Unusual Spread of a Penicillin-Susceptible Methicillin-Resistant Staphylococcus aureus Clone in a Geographic Area of Low Incidence

We describe the unusual spread of a penicillin-susceptible methicillin-resistant Staphylococcus aureus (MRSA) clone in hospitals in western Switzerland, where the incidence of MRSA is usually low. During a 2-year period, this clone had been responsible for several outbreaks and had been isolated from >156 persons in 21 institutions. Molecular typing by pulsed-field gel electrophoresis (PFGE) demonstrated that all of these isolates belonged to the same clone. In 1 of the outbreaks, involving 30 cases, the clone was responsible for at least 17 secondary cases. In contrast, during the period of the latter outbreak, 9 other patients harboring different MRSA strains, as assessed by PFGE, were hospitalized in the same wards, but no secondary cases occurred. These observations suggest that this clone, compared with other MRSA strains, had some intrinsic factor(s) that contributed to its ability to disseminate and could thus be considered epidemi

Faucets as a reservoir of endemic Pseudomonas aeruginosa colonization/infections in intensive care units

Objective: To evaluate the role of faucets as a reservoir for Pseudomonas aeruginosa colonization/infection of patients hospitalized in intensive care units (ICUs). Design: Prospective epidemiological investigation performed during a nonepidemic period of 1year. The inner part of the ICU faucets were swabbed for P. aeruginosa. Data were recorded on all patients with at least one culture of a clinical specimens positive for P. aeruginosa. Pulsed-field gel electrophoresis was used to characterize the strains. Setting: Five ICUs of a university hospital which are supplied by two separate water distribution networks. Patients: During a 1-year period 132 cases were investigated. Results: In 42% of cases (56/132) there were isolates identical to those found in the faucets, with a total of nine different genotypes. Among the nine genotypes isolated from both patients and faucets one of them, the most prevalent, was isolated in the two networks and in 30 cases. The other eight genotypes were recovered almost exclusively from either one (three genotypes in 12 cases) or the other (five genotypes in 12 cases) network and from the patients in the corresponding ICUs. Conclusions: These results suggest that the water system of the ICUs was the primary reservoir of patient's colonization/infection with P. aeruginosa in a substantial proportion of patients, although the exact mode of acquisition could not be determine

Postoperative urinary retention in colorectal surgery within an enhanced recovery pathway.

Enhanced recovery after surgery (ERAS) guidelines for colorectal surgery suggest routine transurethral bladder drainage with early removal to prevent urinary tract infection (UTI). The aim of this study was to identify risk factors for urinary retention (UR). This retrospective analysis included all colorectal patients since ERAS implementation in May 2011-November 2014. From the prospective ERAS database, over 100 items related to demographics, surgery, compliance, and outcome were analyzed. Risk factors for UR were identified by multiple logistic regressions; then, UR was correlated to functional outcomes and UTI and acute kidney injury rates. The study cohort consisted of 513 consecutive patients. Of these, 73 patients (14%) presented with UR. Multivariate analysis identified male gender (odds ratio 1.4; 95% CI, 1-1.8; P = 0.045) and postoperative thoracic epidural analgesia (EDA; odds ratio 2.6; 95% CI, 1.6-4.3; P ≤ 0.001) as independent risk factors for postoperative UR. Functional recovery was impeded in patients with UR, who were less mobile (mobilization day 1 >4 h: 57% versus 70%, P = 0.024) and gained more weight (2.8 ± 2.5 kg versus 1.6 ±3 kg on day 1, P = 0.001) due to fluid overload. Furthermore, patients with urinary catheters reported more pain (visual analog scales day 3: 3.1 ± 2.5 versus 2.2 ± 2.4, P = 0.002) and depended longer on intravenous fluid administration (termination of intravenous fluids later than day 1: 53% versus 39%, P = 0.021). Ten of 73 patients (14%) developed UTI in patients with UR and 42 of 440 (10%) in patients without UR (P = 0.276). Six of 73 patients (8%) developed acute kidney injury in patients with UR and 36 of 440 (8%) in patients without UR (P = 0.991). Male gender and EDA were independent risk factors for postoperative UR which appeared to be a significant impediment for functional recovery

Retrieval of publications addressing shared decision making: an evaluation of full-text searches on medical journal websites.

BACKGROUND: Full-text searches of articles increase the recall, defined by the proportion of relevant publications that are retrieved. However, this method is rarely used in medical research due to resource constraints. For the purpose of a systematic review of publications addressing shared decision making, a full-text search method was required to retrieve publications where shared decision making does not appear in the title or abstract. OBJECTIVE: The objective of our study was to assess the efficiency and reliability of full-text searches in major medical journals for identifying shared decision making publications. METHODS: A full-text search was performed on the websites of 15 high-impact journals in general internal medicine to look up publications of any type from 1996-2011 containing the phrase "shared decision making". The search method was compared with a PubMed search of titles and abstracts only. The full-text search was further validated by requesting all publications from the same time period from the individual journal publishers and searching through the collected dataset. RESULTS: The full-text search for "shared decision making" on journal websites identified 1286 publications in 15 journals compared to 119 through the PubMed search. The search within the publisher-provided publications of 6 journals identified 613 publications compared to 646 with the full-text search on the respective journal websites. The concordance rate was 94.3% between both full-text searches. CONCLUSIONS: Full-text searching on medical journal websites is an efficient and reliable way to identify relevant articles in the field of shared decision making for review or other purposes. It may be more widely used in biomedical research in other fields in the future, with the collaboration of publishers and journals toward open-access data

Discontinuous Change in the Smectic Layer Thickness in Ferrielectric Liquid Crystals

The temperature dependence of the thickness of thick free-standing films is studied using a high-resolution film thickness measurement technique. A small discontinuity in the temperature dependence of the smectic layer thickness at every phase transition between ferro-, ferri-, and antiferroelectric phases is observed. We show that the major contribution to it arises from a change in the smectic tilt angle

Are Steadily Moving Crystals Unstable?

We study the dynamics of small fluctuations about the uniform state of a crystal moving through a dissipative medium, e.g. a sedimenting colloidal crystal or a moving flux lattice, using a set of continuum equations for the displacement fields, and a one-dimensional driven lattice-gas model for the coupled concentration and tilt fields. For the colloidal crystal we predict a continuous nonequilibrium phase transition to a clumped state above a critical Peclet number.Comment: 4 pages, revtex, 2 .eps figures, uses epsf.sty; To be published in Phys. Rev. Lett. This version is substantially rewritten but the essential content is the same as befor

Generic Model Refactorings

Many modeling languages share some common concepts and principles. For example, Java, MOF, and UML share some aspects of the concepts\ud of classes, methods, attributes, and inheritance. However, model\ud transformations such as refactorings specified for a given language\ud cannot be readily reused for another language because their related\ud metamodels may be structurally different. Our aim is to enable a\ud flexible reuse of model transformations across various metamodels.\ud Thus, in this paper, we present an approach allowing the specification\ud of generic model transformations, in particular refactorings, so\ud that they can be applied to different metamodels. Our approach relies\ud on two mechanisms: (1) an adaptation based mainly on the weaving\ud of aspects; (2) the notion of model typing, an extension of object\ud typing in the model-oriented context. We validated our approach by\ud performing some experiments that consisted of specifying three well\ud known refactorings (Encapsulate Field, Move Method, and Pull Up Method)\ud and applying each of them onto three different metamodels (Java,\ud MOF, and UML)

Credibility and adjustment: gold standards versus currency boards

It is often maintained that currency boards (CBs) and gold standards (GSs) are alike in that they are stringent monetary rules, the two basic features of which are high credibility of monetary authorities and the existence of automatic adjustment (non discretionary) mechanism. This article includes a comparative analysis of these two types of regimes both from the perspective of the sources and mechanisms of generating confidence and credibility, and the elements of operation of the automatic adjustment mechanism. Confidence under the GS is endogenously driven, whereas it is exogenously determined under the CB. CB is a much more asymmetric regime than GS (the adjustment is much to the detriment of peripheral countries) although asymmetry is a typical feature of any monetary regime. The lack of credibility is typical for peripheral countries and cannot be overcome completely even by “hard” monetary regimes.http://deepblue.lib.umich.edu/bitstream/2027.42/40078/3/wp692.pd

On the elliptic nonabelian Fourier transform for unipotent representations of p-adic groups

In this paper, we consider the relation between two nonabelian Fourier transforms. The first one is defined in terms of the Langlands-Kazhdan-Lusztig parameters for unipotent elliptic representations of a split p-adic group and the second is defined in terms of the pseudocoefficients of these representations and Lusztig's nonabelian Fourier transform for characters of finite groups of Lie type. We exemplify this relation in the case of the p-adic group of type G_2.Comment: 17 pages; v2: several minor corrections, references added; v3: corrections in the table with unipotent discrete series of G