. It is shown that in all these cases the definition of an appropriate equivalent tariff to be used in tariffication is not straightforward, and that in general this equivalent tariff cannot be computed on the basis of only observed price differences between countries

Global Cortical Atrophy Is Associated with an Unfavorable Outcome in Stroke Patients on Oral Anticoagulation.

INTRODUCTION Measures of cerebral small vessel disease (cSVD), such as white matter hyperintensities (WMH) and cerebral microbleeds (CMB), are associated with an unfavorable clinical course in stroke patients on oral anticoagulation (OAC) for atrial fibrillation (AF). Here, we investigated whether similar findings can be observed for global cortical atrophy (GCA). METHODS Registry-based prospective observational study of 320 patients treated with OAC following AF stroke. Patients underwent magnetic resonance imaging (MRI) allowing assessment of GCA. Using the simplified visual Pasquier scale, the severity of GCA was categorized as follows: 0: no atrophy, 1: mild atrophy; 2: moderate atrophy, and 3: severe atrophy. Using adjusted logistic and Cox regression analysis, we investigated the association of GCA using a composite outcome measure, comprising: (i) recurrent acute ischemic stroke (IS); (ii) intracranial hemorrhage (ICH); and (iii) death. RESULTS In our time to event analysis after adjusting for potential confounders (i.e., WMH, CMB, age, sex, diabetes, arterial hypertension, coronary heart disease, hyperlipidemia, and antiplatelet use), GCA was associated with an increased risk for the composite outcome in all three degrees of atrophy (grade 1: aHR 3.95, 95% CI 1.34-11.63, p = 0.013; grade 2: aHR 3.89, 95% CI 1.23-12.30, p = 0.021; grade 3: aHR 4.16, 95% CI 1.17-14.84, p = 0.028). CONCLUSION GCA was associated with our composite outcome also after adjusting for other cSVD markers (i.e., CMB, WMH) and age, indicating that GCA may potentially serve as a prognostic marker for stroke patients with atrial fibrillation on oral anticoagulation

Impact of type of oral anticoagulants in patients with cerebral microbleeds after atrial fibrillation-related ischemic stroke or TIA: Results of the NOACISP-LONGTERM registry.

Background Cerebral microbleeds (CMBs) may have a differential impact on clinical outcome in stroke patients with atrial fibrillation (AF) treated with different types of oral anticoagulation (OAC). Methods Observational single-center study on AF-stroke-patients treated with OAC. Magnetic-resonance-imaging was performed to assess CMBs. Outcome measures consisted of recurrent ischemic stroke (IS), intracranial hemorrhage (ICH), death, and their combined analysis. Functional disability was assessed by mRS. Using adjusted logistic regression and Cox proportional-hazards models, we assessed the association of the presence of CMBs and OAC type (vitamin K antagonists [VKAs] vs. direct oral anticoagulants [DOACs]) with clinical outcome. Results Of 310 AF-stroke patients treated with OAC [DOACs: n = 234 (75%); VKAs: n = 76 (25%)], CMBs were present in 86 (28%) patients; of these, 66 (77%) received DOACs. In both groups, CMBs were associated with an increased risk for the composite outcome: VKAs: HR 3.654 [1.614; 8.277]; p = 0.002; DOACs: HR 2.230 [1.233; 4.034]; p = 0.008. Patients with CMBs had ~50% higher absolute rates of the composite outcome compared to the overall cohort, with a comparable ratio between treatment groups [VKAs 13/20(65%) vs. DOACs 19/66(29%); p < 0.01]. The VKA-group had a 2-fold higher IS [VKAs:4 (20%) vs. DOACs:6 (9%); p = 0.35] and a 10-fold higher ICH rate [VKAs: 3 (15%) vs. DOACs: 1 (1.5%); p = 0.038]. No significant interaction was observed between type of OAC and presence of CMBs. DOAC-patients showed a significantly better functional outcome (OR 0.40 [0.17; 0.94]; p = 0.04). Conclusions In AF-stroke patients treated with OAC, the presence of CMBs was associated with an unfavorable composite outcome for both VKAs and DOACs, with a higher risk for recurrent IS than for ICH. Strokes were numerically higher under VKAs and increased in the presence of CMBs. Clinical trial registration http://www.clinicaltrials.gov, Unique identifier: NCT03826927

Culture and Social Change in Mothers’ and Fathers’ Individualism, Collectivism and Parenting Attitudes

Cultures and families are not static over time but evolve in response to social transformations, such as changing gender roles, urbanization, globalization, and technology uptake. Historically, individualism and collectivism have been widely used heuristics guiding cross-cultural comparisons, yet these orientations may evolve over time, and individuals within cultures and cultures themselves can have both individualist and collectivist orientations. Historical shifts in parents’ attitudes also have occurred within families in several cultures. As a way of understanding mothers’ and fathers’ individualism, collectivism, and parenting attitudes at this point in history, we examined parents in nine countries that varied widely in country-level individualism rankings. Data included mothers’ and fathers’ reports (N = 1338 families) at three time points in China, Colombia, Italy, Jordan, Kenya, Philippines, Sweden, Thailand, and the United States. More variance was accounted for by within-culture than between-culture factors for parents’ individualism, collectivism, progressive parenting attitudes, and authoritarian parenting attitudes, which were predicted by a range of sociodemographic factors that were largely similar for mothers and fathers and across cultural groups. Social changes from the 20th to the 21st century may have contributed to some of the similarities between mothers and fathers and across the nine countries

The impact of competing stroke etiologies in patients with atrial fibrillation.

BACKGROUND Data on the impact of competing stroke etiologies in stroke patients with atrial fibrillation (AF) are scarce. METHODS We used prospectively obtained data from an observational registry (Novel-Oral-Anticoagulants-in-Ischemic-Stroke-Patients-(NOACISP)-LONGTERM) of consecutive AF-stroke patients treated with oral anticoagulants. We compared the frequency of (i) the composite outcome of recurrent ischemic stroke (IS), intracerebral hemorrhage (ICH) or all-cause death as well as (ii) recurrent IS alone among AF-stroke patients with versus without competing stroke etiologies according to the TOAST classification. We performed cox proportional hazards regression modeling adjusted for potential confounders. Furthermore, the etiology of recurrent IS was assessed. RESULTS Among 907 patients (median age 81, 45.6% female), 184 patients (20.3%) had competing etiologies, while 723 (79.7%) had cardioembolism as the only plausible etiology. During 1587 patient-years of follow-up, patients with additional large-artery atherosclerosis had higher rates of the composite outcome (adjusted HR [95% CI] 1.64 [1.11, 2.40], p = 0.017) and recurrent IS (aHR 2.96 [1.65, 5.35 ], p < 0.001), compared to patients with cardioembolism as the only plausible etiology. Overall 71 patients had recurrent IS (7.8%) of whom 26.7% had a different etiology than the index IS with large-artery-atherosclerosis (19.7%) being the most common non-cardioembolic cause. CONCLUSION In stroke patients with AF, causes other than cardioembolism as competing etiologies were common in index or recurrent IS. Concomitant presence of large-artery-atherosclerosis seems to indicate an increased risk for recurrences suggesting that stroke preventive means might be more effective if they also address competing stroke etiologies in AF-stroke patients. CLINICAL TRIAL REGISTRATION NCT03826927