Phage ϕC2 mediates transduction of Tn6215, encoding erythromycin resistance, between Clostridium difficile strains

UNLABELLED: In this work, we show that Clostridium difficile phage ϕC2 transduces erm(B), which confers erythromycin resistance, from a donor to a recipient strain at a frequency of 10(-6) per PFU. The transductants were lysogenic for ϕC2 and contained the erm(B) gene in a novel transposon, Tn6215. This element is 13,008 bp in length and contains 17 putative open reading frames (ORFs). It could also be transferred at a lower frequency by filter mating. IMPORTANCE: Clostridium difficile is a major human pathogen that causes diarrhea that can be persistent and difficult to resolve using antibiotics. C. difficile is potentially zoonotic and has been detected in animals, food, and environmental samples. C. difficile genomes contain large portions of horizontally acquired genetic elements. The conjugative elements have been reasonably well studied, but transduction has not yet been demonstrated. Here, we show for the first time transduction as a mechanism for the transfer of a novel genetic element in C. difficile. Transduction may also be a useful tool for the genetic manipulation of C. difficile.Peer reviewe

Oscillations of First Order Linear Delay Differential Equations with positive and negative coefficients

Oscillation criteria are obtained for all solutions of the first-order linear delay differential equations with positive and negative coefficients where we established some sufficient conditions so that every solution of (1.1) oscillate. This paper generalized the results in [11]. Some examples are considered to illustrate our main results

Evaluation of Seepage Force and Overall Stability Factor Along Proposed Baghdad Metro Tunnel Across Tigris River

Baghdad Metro is a vital project to fulfill the rapidly increased traffic volume requirements. The proposed metro will connect both sides of Baghdad City, passing under the Tigris River. This study is employed finite elements software (PLAXIS 3D) to evaluate the seepage force developed around the sub-river segment during different construction stages and for other water levels of Tigris. The study found that when the water level changes from maximum to minimum, the developed seepage force decreases by (8 to 13%) and (22 to 27%) respectively. The seepage forces were found to be maximum during the excavation stage. The concrete lining process led to a noticeable reduction in seepage forces at all locations. The study also implemented the strength reduction theory to assess the overall stability of the tunnel. The study shows that the overall stability factor was minimum during the concrete lining process. As the water level decreased, the overall stability factor increased by (5% - 8%).

Behavioral Measurement of Young Generation towards Brand Products in Saudi Arabia: Al- Hassa Case Study

Brand products are rapidly prevailing in developed countries. The behavioral measurement and attitude among young generation is vital to understand in order to make a good marketing plan. This paper highlights the behavioral measurement of young generation towards brand products. It specifically measures  demographic variables ( age, gender, income, social status, education, employment status, friendship effect and price) towards the brand products. Methodology used is the quantitative method which is a self-administrated questionnaire  with 170 responses from the online/paper filling survey participation. SPSS is the software tool used for the statistical analysis to test the suggested hypothesis. Results showed that the price of well-known brand products affects the purchase process negatively. Although young people are interested in purchasing brand products, their low income prevents them from the buying process while they are considered as a major segmentation for brand names. Keywords: Young generation, Brand products, Al-Hass

Castleman Disease Mimicking Neurogenic Tumor Radiologically: A Case Report

Background: There are only few case reports of enlarged lymph node affecting carotid artery and mimicking neurogenic tumor radiologically. We have one such report to present Case presentation: We presented a young male with mass in left upper part of neck mimicking carotid body tumor on CT scan and MRI. Post operatively histopathology sample was sent which was identified as a case of castleman disease. This case has been described in detail in our report. Conclusion: Mass that was initially misunderstood as a case of neurogenic tumor and prepared accordingly showed out to a case of castleman lymphadenopathy. Thus the diagnosis of such unique presentation was made Due to castleman disease rarity and mostly asymptomatic presentation it is difficult to diagnose. Its similarity to lymphoma and paraganglioma radiologically further adds to its difficulty in diagnosis.. Thus it is important to consider castleman disease as a differential diagnosis of such mass

Cement Industry in Saudi Arabia during (2009 – 2012) : Supply and Demand Analysis

The growth of mega projects in Saudi Arabia due to the overflow public budget is considered as major catalyst for cement industry . However, governmental rules contribute critically in monitoring and controlling in cement prices . So, companies can not raise prices even if different factors appear. In this paper, three cement companies are selected as samples of the sector: Southern Cement, Yamamah and Arabian Cement which analyzed by look to supply and demand side with their determinants during (2009 - 2012 ) by applying the law of supply and the law of demand. Also, the black market and the reasons of emergence are discussed. Finally, conclusion and implication are explained at the end. Keywords: Cement Industry, Saudi Arabia, Supply, Deman

Protecting healthcare workers from COVID-19: learning from variation in practice and policy identified through a global cross-sectional survey.

AIMS: The COVID-19 pandemic presents an unprecedented burden on global healthcare systems, and existing infrastructures must adapt and evolve to meet the challenge. With health systems reliant on the health of their workforce, the importance of protection against disease transmission in healthcare workers (HCWs) is clear. This study collated responses from several countries, provided by clinicians familiar with practice in each location, to identify areas of best practice and policy so as to build consensus of those measures that might reduce the risk of transmission of COVID-19 to HCWs at work. METHODS: A cross-sectional descriptive survey was designed with ten open and closed questions and sent to a representative sample. The sample was selected on a convenience basis of 27 senior surgeons, members of an international surgical society, who were all frontline workers in the COVID-19 pandemic. This study was reported according to the Standards for Reporting Qualitative Research (SRQR) checklist. RESULTS: Responses were received by all 27 surgeons from 22 countries across six continents. A number of the study respondents reported COVID-19-related infection and mortality in HCWs in their countries. Differing areas of practice and policy were identified and organized into themes including the specification of units receiving COVID-19 patients, availability and usage of personal protective equipment (PPE), other measures to reduce staff exposure, and communicating with and supporting HCWs. Areas more specific to surgery also identified some variation in practice and policy in relation to visitors to the hospital, the outpatient department, and in the operating room for both non-urgent and emergency care. CONCLUSION: COVID-19 presents a disproportionate risk to HCWs, potentially resulting in a diminished health system capacity, and consequently an impairment to population health. Implementation of these recommendations at an international level could provide a framework to reduce this burden

A dual source fed eleven level switched capacitor multilevel inverter with voltage boosting capability

This work introduces an 11-level switched-capacitor multilevel inverter (SCMLI) designed for solar photo-voltaic (PV) applications, capitalizing on the growing popularity of multilevel inverters due to their superior power quality. With a 1.67-times boosting capability, the proposed SCMLI employs 10 switches, 2 DC supplies, and 2 capacitors to achieve an 11-level output voltage waveform. The topology requires only seven driver circuits, incorporating 2 bidirectional switches and 3 complementary pairs of switches. The proposed inverter has intrinsic capacitor self-balancing features since the capacitors are connected across the DC voltage source at different times throughout a basic cycle to charge the capacitors at a level of input voltage. A thorough comparison between the topology and recently developed SCMLI’s has been presented. The comparison demonstrates the effectiveness in terms of switches, capacitors, sources, efficiency, total standing voltage (TSV), and boosting capacity. To experimentally validate its performance, the suggested SCMLI undergoes testing using a frequency-based switching method. The topology exhibits low total harmonic distortion (THD) of 7.65% in its output voltage waveform and 0.89% in the output current waveform

The development and validation of a scoring tool to predict the operative duration of elective laparoscopic cholecystectomy

Background: The ability to accurately predict operative duration has the potential to optimise theatre efficiency and utilisation, thus reducing costs and increasing staff and patient satisfaction. With laparoscopic cholecystectomy being one of the most commonly performed procedures worldwide, a tool to predict operative duration could be extremely beneficial to healthcare organisations. Methods: Data collected from the CholeS study on patients undergoing cholecystectomy in UK and Irish hospitals between 04/2014 and 05/2014 were used to study operative duration. A multivariable binary logistic regression model was produced in order to identify significant independent predictors of long (> 90 min) operations. The resulting model was converted to a risk score, which was subsequently validated on second cohort of patients using ROC curves. Results: After exclusions, data were available for 7227 patients in the derivation (CholeS) cohort. The median operative duration was 60 min (interquartile range 45–85), with 17.7% of operations lasting longer than 90 min. Ten factors were found to be significant independent predictors of operative durations > 90 min, including ASA, age, previous surgical admissions, BMI, gallbladder wall thickness and CBD diameter. A risk score was then produced from these factors, and applied to a cohort of 2405 patients from a tertiary centre for external validation. This returned an area under the ROC curve of 0.708 (SE = 0.013, p  90 min increasing more than eightfold from 5.1 to 41.8% in the extremes of the score. Conclusion: The scoring tool produced in this study was found to be significantly predictive of long operative durations on validation in an external cohort. As such, the tool may have the potential to enable organisations to better organise theatre lists and deliver greater efficiencies in care

Burnout among surgeons before and during the SARS-CoV-2 pandemic: an international survey

Background: SARS-CoV-2 pandemic has had many significant impacts within the surgical realm, and surgeons have been obligated to reconsider almost every aspect of daily clinical practice. Methods: This is a cross-sectional study reported in compliance with the CHERRIES guidelines and conducted through an online platform from June 14th to July 15th, 2020. The primary outcome was the burden of burnout during the pandemic indicated by the validated Shirom-Melamed Burnout Measure. Results: Nine hundred fifty-four surgeons completed the survey. The median length of practice was 10 years; 78.2% included were male with a median age of 37 years old, 39.5% were consultants, 68.9% were general surgeons, and 55.7% were affiliated with an academic institution. Overall, there was a significant increase in the mean burnout score during the pandemic; longer years of practice and older age were significantly associated with less burnout. There were significant reductions in the median number of outpatient visits, operated cases, on-call hours, emergency visits, and research work, so, 48.2% of respondents felt that the training resources were insufficient. The majority (81.3%) of respondents reported that their hospitals were included in the management of COVID-19, 66.5% felt their roles had been minimized; 41% were asked to assist in non-surgical medical practices, and 37.6% of respondents were included in COVID-19 management. Conclusions: There was a significant burnout among trainees. Almost all aspects of clinical and research activities were affected with a significant reduction in the volume of research, outpatient clinic visits, surgical procedures, on-call hours, and emergency cases hindering the training. Trial registration: The study was registered on clicaltrials.gov "NCT04433286" on 16/06/2020