Massive Increase, Spread, and Exchange of Extended Spectrum {beta}-Lactamase-Encoding Genes Among Intestinal Enterobacteriaceae in Hospitalized Children With Severe Acute Malnutrition in Niger.

Background. From the time of CTX-M emergence, extended-spectrum β-lactamase-producing enterobacteria (ESBL-E) have spread worldwide in community settings as well as in hospitals, particularly in developing countries. Although their dissemination appears linked to Escherichia coli intestinal carriage, precise paths of this dynamic are largely unknown. Methods. Children from a pediatric renutrition center were prospectively enrolled in a fecal carriage study. Antibiotic exposure was recorded. ESBL-E strains were isolated using selective media from fecal samples obtained at admission and, when negative, also at discharge. ESBL-encoding genes were identified, their environments and plasmids were characterized, and clonality was assessed with polymerase chain reaction-based methods and pulsed-field gel electrophoresis for E. coli and Klebsiella pneumoniae. E. coli strains were subjected to multilocus sequence typing. Results. The ESBL-E carriage rate was 31% at admission in the 55 children enrolled. All children enrolled received antibiotics during hospitalization. Among the ESBL-E-negative children, 16 were resampled at discharge, and the acquisition rate was 94%. The bla(CTX-M-15) gene was found in >90% of the carriers. Genetic environments and plasmid characterization evidenced the roles of a worldwide, previously described, multidrug-resistant region and of IncF plasmids in CTX-M-15 E. coli dissemination. Diversity of CTX-M-15-carrying genetic structures and clonality of acquired ESBL E. coli suggested horizontal genetic transfer and underlined the potential of some ST types for nosocomial cross-transmission. Conclusions. Cross-transmission and high selective pressure lead to very high acquisition of ESBL-E carriage, contributing to dissemination in the community. Strict hygiene measures as well as careful balancing of benefit-risk ratio of current antibiotic policies need to be reevaluated

Brand and generic use of inhalation medication and frequency of switching in children and adults : a population-based cohort study

BACKGROUND: The expiration of patents of brand inhalation medications and the ongoing pressure on healthcare budgets resulted in a growing market for generics. AIM: To study the use of brand and generic inhalation medication and the frequency of switching between brand and generic and between devices. In addition, we investigated whether switching affected adherence. METHODS: From dispensing data from the Dutch PHARMO Database Network a cohort aged ≥ 5 years, using ≥ 1 year of inhalation medication between 2003 and 2012 was selected. Switching was defined as changing from brand to generic or vice versa. In addition, we studied change in aerosol delivery device type (e.g., DPI, pMDI, and nebulizers). Adherence was calculated using the medication possession ratio (MPR). RESULTS: The total cohort comprised 70,053 patients with 1,604,488 dispensations. Per calendar year, 5% switched between brand and generic inhalation medication and 5% switched between devices. Median MPRs over the first 12 months ranged between 33 and 55%. Median MPR over the total period was lower after switch from brand to generic and vice versa for formoterol (44.5 vs. 42.1 and 63.5 vs. 53.8) and beclomethasone (93.8 vs. 59.8 and 81.3 vs. 55.9). CONCLUSION: Per year, switching between brand and generic inhalation medication was limited to 5% of the patients, switching between device types was observed in 5% as well. Adherence to both generic and brand inhalation medication was low. Effect of switching on adherence was contradictory; depending on time period, medication and type, and direction of switching. Further research on reasons for switching and potential impact on clinical outcomes is warranted

Single and vertically coupled type II quantum dots in a perpendicular magnetic field: exciton groundstate properties

The properties of an exciton in a type II quantum dot are studied under the influence of a perpendicular applied magnetic field. The dot is modelled by a quantum disk with radius $R$, thickness $d$ and the electron is confined in the disk, whereas the hole is located in the barrier. The exciton energy and wavefunctions are calculated using a Hartree-Fock mesh method. We distinguish two different regimes, namely $d<<2R$ (the hole is located at the radial boundary of the disk) and $d>>2R$ (the hole is located above and below the disk), for which angular momentum $(l)$ transitions are predicted with increasing magnetic field. We also considered a system of two vertically coupled dots where now an extra parameter is introduced, namely the interdot distance $d_{z}$. For each $l_{h}$ and for a sufficient large magnetic field, the ground state becomes spontaneous symmetry broken in which the electron and the hole move towards one of the dots. This transition is induced by the Coulomb interaction and leads to a magnetic field induced dipole moment. No such symmetry broken ground states are found for a single dot (and for three vertically coupled symmetric quantum disks). For a system of two vertically coupled truncated cones, which is asymmetric from the start, we still find angular momentum transitions. For a symmetric system of three vertically coupled quantum disks, the system resembles for small $d_{z}$ the pillar-like regime of a single dot, where the hole tends to stay at the radial boundary, which induces angular momentum transitions with increasing magnetic field. For larger $d_{z}$ the hole can sit between the disks and the $l_{h}=0$ state remains the groundstate for the whole $B$-region.Comment: 11 pages, 16 figure

Predicting Type 2 Diabetes Based on Polymorphisms From Genome-Wide Association Studies : A Population-Based Study

OBJECTIVE—Prediction of type 2 diabetes based on genetic testing might improve identification of high-risk subjects. Genome-wide association (GWA) studies identified multiple new genetic variants that associate with type 2 diabetes. The predictive value of genetic testing for prediction of type 2 diabetes in the general population is unclear

How to measure the need for transition to adult services among young people with Attention Deficit Hyperactivity Disorder(ADHD): a comparison of surveillance versus case note review methods

This is the author accepted manuscript. The final version is available from BioMed Central via the DOI in this recordBackground: Health services have not provided adequate support for young people with long term health conditions to transfer from child to adult services. National Institute of Health and Care (NICE) guidance on transition has been issued to address these gaps. However, data are often sparse about the number of young adults who might need to transition. Using Attention Deficit Hyperactivity Disorder (ADHD) as an exemplar, this study used an existing surveillance system and a case note review to capture the incidence of the transition process, and compared and contrasted the findings. Methods: The Child and Adolescent Psychiatry Surveillance System (CAPSS) was used to estimate the incident transition of young people with Attention Deficit Hyperactivity Disorder (ADHD) from child to adult services. This involves consultant child and adolescent psychiatrists from the United Kingdom (UK) and Republic of Ireland (ROI) reporting relevant young people as they are seen in clinics. In parallel, a case note review was conducted using the Maudsley Biomedical Research Centre (BRC) Clinical Records Interactive Search (CRIS). The study period ran for twelve months with a nine month follow up to see how the transition proceeded. Results: CRIS identified 76 cases in the study period, compared to 18 identified using surveillance via CAPSS. Methodological issues were experienced using both methods. Surveillance issues; eligibility criteria confusion, reporting errors, incomplete questionnaires, difficulties contacting clinicians, and surveillance systems do not cover non-doctors and psychiatrists who are not consultants. Case note review issues using CRIS included the need for researchers to interpret clinical notes, the availability and completeness of data in the notes, and data limited to the catchment of one particular mental health trust. Conclusions: Both methods demonstrate strengths and weaknesses; the combination of both methods in the absence of strong routinely collected data, allowed a more robust estimate of the level of need for service planning and commissioning.National Institute for Health Researc

One-neutron knockout in the vicinity of the N=32 sub-shell closure: 9Be(57Cr,56Cr+ gamma)X

The one-neutron knockout reaction 9Be(57Cr,56Cr + gamma)X has been measured in inverse kinematics with an intermediate-energy beam. Cross sections to individual states in 56Cr were partially untangled through the detection of the characteristic gamma-ray transitions in coincidence with the reaction residues. The experimental inclusive longitudinal momentum distribution and the yields to individual states are compared to calculations that combine spectroscopic factors from the full fp shell model and nucleon-removal cross sections computed in a few-body eikonal approach.Comment: PRC, in pres

Probing the single-particle character of rotational states in 19^{19}F using a short-lived isomeric beam

A beam containing a substantial component of both the $J^{\pi}=5^+$, $T_{1/2}=162$ ns isomeric state of $^{18}$F and its $1^+$, 109.77-min ground state has been utilized to study members of the ground-state rotational band in $^{19}$F through the neutron transfer reaction $(d$,$p)$ in inverse kinematics. The resulting spectroscopic strengths confirm the single-particle nature of the 13/2$^+$ band-terminating state. The agreement between shell-model calculations, using an interaction constructed within the $sd$ shell, and our experimental results reinforces the idea of a single-particle/collective duality in the descriptions of the structure of atomic nuclei

Spectroscopy of the odd-odd fp-shell nucleus 52Sc from secondary fragmentation

The odd-odd fp-shell nucleus 52Sc was investigated using in-beam gamma-ray spectroscopy following secondary fragmentation of a 55V and 57Cr cocktail beam. Aside from the known gamma-ray transition at 674(5)keV, a new decay at E_gamma=212(3) keV was observed. It is attributed to the depopulation of a low-lying excited level. This new state is discussed in the framework of shell-model calculations with the GXPF1, GXPF1A, and KB3G effective interactions. These calculations are found to be fairly robust for the low-lying level scheme of 52Sc irrespective of the choice of the effective interaction. In addition, the frequency of spin values predicted by the shell model is successfully modeled by a spin distribution formulated in a statistical approach with an empirical, energy-independent spin-cutoff parameter.Comment: accepted for publication in PR