The emergence of <i>Escherichia coli</i> with CTX-M extended-spectrum beta-lactamases in the United Kingdom

In the past decade, multi-resistant Escherichia coli with CTX-M enzymes have rapidly become the leading producers of extended-spectrum β-Iactamases (ESBLs) worldwide. E. coli with CTX-M-15 β-Iactamases are the most common, and are now endemic in many UK hospitals and in the community. Their epidemiology is complex, including five major epidemic clones as defined by pulsed-field gel electrophoresis, as well as many unrelated producers. This study sought to characterise, at a molecular level, E. coli isolates with CTX-M ESBLs and to investigate their nationwide dissemination, so as to identify the basis for the clinical success of thest? organisms. The molecular mechanisms responsible for the multi-drug resistance phrnotype of representative isolates with CTX-M enzymes were explored and compared, as were their phylogenetic and virulence backgrounds. The genetic support and environment of the various blaCTX-M genes were also investigated. The multi-drug resistance of E. coli with CTX-M enzymes was principally encoded by single plasmids, generally self-transferable. Among producers of CTX-M-15 enzyme, and regardless of their host strain's epidemic status, these plasmids were closely-related (IncFII) and encoded most often blaTEM-1, blaOXA-1 along blaCTX-M-15, as well as aac(6')-Ib-cr, aac(3)-IIa and tet(A). The most prevalent UK clone (A) expressed a lower level of CTX-M-15 enzyme than most other producers, probably owing to an IS26 element located downstream of the gene's normal promoter. Its CTX-M-15-encoding plasmid was not self-transferable in-vitro, but carried twelve genes effecting resistance to eight classes of antibiotics, as well as genes for virulence determinents. Most E. coli with CTX-M enzymes, including the major epidemic clones, belonged to the virulence-associated phylogenetic group B2 or D, but did not harbour more virulence determinants than B2 isolates with non-CTX-M ESBLs. Although related, three slightly distinct virulence profiles were apparent for clonal and non-clonal isolates with CTX-M-15 enzymes. In conclusion, CTX-M ESBLs have rapidly spread in the UK among virulent E. coli isolates, aided by horizontal transfer of multi-resistance plasmids, as well as by clonal spread of epidemic producer strains. Their dissemination worryingly undermines the success of antibiotic therapy, especially in community patients, where few oral options remain

Analysis of Ventricular Depolarisation and Repolarisation Using Registration and Machine Learning

Our understanding of cardiac diseases has greatly advanced since the advent of electrocardiography (ECG). With the increasing influx of available data in recent times, significant research efforts have been put forth to automate the study and detection of cardiac conditions. Naturally, the focus has progressed toward studying dynamic changes in ventricular depolarisation and repolarisation across serial recordings - as complex beat-to-beat changes in morphology manifest over time. Manual extraction of diagnostic and prognostic markers is a laborious task. Hence, automated and accurate methods are required to extract markers for the study of ventricular lability and detection of common diseases, such as myocardial ischemia and myocardial infarction. The aim of this thesis is to improve automated marker extraction and detection of diseases for the study of ventricular depolarisation and repolarisation lability in ECG. As such, two novel template adaptation methods capable of capturing complex beat-to-beat morphological changes are proposed for three-dimensional and two-dimensional data, respectively. The proposed three-dimensional template adaptation method provides an inhomogeneous method for transforming template vectorcardiogram (VCG) by exploiting registrationinspired parametrisation and an efficient kernel ridge regression formulation. Analysis across simulated data and clinical myocardial infarction data demonstrates state-of-the-art results. The two-dimensional template adaptation method draws from traditional registrationbased techniques and treats the ECG as a two-dimensional point set problem. Validation against previously employed simulated data and a gold-standard annotated clinical database demonstrate the highest level of performance. Subsequently, frameworks employing the proposed template adaptation techniques are developed for the automated detection of ischemic beats and myocardial infarction. Furthermore, a small study analysing ventricular repolarisation variability (VRV) in non-ischemic cardiomyopathy (CM) is considered, utilising markers of cardiac lability proposed in the development of the three-dimensional template adaptation system. In summary, this thesis highlights the necessity for custom template adaptation methods for the accurate measurement of beat-to-beat variability in cardiac data. Two novel stateof- the-art methods are proposed and extended to study myocardial ischemia, myocardial infarction and non-ischemic CM.Thesis (Ph.D.) -- University of Adelaide, School of Electrical and Electronic Engineering, 202

Body Composition and Somatotype in Elite Handball Players

As the main objective, this research work had to compare pre and post complex training effects on body composition in elite handball players in the Spanish 2nd Division. Eleven players were included in the study. Six of them formed an experimental group, and 5 of them the control group. They have undergone the complex training session which was done once a week. The following parameters were analyzed: BMI (Body Mass Index), somatotype, FM (Fat Mass), MM (Muscle mass), RM (Residual Mass), WHR (Waist to Hip Ratio), BM (Bone Mass). The results have shown that there was a not statistically significant difference after the 6 – week program neither in body composition and somatotypes. Since this program did not have a big influence on body composition we could say that complex training influences body composition should be further researched

Oral health and systemic inflammatory, cardiac and nitroxid biomarkers in hemodialysis patients

Periodontal diseases have systemic inflammatory effects and have been adversely associated with cardiovascular diseases, which are also the most frequent cause of death in the end-stage renal disease. The aim of this cross-sectional study was to investigate the oral health and serum biomarkers among the hemodialysis (HD) patients in Slovenia. 111 HD patients were periodontally examined and their sera were assayed for C reactive protein (CRP), cardiac troponin T (TnT), nitrite/nitrate (NOx) and antibody levels to A. actinomycetemcomitans and P. gingivalis. The association of oral health with systemic response was analyzed with Kruskal-Wallis test, Fisher?s exact test and multivariate linear regression. Bleeding on probing without periodontal pockets was present in 5.2%, calculus without periodontal pockets in 42.1%, shallow periodontal pockets in 39.5% and deep periodontal pockets in 13.2% of dentate patients. There were 28.8% edentulous participants. 63.1% of the patients had CRP levels higher than 3 mg/L and 34.2% higher than 10 mg/L. TnT was detectable in all participants, with 25.2% exhibiting levels higher than 100 ng/L. The median level of NOx was 43.1 µmol/L. Participants with higher CRP were more likely to be edentulous and have higher TnT levels. A direct association of oral health with TnT or NOx was not detected. HD patients in Slovenia have compromised oral health and increased serum inflammatory and cardiac biomarkers. Edentulousness was an independent predictor for the increased CRP, indicating a need for improved dental care to retain the teeth as long as possible

Dissemination of Clonally Related Escherichia coli Strains Expressing Extended-Spectrum β-Lactamase CTX-M-15

E. coli ST131 and ST405 and multidrug-resistant IncFII plasmids may determine spread of this lactamase

Conjugative IncFI plasmids carrying CTX-M-15 among Escherichia coli ESBL producing isolates at a University hospital in Germany

<p>Abstract</p> <p>Background</p> <p>Multi-drug-resistant, extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae, constitute an emerging public-health concern. Little data on the molecular epidemiology of ESBL producing <it>Escherichia coli </it>is available in Germany. Here we describe the prevalence and molecular epidemiology of ESBL producing-<it>Escherichia coli </it>isolates at a German University hospital.</p> <p>Methods</p> <p>We analysed 63 non-duplicate clinical ESBL isolates obtained over an 8-month period using PCR and sequence-based ESBL allele typing, plasmid replicon typing, phylogenetic group typing. Pulsed-field gel electrophoresis (PFGE) based genotyping and plasmid profiling was performed, as well as confirmatory DNA-based hybridization assays.</p> <p>Results</p> <p>Examination of the 63 <it>Escherichia coli </it>isolates revealed an almost equal distribution among the <it>E. coli </it>phylogenetic groups A, B1, B2 and D. High prevalence (36/63) of the CTX-M-15 gene was observed and an analysis of PFGE-based patterns revealed the presence of this CTX-M allele in multiple clones. Resistance to cefotaxime was a transferable trait and a commonly occurring 145.5 kb conjugative IncFI plasmid was detected in 65% of <it>E. coli </it>carrying the CTX-M-15 allele. The rate of transferable antibiotic resistances for GM, SXT, TET, GM-SXT-TET, SXT-TET and GM-TET was 33%, 61%, 61%, 27%, 44% and 11%, respectively. The remaining strains did not have a common IncFI plasmid but harboured transferable IncFI plasmids with sizes that ranged from 97 to 242.5 kb.</p> <p>Conclusion</p> <p>Our data demonstrate the presence of IncFI plasmids within the prevailing <it>E. coli </it>population in a hospital setting and suggest that the dissemination of CTX-M-15 allele is associated to lateral transfer of these well-adapted, conjugative IncFI plasmids among various <it>E. coli </it>genotypes.</p

The emergence of Escherichia coli with CTX-M extended-spectrum beta-lactamases in the United Kingdom

In the past decade, multi-resistant Escherichia coli with CTX-M enzymes have rapidly become the leading producers of extended-spectrum p-Iactamases (ESBLs) worldwide. E. coli with CTX-M-lS p-Iactamases are the most common, and are now endemic in many UK hospitals and in the community. Their epidemiology is complex, including five major epidemic clones as defined by pulsed-field gel electrophoresis, as well as many unrelated producers. This study sought to characterise, at a molecular level, E. coli isolates with CTX-M ESBLs and to investigate their nationwide dissemination, so as to identify the basis for the clinical success of thest? organisms. The molecular mechanisms responsible for the multi-drug resistance phrnotype of representative isolates with CTX-M enzymes were explored and compared, as were their phylogenetic and virulence backgrounds. The genetic support and environment of the various blacrx-M genes were also investigated. The multi-drug resistance of E. coli with CTX-M enzymes was principally encoded by single plasmids, generally self-transferable. Among producers of CTX-M-15 enzyme, and .. regardless of their host strain's epidemic status, these plasmids were closely-related (IncFII) and encoded most often blaTFM_1> blaoXA.l along blacrx_M_15, as well as aac(6')-Ib-cr, aac(3)-IIa and tet(A). The most prevalent UK clone (A) expressed a lower level ofCTX-M-lS enzyme than most other producers, probably owing to an IS26 element located downstream of the gene's normal promoter. Its CTX-M-15-encoding plasmid was not self-transferable in-vitro, but carried twelve genes effecting resistance to eight classes of antibiotics, as well as genes for virulence determin~nts. Most E. coli.with CTX-M enzymes, including the major epidemic clones, belonged to the virulence-associated phylogenetic group B2 or D, but did not harbour more virulence determinants than B2 isolates with non-CTX-M ESBLs. Although related, three slightly distinct virulence profiles were apparent for clonal and non-clonal isolates with CTX-M-15 enzymes. In conclusion, CTX-M ESBLs have rapidly spread in the UK among virulent E. coli isolates, aided by horizontal transfer of multi-resistance plasmids, as well as by clonal spread of epidemic producer strains. Their dissemination worryingly undermines the success of antibiotic therapy, especially in community patients, where few oral options remain.EThOS - Electronic Theses Online ServiceGBUnited Kingdo

An attractive employer : A qualitative study of what makes an employer attractive according to employees working within human resource management

Syftet med denna kvalitativa uppsats är att få en djupare förståelse för vilka kriterier som gör en arbetsgivare attraktiv för personalvetare. Eftersom humankapitalet är viktigare än någonsin måste arbetsgivare kunna både attrahera och behålla bra anställda, och detta är något som många arbetsgivare arbetar med. Studien är gjord utifrån anställdas perspektiv men det är snarare arbetsgivare som kan dra nytta av de resultat som vår studie har visat. De teoretiska referensramar vi har använt oss av är employer branding, vad som attraherar hos en arbetsgivare och vad som gör en arbetsgivare attraktiv för generation Y. Vi har även använt oss av motivation som begrepp samt Herzbergs tvåfaktorteori om arbetsmotivation. De teoretiska referensramar vi har använt oss av ligger till grund för både utformandet av intervjuguiden och för hur resultatet har analyserats. Det empiriska materialet har införskaffats genom åtta digitala semistrukturerade intervjuer med personalvetare som arbetar inom HR runt om i Sverige. Vi har använt oss av ett bekvämlighetsurval för vår studie genom att vi har kontaktat personer i vår närhet som ingår i populationen för studien. Resultatet visar att det är många faktorer som samspelar för att en arbetsgivare ska vara attraktiv för personalvetare. Några av de viktigaste faktorerna för att arbetsgivaren ska vara attraktiv är en bra arbetsmiljö, flexibla arbetstider, att alla behandlas lika och att få utvecklas i arbetet. De faktorer som har utmärkt sig gällande motivation är till exempel att göra skillnad för andra, att få utvecklas och utmanas samt en bra arbetsmiljö

An attractive employer : A qualitative study of what makes an employer attractive according to employees working within human resource management

Syftet med denna kvalitativa uppsats är att få en djupare förståelse för vilka kriterier som gör en arbetsgivare attraktiv för personalvetare. Eftersom humankapitalet är viktigare än någonsin måste arbetsgivare kunna både attrahera och behålla bra anställda, och detta är något som många arbetsgivare arbetar med. Studien är gjord utifrån anställdas perspektiv men det är snarare arbetsgivare som kan dra nytta av de resultat som vår studie har visat. De teoretiska referensramar vi har använt oss av är employer branding, vad som attraherar hos en arbetsgivare och vad som gör en arbetsgivare attraktiv för generation Y. Vi har även använt oss av motivation som begrepp samt Herzbergs tvåfaktorteori om arbetsmotivation. De teoretiska referensramar vi har använt oss av ligger till grund för både utformandet av intervjuguiden och för hur resultatet har analyserats. Det empiriska materialet har införskaffats genom åtta digitala semistrukturerade intervjuer med personalvetare som arbetar inom HR runt om i Sverige. Vi har använt oss av ett bekvämlighetsurval för vår studie genom att vi har kontaktat personer i vår närhet som ingår i populationen för studien. Resultatet visar att det är många faktorer som samspelar för att en arbetsgivare ska vara attraktiv för personalvetare. Några av de viktigaste faktorerna för att arbetsgivaren ska vara attraktiv är en bra arbetsmiljö, flexibla arbetstider, att alla behandlas lika och att få utvecklas i arbetet. De faktorer som har utmärkt sig gällande motivation är till exempel att göra skillnad för andra, att få utvecklas och utmanas samt en bra arbetsmiljö