Australian Group on Antimicrobial Resistance (AGAR) Australian Gram-negative Sepsis Outcome Programme (GnSOP) Annual Report 2020

The Australian Group on Antimicrobial Resistance (AGAR) performs regular period-prevalence studies to monitor changes in antimicrobial resistance in selected enteric gram-negative pathogens. The 2020 survey was the eighth year to focus on bloodstream infections caused by Enterobacterales, and the sixth year in which Pseudomonas aeruginosa and Acinetobacter species were included. Eight thousand seven hundred and fifty-two isolates, comprising Enterobacterales (7,871, 89.9%), P. aeruginosa (771, 8.8%) and Acinetobacter species (110, 1.3%), were tested using commercial automated methods. The results were analysed using Clinical and Laboratory Standards Institute (CLSI) and European Committee on Antimicrobial Susceptibility Testing (EUCAST) breakpoints (January 2021). Of the key resistances, resistance to the third-generation cephalosporin ceftriaxone was found in 13.5%/13.5% (CLSI/EUCAST criteria) of Escherichia coli and 8.7%/8.7% of Klebsiella pneumoniae. Resistance rates to ciprofloxacin were 16.1%/16.1% for E. coli; 9.9%/9.9% for K. pneumoniae; 5.8%/5.8% for Enterobacter cloacae complex; and 4.5%/8.1% for P. aeruginosa. Resistance rates to piperacillin-tazobactam were 2.5%/6.6%; 3.9%/12.5%; 16.9%/26.3%; and 5.5%/14.4% for the same four species respectively. Thirty-two isolates from 32 patients were shown to harbour at least one carbapenemase gene: 19 blaIMP-4, three blaGES-5, two blaNDM-1, two blaNDM-5, two blaOXA-48, two blaOXA-181, one blaIMI-1, and one blaOXA-23+NDM-1

Nonclassical correlations of photon number and field components in the vacuum state

It is shown that the quantum jumps in the photon number n from zero to one or more photons induced by backaction evasion quantum nondemolition measurements of a quadrature component x of the vacuum light field state are strongly correlated with the quadrature component measurement results. This correlation corresponds to the operator expectation value which is equal to one fourth for the vacuum even though the photon number eigenvalue is zero. Quantum nondemolition measurements of a quadrature component can thus provide experimental evidence of the nonclassical operator ordering dependence of the correlations between photon number and field components in the vacuum state.Comment: 13 pages, 3 figures, corrections of omissions in equations (6) and (25). To be published in Phys. Rev.

Associations between blood sex steroid concentrations and risk of major adverse cardiovascular events in healthy older women in Australia: a prospective cohort substudy of the ASPREE trial

Background: Blood testosterone concentrations in women decline during the reproductive years and reach a nadir in the seventh decade, after which concentrations increase and are restored to those of reproductive-aged women early in the eighth decade. We aimed to establish the association between the concentration of testosterone in the blood and risk of major adverse cardiovascular events (MACE) and all-cause mortality in healthy older women. Methods: SHOW was a prospective cohort substudy of the longitudinal randomised ASPREE trial. Eligible participants were women aged at least 70 years from Australia with unimpaired cognition, no previous MACE, and a life expectancy of at least 5 years. Participants who were receiving hormonal or steroid therapy were ineligible for inclusion. We measured serum concentrations of sex steroids with liquid chromatography–tandem mass spectrometry and of SHBG with immunoassay. We compared lower concentrations of sex hormones with higher concentrations using four quartiles. Primary endpoints were risk of MACE and all-cause mortality, the associations of which with sex steroid concentrations were assessed using Cox proportional hazards regression that included age, body-mass index, smoking status, alcohol consumption, diabetes, hypertension, dyslipidaemia, impaired renal function, and treatment allocation in the ASPREE trial (aspirin vs placebo). ASPREE is registered with ClinicalTrials.gov, NCT01038583. Findings: Of the 9180 women recruited to the ASPREE trial between March 10, 2010, and Dec 31 2014, 6358 participants provided sufficient biobank samples at baseline and 5535 were included in the final analysis. Median age at entry was 74·0 years (IQR 71·7–77·7). During a median 4·4 years of follow-up (24 553 person-years), 144 (2·6%) women had a first MACE (incidence 5·9 per 1000 person-years). During a median 4·6 years of follow-up (3·8–5·6), 200 women died (7·9 per 1000 person-years). In the fully adjusted models, higher concentrations of testosterone were associated with a lower incidence of MACE (quartile 4 vs quartile 1: hazard ratio 0·57 [95% CI 0·36–0·91]; p=0·02), as were higher concentrations of DHEA (quartile 4 vs quartile 1: 0·61 [0·38–0·97]; p=0·04). For oestrone, a lower risk of MACE was seen for concentrations in quartile 2 only, compared with quartile 1 (0·55 [0·33–0·92]; p=0·02). In fully adjusted models, no association was seen between SHBG and MACE, or between any hormone or SHBG and all-cause mortality. Interpretation: Blood concentrations of testosterone and DHEA above the lowest quartile in older women were associated with a reduced risk of a first-ever MACE. Given that the physiological effects of DHEA are mediated through its steroid metabolites, if the current findings were to be replicated, trials investigating testosterone therapy for the primary prevention of ischaemic cardiovascular disease events in older women would be warranted. Funding: The National Health and Medical Research Council of Australia, US National Institute on Aging, the Victorian Cancer Agency, the Commonwealth Scientific and Industrial Research Organisation, and Monash University

Patient reported outcome of adult perioperative anaesthesia in the United Kingdom: a cross-sectional observational study

Background. Understanding the patient perspective on healthcare is central to the evaluation of quality. This study measured selected patient-reported outcomes after anaesthesia in order to identify targets for research and quality improvement. Methods. This cross-sectional observational study in UK National Health Service hospitals, recruited adults undergoing non-obstetric surgery requiring anaesthesia care over a 48 h period. Within 24 h of surgery, patients completed the Bauer questionnaire (measuring postoperative discomfort and satisfaction with anaesthesia care), and a modified Brice questionnaire to elicit symptoms suggestive of accidental awareness during general anaesthesia (AAGA). Patient, procedural and pharmacological data were recorded to enable exploration of risk factors for these poor outcomes. Results. 257 hospitals in 171 NHS Trusts participated (97% of eligible organisations). Baseline characteristics were collected on 16,222 patients; 15,040 (93%) completed postoperative questionnaires. Anxiety was most frequently cited as the worst aspect of the perioperative experience. Thirty-five per cent of patients reported severe discomfort in at least one domain: thirst (18.5%; 95% CI 17.8-19.1), surgical pain (11.0%; 10.5-11.5) and drowsiness (10.1%; 9.6-10.5) were most common. Despite this, only 5% reported dissatisfaction with any aspect of anaesthesia-related care. Regional anaesthesia was associated with a reduced burden of side-effects. The incidence of reported AAGA was one in 800 general anaesthetics (0.12%) Conclusions. Anxiety and discomfort after surgery are common; despite this, satisfaction with anaesthesia care in the UK is high. The inconsistent relationship between patient-reported outcome, patient experience and patient satisfaction supports using all three of these domains to provide a comprehensive assessment of the quality of anaesthesia care

Nonclassical correlations of phase noise and photon number in quantum nondemolition measurements

The continuous transition from a low resolution quantum nondemolition measurement of light field intensity to a precise measurement of photon number is described using a generalized measurement postulate. In the intermediate regime, quantization appears as a weak modulation of measurement probability. In this regime, the measurement result is strongly correlated with the amount of phase decoherence introduced by the measurement interaction. In particular, the accidental observation of half integer photon numbers preserves phase coherence in the light field, while the accidental observation of quantized values increases decoherence. The quantum mechanical nature of this correlation is discussed and the implications for the general interpretation of quantization are considered.Comment: 16 pages, 5 figures, final version to be published in Phys. Rev. A, Clarifications of the nature of the measurement result and the noise added in section I

Information and noise in quantum measurement

Even though measurement results obtained in the real world are generally both noisy and continuous, quantum measurement theory tends to emphasize the ideal limit of perfect precision and quantized measurement results. In this article, a more general concept of noisy measurements is applied to investigate the role of quantum noise in the measurement process. In particular, it is shown that the effects of quantum noise can be separated from the effects of information obtained in the measurement. However, quantum noise is required to ``cover up'' negative probabilities arising as the quantum limit is approached. These negative probabilities represent fundamental quantum mechanical correlations between the measured variable and the variables affected by quantum noise.Comment: 16 pages, short comment added in II.B., final version for publication in Phys. Rev.

The mixed problem in L^p for some two-dimensional Lipschitz domains

We consider the mixed problem for the Laplace operator in a class of Lipschitz graph domains in two dimensions with Lipschitz constant at most 1. The boundary of the domain is decomposed into two disjoint sets D and N. We suppose the Dirichlet data, f_D has one derivative in L^p(D) of the boundary and the Neumann data is in L^p(N). We find conditions on the domain and the sets D and N so that there is a p_0>1 so that for p in the interval (1,p_0), we may find a unique solution to the mixed problem and the gradient of the solution lies in L^p

High-sensitivity cardiac troponin I improves cardiovascular risk prediction in older men: HIMS (The Health in Men Study)

Background: The Framingham Risk Score estimates the 10-year risk of cardiovascular events. However, it performs poorly in older adults. We evaluated the incremental benefit of adding high-sensitivity cardiac troponin I (hs-cTnI) to the Framingham Risk Score. Methods and Results: The HIMS (Health in Men Study) is a cohort study of community-dwelling men aged 70 to 89 years in Western Australia. Participants were identified from the electoral roll, with a subset undergoing plasma analysis. Hs-cTnI (Abbott Architect i2000SR) was measured in 1151 men without prior cardiovascular disease. The Western Australia Data Linkage System was used to identify incident cardiovascular events. After 10 years of follow-up, 252 men (22%) had a cardiovascular event (CVE+) and 899 did not (CVE–). The Framingham Risk Score placed 148 (59%) CVE+ and 415 (46%) CVE– in the high-risk category. In CVE– men, adding hs-cTnI affected the risk categories of 244 (27.2%) men, with 64.8% appropriately reclassified to a lower and 35.2% to a higher category, which decreased the number of high-risk men in the CVE– to 39%. In CVE+ men, adding hs-cTnI affected the risk categories of 61 (24.2%), with 50.8% appropriately reclassified to a higher and 49.2% to a lower category and 82.5% remaining above the 15% risk treatment threshold. The net reclassification index was 0.305 (P<0.001). Adding hs-cTnI increased the C-statistic modestly from 0.588 (95% CI, 0.552–0.624) to 0.624 (95% CI, 0.589–0.659) and improved model fit (likelihood ratio test, P<0.001). Conclusions: Adding hs-cTnI to the Framingham Risk Score provided incremental prognostic benefit in older men, especially aiding reclassification of individuals into a lower risk category

A Derivation of Three-Dimensional Inertial Transformations

The derivation of the transformations between inertial frames made by Mansouri and Sexl is generalised to three dimensions for an arbitrary direction of the velocity. Assuming lenght contraction and time dilation to have their relativistic values, a set of transformations kinematically equivalent to special relativity is obtained. The ``clock hypothesis'' allows the derivation to be extended to accelerated systems. A theory of inertial transformations maintaining an absolute simultaneity is shown to be the only one logically consistent with accelerated movements. Algebraic properties of these transformations are discussed. Keywords: special relativity, synchronization, one-way velocity of light, ether, clock hypothesis.Comment: 16 pages (A5), Latex, one figure, to be published in Found. Phys. Lett. (1997

Anomalous Commutator Algebra for Conformal Quantum Mechanics

The structure of the commutator algebra for conformal quantum mechanics is considered. Specifically, it is shown that the emergence of a dimensional scale by renormalization implies the existence of an anomaly or quantum-mechanical symmetry breaking, which is explicitly displayed at the level of the generators of the SO(2,1) conformal group. Correspondingly, the associated breakdown of the conservation of the dilation and special conformal charges is derived.Comment: 23 pages. A few typos corrected in the final version (which agrees with the published Phys. Rev. D article