Serratia marcescens bacteremia traced to an infused narcotic

BACKGROUND From June 30, 1998, through March 21, 1999, several patients in the surgical intensive care unit of a hospital acquired Serratia marcescens bacteremia. We investigated this outbreak. METHODS A case was defined as the occurrence of S. marcescens bacteremia in any patient in the surgical intensive care unit during the period of the epidemic. To identify risk factors, we compared patients with S. marcescens bacteremia with randomly selected controls. Isolates from patients and from medications were evaluated by pulsed-field gel electrophoresis. The hair of one employee was tested for fentanyl. RESULTS Twenty-six patients with S. marcescens bacteremia were identified; eight (31 percent) had polymicrobial bacteremia, and seven of these had Enterobacter cloacae and S. marcescens in the same culture. According to univariate analysis, patients with S. marcescensbacteremia stayed in the surgical intensive care unit longer than controls (13.5 vs. 4.0 days, PS. marcescens and E. cloacae. The isolates from the case patients and from the fentanyl infusions had similar patterns on pulsed-field gel electrophoresis. After removal of the implicated respiratory therapist, no further cases occurred. Full Text of Results... CONCLUSIONS An outbreak of S. marcescens and E. cloacae bacteremia in a surgical intensive care unit was traced to extrinsic contamination of the parenteral narcotic fentanyl by a health care worker. Our findings underscore the risk of complications in patients that is associated with illicit narcotic use by health care workers

Success rate of brace treatment for juvenile-onset idiopathic scoliosis up to skeletal maturity

Background: Natural history studies have reported that the progression rate of juvenile idiopathic scoliosis (JIS) curves larger than 208 is high and tends to progress. The aim of this study was to investigate the outcome of bracing on JIS and to determine the prognostic factors on the success rate of brace treatment. Methods: From March 1985 to February 2015, the clinical data of all JIS patients with referral age from 4 to 10 years who received brace treatment were reviewed. Those patients with a prebrace Cobb angle.208 and a Risser sign of 0 to 2 were included and followed up a minimum of 2 years after discontinuation of the brace or time of spinal fusion. The Cobb angle was recorded at the time of diagnosis, before initiation of bracing, weaning time, brace discontinuation, and final follow-up. Results: From 297 patients with JIS, a total of 75 cases (18 boys, 57 girls) with an average curve magnitude of 31.98 at the time of diagnosis met the inclusion criteria of the study. For successfully treated patients, the average best in-brace correction was 55 for Lenke I curves, 59 for Lenke II curves, 41 for Lenke III curves, and 62 for Lenke V curves. For a total of 27 patients (36), the brace treatment failed. Of these, 21 patients (78) reached spinal fusion, and curves of 6 patients (22) increased to �508. The progression rate was highest in patients with Lenke type III curves (67), and also in those with a curve magnitude of �468 (94). Conclusions: Brace treatment is an effective strategy for controlling the curve progression and avoiding spinal fusion in JIS. © International Society for the Advancement of Spine Surger

Control of Vancomycin-Resistant Enterococcus in Health Care Facilities in a Region

Background In late 1996, vancomycin-resistant enterococci were first detected in the Siouxland region of Iowa, Nebraska, and South Dakota. A task force was created, and in 1997 the assistance of the Centers for Disease Control and Prevention was sought in assessing the prevalence of vancomycin-resistant enterococci in the region’s facilities and implementing recommendations for screening, infection control, and education at all 32 health care facilities in the region. Methods The infection-control intervention was evaluated in October 1998 and October 1999. We performed point-prevalence surveys, conducted a case– control study of gastrointestinal colonization with vancomycin-resistant enterococci, and compared infection-control practices and screening policies for vancomycin-resistant enterococci at the acute care and long-term care facilities in the Siouxland region. Results Perianal-swab samples were obtained from 1954 of 2196 eligible patients (89 percent) in 1998 and 1820 of 2049 eligible patients (89 percent) in 1999. The overall prevalence of vancomycin-resistant enterococci at 30 facilities that participated in all three years of the study decreased from 2.2 percent in 1997 to 1.4 percent in 1998 and to 0.5 percent in 1999 (P Conclusions An active infection-control intervention, which includes the obtaining of surveillance cultures and the isolation of infected patients, can reduce or eliminate the transmission of vancomycinresistant enterococci in the health care facilities of a region. (N Engl J Med 2001;344:1427-33.

Modelling Landscape-scale Species Response to Agri-Environment Schemes

Agri-environment schemes (AES) are the most significant environmental policy delivery mechanism in England, and include the conservation of biodiversity as a key objective. Provisional results from the ongoing Landscape-scale species monitoring of AES (LandSpAES) baseline field survey have shown some positive responses of mobile taxa to AES gradients at local (1km2) or landscape (3 × 3km) scales. However, it is not known whether these provisional results might be more broadly applicable outside the regions surveyed in the LandSpAES project, i.e. in other regions, or nationally. Here, we present the findings of an analytical project to explore the use of national Citizen Science (CitSci) scheme data, to investigate whether similar relationships with AES gradients would be found at a national scale in CitSci data to those shown with LandSpAES data, and whether integrated modelling was possible with combined CitSci and LandSpAES datasets. The design of LandSpAES has high power to detect AES effects, including the independent testing of the local and landscape AES gradients, but is restricted to six regions. The national CitSci are more representative of England as a whole, but have not been designed to detect AES effects. The aim of this project was to determine whether the provisional taxon responses to the AES gradients found in the LandSpAES project could be detected at a national scale using CitSci scheme data. To achieve this aim, three key questions were addressed through the analytical work: 1) Can addition of covariates account for environmental variation between survey squares in each dataset, to improve the comparability of AES gradient effects between LandSpAES and CitSci schemes? 2) Do the CitSci scheme datasets show similar relationships between taxa responses and the AES gradients, to those found with the LandSpAES data? 3) Can integrated approaches to combining datasets be used to jointly model CitSci and LandSpAES data, and does integrated modelling reduce uncertainty in quantifying the effects of AES gradients on taxa responses at a national scale across England

Designing a survey to monitor multi-scale impacts of agri-environment schemes on mobile taxa

Agri-environment schemes (AES) are key mechanisms to deliver conservation policy, and include management to provide resources for target taxa. Mobile species may move to areas where resources are increased, without this necessarily having an effect across the wider countryside or on populations over time. Most assessments of AES efficacy have been at small spatial scales, over short timescales, and shown varying results. We developed a survey design based on orthogonal gradients of AES management at local and landscape scales, which will enable the response of several taxa to be monitored. An evidence review of management effects on butterflies, birds and pollinating insects provided data to score AES options. Predicted gradients were calculated using AES uptake, weighted by the evidence scores. Predicted AES gradients for each taxon correlated strongly, and with the average gradient across taxa, supporting the co-location of surveys across different taxa. Nine 1 × 1 km survey squares were selected in each of four regional blocks with broadly homogenous background habitat characteristics. Squares in each block covered orthogonal contrasts across the range of AES gradients at local and landscape scales. This allows the effects of AES on species at each scale, and the interaction between scales, to be tested. AES options and broad habitats were mapped in field surveys, to verify predicted gradients which were based on AES option uptake data. The verified AES gradient had a strong positive relationship with the predicted gradient. AES gradients were broadly independent of background habitat within each block, likely allowing AES effects to be distinguished from potential effects of other habitat variables. Surveys of several mobile taxa are ongoing. This design will allow mobile taxa responses to AES to be tested in the surrounding countryside, as well as on land under AES management, and potentially in terms of population change over time. The design developed here provides a novel, pseudo-experimental approach for assessing the response of mobile species to gradients of management at two spatial scales. A similar design process could be applied in other regions that require a standardized approach to monitoring the impacts of management interventions on target taxa at landscape scales, if equivalent spatial data are available

Cosmological parameters from SDSS and WMAP

We measure cosmological parameters using the three-dimensional power spectrum P(k) from over 200,000 galaxies in the Sloan Digital Sky Survey (SDSS) in combination with WMAP and other data. Our results are consistent with a ``vanilla'' flat adiabatic Lambda-CDM model without tilt (n=1), running tilt, tensor modes or massive neutrinos. Adding SDSS information more than halves the WMAP-only error bars on some parameters, tightening 1 sigma constraints on the Hubble parameter from h~0.74+0.18-0.07 to h~0.70+0.04-0.03, on the matter density from Omega_m~0.25+/-0.10 to Omega_m~0.30+/-0.04 (1 sigma) and on neutrino masses from <11 eV to <0.6 eV (95%). SDSS helps even more when dropping prior assumptions about curvature, neutrinos, tensor modes and the equation of state. Our results are in substantial agreement with the joint analysis of WMAP and the 2dF Galaxy Redshift Survey, which is an impressive consistency check with independent redshift survey data and analysis techniques. In this paper, we place particular emphasis on clarifying the physical origin of the constraints, i.e., what we do and do not know when using different data sets and prior assumptions. For instance, dropping the assumption that space is perfectly flat, the WMAP-only constraint on the measured age of the Universe tightens from t0~16.3+2.3-1.8 Gyr to t0~14.1+1.0-0.9 Gyr by adding SDSS and SN Ia data. Including tensors, running tilt, neutrino mass and equation of state in the list of free parameters, many constraints are still quite weak, but future cosmological measurements from SDSS and other sources should allow these to be substantially tightened.Comment: Minor revisions to match accepted PRD version. SDSS data and ppt figures available at http://www.hep.upenn.edu/~max/sdsspars.htm

Search for the standard model Higgs boson in tau final states

We present a search for the standard model Higgs boson using hadronically decaying tau leptons, in 1 inverse femtobarn of data collected with the D0 detector at the Fermilab Tevatron ppbar collider. We select two final states: tau plus missing transverse energy and b jets, and tau+ tau- plus jets. These final states are sensitive to a combination of associated W/Z boson plus Higgs boson, vector boson fusion and gluon-gluon fusion production processes. The observed ratio of the combined limit on the Higgs production cross section at the 95% C.L. to the standard model expectation is 29 for a Higgs boson mass of 115 GeV.Comment: publication versio

Search for W' bosons decaying to an electron and a neutrino with the D0 detector

This Letter describes the search for a new heavy charged gauge boson W' decaying into an electron and a neutrino. The data were collected with the D0 detector at the Fermilab Tevatron proton-antiproton Collider at a center-of-mass energy of 1.96 TeV, and correspond to an integrated luminosity of about 1 inverse femtobarn. Lacking any significant excess in the data in comparison with known processes, an upper limit is set on the production cross section times branching fraction, and a W' boson with mass below 1.00 TeV can be excluded at the 95% C.L., assuming standard-model-like couplings to fermions. This result significantly improves upon previous limits, and is the most stringent to date.Comment: submitted to Phys. Rev. Let

Search for a scalar or vector particle decaying into Zgamma in ppbar collisions at sqrt(s) = 1.96 TeV

We present a search for a narrow scalar or vector resonance decaying into Zgamma with a subsequent Z decay into a pair of electrons or muons. The data for this search were collected with the D0 detector at the Fermilab Tevatron ppbar collider at a center of mass energy sqrt(s) = 1.96 TeV. Using 1.1 (1.0) fb-1 of data, we observe 49 (50) candidate events in the electron (muon) channel, in good agreement with the standard model prediction. From the combination of both channels, we derive 95% C.L. upper limits on the cross section times branching fraction (sigma x B) into Zgamma. These limits range from 0.19 (0.20) pb for a scalar (vector) resonance mass of 600 GeV/c^2 to 2.5 (3.1) pb for a mass of 140 GeV/c^2.Comment: Published by Phys. Lett.