The Highly Virulent 2006 Norwegian EHEC O103:H25 Outbreak Strain Is Related to the 2011 German O104:H4 Outbreak Strain

In 2006, a severe foodborne EHEC outbreak occured in Norway. Seventeen cases were recorded and the HUS frequency was 60%. The causative strain, Esherichia coli O103:H25, is considered to be particularly virulent. Sequencing of the outbreak strain revealed resemblance to the 2011 German outbreak strain E. coli O104:H4, both in genome and Shiga toxin 2-encoding (Stx2) phage sequence. The nucleotide identity between the Stx2 phages from the Norwegian and German outbreak strains was 90%. During the 2006 outbreak, stx2-positive O103:H25 E. coli was isolated from two patients. All the other outbreak associated isolates, including all food isolates, were stx-negative, and carried a different phage replacing the Stx2 phage. This phage was of similar size to the Stx2 phage, but had a distinctive early phage region and no stx gene. The sequence of the early region of this phage was not retrieved from the bacterial host genome, and the origin of the phage is unknown. The contaminated food most likely contained a mixture of E. coli O103:H25 cells with either one of the phages

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Background: Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. // Methods: We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung's disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. // Findings: We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung's disease) from 264 hospitals (89 in high-income countries, 166 in middle-income countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in low-income countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. // Interpretation: Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between low-income, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Improving query processing performance in database management systems

Improving Query Processing Performance in Database Management Systems has been a research challenge. This is the most important and is a real problem, this happens to be very crucial in large organizations with heterogeneous data, online system, billing systems and so on. Among other issues in the query optimization problem, faced by everyday query optimizers, get more and more complex with the server increasing complexity of user queries. During the last decade, database management systems have become important information processing system supporting business activities of geographically decentralized organizations. The Performance monitoring has been evaluated and used by various tools. Most DBA's agreed that these tools are valuable. Our research also tried to identify how performance problems could be reduced and which methods were used in practice. Besides hardware upgrades, the following areas in tuning are known to have major impacts. The main aim of this thesis is to produce flexible database monitoring tool and query optimization techniques that is capable of get basic idea of database server, database log, missing indexes, graphical user interface of currently running queries, optimizing large queries in a complex database. Among other issues in a database, such as deadlock, expensive query, primary key missing places, badly design quarries can be simply identified. This database monitoring tool and proposed new optimization techniques will more helpful to identify database performance issues and provide better solutions. During the evaluation, it was shown that system was successful more than 70%

FE Modeling of CFRP strengthened concrete beam exposed to cycle temperature, humidity and sustained loading

Need for strengthening of civil engineering structures has been growing in recent linn", due to many reasons such as improper design, increased loading and environmental deterioration. Use of Carbon Fiber Reinforced Polymers (CFRP) has become a most promising and affordable solution for strengthening of structures due to their superior properties. The major challenge of this composite application in outdoor structures is the long term durability of the bond between CFRP sheet and the concrete substrate. Therefore, the understanding of performance of this system in different service conditions is very important. A finite element model was developed to simulate the behaviour of CFRP strengthened concrete beams. The short term and long term behavior of a composite member was predicted and validated with experimental results. The results showed that the bond between CFRP and concrete is sensitive to the environmental conditions, such as temperature and humidity fluctuations

The role of the mottled water hyacinth weevil (neochetina eichhorniaes on biological control of water hyacinth in Sri Lanka

Water hyacinth (Eichhornia crassipesi has become one of the most obnoxious freshwater weeds \~ith numerous widespread infestations occurring in the North Western. Central and Southern provinces in Sri Lanka. Water hyacinth competes with native plants and phytoplankton in aquatic system for essential nutrients and space due to its rapid grow tho Further it clogs waterways thereby restricting recreational activities including fishing and navigation. lowers dissolved oxygen in water and limits light penetration due to the formation of an extensive network of mats