Transmisión de Klebsiella pneumoniae resistente a carbapenemes en hospitales de EE.UU.

Antecedentes. La Klebsiella pneumoniae resistente a los carbapenemes (CRKp) es el Enterobacterales resistente a los carbapenemes más prevalente en los Estados Unidos. Se evaluó la agrupación de CRKp en pacientes de hospitales estadounidenses. Métodos. De abril de 2016 a agosto de 2017, 350 pacientes con grupo clonal 258 CRKp se inscribieron en el Consortium on Resistance Against Carbapenems in Klebsiella and other Enterobacteriaceae, un estudio de cohortes prospectivo y multicéntrico. Se construyó un árbol de máxima verosimilitud utilizando RAxML. Los conglomerados estáticos compartían ≤21 polimorfismos de un solo nucleótido (SNP) y un ancestro común más reciente. Los conglomerados dinámicos incorporaron la distancia SNP, el tiempo de cultivo y las tasas de acumulación y transmisión SNP utilizando el programa R TransCluster. Resultados. La mayoría de los pacientes ingresaron desde su domicilio (n=150, 43%) o desde centros de cuidados de larga duración (n=115, 33%). La orina (n=149, 43%) fue el lugar de aislamiento más común. En total, se identificaron 55 conglomerados estáticos y 47 dinámicos en 210 de 350 (60%) y 194 de 350 (55%) pacientes, respectivamente. Aproximadamente la mitad de los clusters estáticos eran idénticos a los dinámicos. Los conglomerados estáticos consistían en 33 (60%) conglomerados intrasistema y 22 (40%) conglomerados intersistema. Los conglomerados dinámicos estaban formados por 32 (68%) conglomerados intrasistema y 15 (32%) conglomerados intersistema y presentaban menos diferencias de SNP que los conglomerados estáticos (8 frente a 9; P=.045; intervalo de confianza [IC] del 95%: -4 a 0). Los conglomerados dinámicos intersistema contenían más pacientes que los conglomerados dinámicos intrasistema (mediana [intervalo intercuartílico], 4 [2, 7] frente a 2 [2, 2]; P=,007; IC del 95%: -3 a 0). Conclusiones. Se identificó una amplia transmisión intrasistémica e intersistémica de CRKp en pacientes estadounidenses hospitalizados. El uso de diferentes métodos para evaluar la similitud genética sólo dio lugar a diferencias menores en la interpretación.Background. Carbapenem-resistant Klebsiella pneumoniae (CRKp) is the most prevalent carbapenem-resistant Enterobacterales in the United States. We evaluated CRKp clustering in patients in US hospitals. Methods. From April 2016 to August 2017, 350 patients with clonal group 258 CRKp were enrolled in the Consortium on Resistance Against Carbapenems in Klebsiella and other Enterobacteriaceae, a prospective, multicenter, cohort study. A maximum likelihood tree was constructed using RAxML. Static clusters shared ≤21 single-nucleotide polymorphisms (SNP) and a most recent common ancestor. Dynamic clusters incorporated SNP distance, culture timing, and rates of SNP accumulation and transmission using the R program TransCluster. Results. Most patients were admitted from home (n=150, 43%) or long-term care facilities (n=115, 33%). Urine (n=149, 43%) was the most common isolation site. Overall, 55 static and 47 dynamics clusters were identified involving 210 of 350 (60%) and 194 of 350 (55%) patients, respectively. Approximately half of static clusters were identical to dynamic clusters. Static clusters consisted of 33 (60%) intrasystem and 22 (40%) intersystem clusters. Dynamic clusters consisted of 32 (68%) intrasystem and 15 (32%) intersystem clusters and had fewer SNP differences than static clusters (8 vs 9; P=.045; 95% confidence interval [CI]: −4 to 0). Dynamic intersystem clusters contained more patients than dynamic intrasystem clusters (median [interquartile range], 4 [2, 7] vs 2 [2, 2]; P=.007; 95% CI: −3 to 0). Conclusions. Widespread intrasystem and intersystem transmission of CRKp was identified in hospitalized US patients. Use of different methods for assessing genetic similarity resulted in only minor differences in interpretation

Transmission of Carbapenem-Resistant Klebsiella pneumoniae in US Hospitals

Background: Carbapenem-resistant Klebsiella pneumoniae (CRKp) is the most prevalent carbapenem-resistant Enterobacterales in the United States. We evaluated CRKp clustering in patients in US hospitals. Methods: From April 2016 to August 2017, 350 patients with clonal group 258 CRKp were enrolled in the Consortium on Resistance Against Carbapenems in Klebsiella and other Enterobacteriaceae, a prospective, multicenter, cohort study. A maximum likelihood tree was constructed using RAxML. Static clusters shared ≤21 single-nucleotide polymorphisms (SNP) and a most recent common ancestor. Dynamic clusters incorporated SNP distance, culture timing, and rates of SNP accumulation and transmission using the R program TransCluster. Results: Most patients were admitted from home (n = 150, 43%) or long-term care facilities (n = 115, 33%). Urine (n = 149, 43%) was the most common isolation site. Overall, 55 static and 47 dynamics clusters were identified involving 210 of 350 (60%) and 194 of 350 (55%) patients, respectively. Approximately half of static clusters were identical to dynamic clusters. Static clusters consisted of 33 (60%) intrasystem and 22 (40%) intersystem clusters. Dynamic clusters consisted of 32 (68%) intrasystem and 15 (32%) intersystem clusters and had fewer SNP differences than static clusters (8 vs 9; P =. 045; 95% confidence interval [CI]: -4 to 0). Dynamic intersystem clusters contained more patients than dynamic intrasystem clusters (median [interquartile range], 4 [2, 7] vs 2 [2, 2]; P =. 007; 95% CI: -3 to 0). Conclusions: Widespread intrasystem and intersystem transmission of CRKp was identified in hospitalized US patients. Use of different methods for assessing genetic similarity resulted in only minor differences in interpretation

Intuition as utilized by Filipino managers in decision-making and problem-solving

The study is about the use of intuition by Filipino managers within Metro Manila. A self-constructed test was administered to the participants to determine if they are intuitive or not. Those who have scored highly on the checklist were subjected to in-depth interview. Descriptive research design was utilized to describe how Filipino managers define intuition and how intuition is used in work situations like problem solving and decision-making. Responses were clustered according to the use and definition of intuition, cues or manifestations of intuition, and specific uses on decision-making and problem-solving tasks of managers. Results showed that intuition is being defined as part of mental faculties, innately human, similar to a sixth sense, a product of experience, a gut-feel, and mostly used on personal affairs or human interaction. Specific work situations where intuition was used were reported by the participants

QUALITY ASSESSMENT AND CONTROL OF OUTPUTS OF A NATIONWIDE AGRICULTURAL LAND COVER MAPPING PROGRAM USING LIDAR: PHIL-LIDAR 2 PARMAP EXPERIENCE

The Agricultural Resources Extraction from LiDAR Surveys (PARMAP) project component of the Nationwide Detailed Resources Assessment using LiDAR (Phil-LiDAR 2) Program aims to produce detailed agricultural maps using LiDAR. Agricultural land cover at crop level was classified through object based image analysis using Support Vector Machine as classifier and LiDAR derivatives from point cloud (2 points per sq.m.) and orthophoto (0.5-meter resolution) as inputs. An accuracy of at least 90 %, assessed using validation points from the field and through image interpretation, was required before proceeding to post-processing and map lay-out. Knowledge sharing and capacity development facilitated by the University of the Philippines Diliman (UPD) enabled partner universities across the Philippines to produce outputs for their assigned region. Considering output layers were generated by multiple teams working on different landscape complexities with some degree of data quality variability, quality checking is crucial to ensure accuracy standards were met. UPD PARMap devised a centralized and end-to-end scheme divided into four steps – land classification, GIS post-processing, schema application, and map lay-out. At each step, a block is reviewed and, subsequently, either approved or returned with documentation on required revisions. Turnaround time of review is at least one block (area ranging from 10 to 580 sq. km.) per day. For coastal municipalities, an additional integration process to incorporate mapped coastal features was applied. Common problems observed during quality checking include misclassifications, gaps between features, incomplete attributes and missing map elements. Some issues are particular to specific blocks such as problematic LiDAR derivatives. UPD addressed these problems through discussion and mentoring visits to partner universities. As of March 2017, a total of 336 municipal agricultural maps have been turned-over to various stakeholders. For the remaining months of the program, an additional 360 maps are expected to be distributed