The Sudden Dominance of blaCTX–M Harbouring Plasmids in Shigella spp. Circulating in Southern Vietnam

Shigellosis is a disease caused by bacteria belonging to Shigella spp. and is a leading cause of bacterial gastrointestinal infections in infants in unindustrialized countries. The Shigellae are dynamic and capable of rapid change when placed under selective pressure in a human population. Extended spectrum beta lactamases (ESBLs) are enzymes capable of degrading cephalosporins (a group of antimicrobial agents) and the genes that encode them are common in pathogenic E. coli and other related organisms in industrialized countries. In southern Vietnam, we have isolated multiple cephalosporin-resistant Shigella that express ESBLs. Furthermore, over two years these strains have replaced strains isolated from patients with shigellosis that cannot express ESBLs. Our work describes the genes responsible for this characteristic and we investigate one of the elements carrying one of these genes. These finding have implications for treatment of shigellosis and support the growing necessity for vaccine development. Our findings also may be pertinent for other countries undergoing a similar economic transition to Vietnam's and the corresponding effect on bacterial populations

Global, regional, and national burden of stroke, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016

Summary Background Stroke is a leading cause of mortality and disability worldwide and the economic costs of treatment and post-stroke care are substantial. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) provides a systematic, comparable method of quantifying health loss by disease, age, sex, year, and location to provide information to health systems and policy makers on more than 300 causes of disease and injury, including stroke. The results presented here are the estimates of burden due to overall stroke and ischaemic and haemorrhagic stroke from GBD 2016. Methods We report estimates and corresponding uncertainty intervals (UIs), from 1990 to 2016, for incidence, prevalence, deaths, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs). DALYs were generated by summing YLLs and YLDs. Cause-specific mortality was estimated using an ensemble modelling process with vital registration and verbal autopsy data as inputs. Non-fatal estimates were generated using Bayesian meta-regression incorporating data from registries, scientific literature, administrative records, and surveys. The Socio-demographic Index (SDI), a summary indicator generated using educational attainment, lagged distributed income, and total fertility rate, was used to group countries into quintiles. Findings In 2016, there were 5·5 million (95% UI 5·3 to 5·7) deaths and 116·4 million (111·4 to 121·4) DALYs due to stroke. The global age-standardised mortality rate decreased by 36·2% (–39·3 to –33·6) from 1990 to 2016, with decreases in all SDI quintiles. Over the same period, the global age-standardised DALY rate declined by 34·2% (–37·2 to –31·5), also with decreases in all SDI quintiles. There were 13·7 million (12·7 to 14·7) new stroke cases in 2016. Global age-standardised incidence declined by 8·1% (–10·7 to –5·5) from 1990 to 2016 and decreased in all SDI quintiles except the middle SDI group. There were 80·1 million (74·1 to 86·3) prevalent cases of stroke globally in 2016; 41·1 million (38·0 to 44·3) in women and 39·0 million (36·1 to 42·1) in men. Interpretation Although age-standardised mortality rates have decreased sharply from 1990 to 2016, the decrease in age-standardised incidence has been less steep, indicating that the burden of stroke is likely to remain high. Planned updates to future GBD iterations include generating separate estimates for subarachnoid haemorrhage and intracerebral haemorrhage, generating estimates of transient ischaemic attack, and including atrial fibrillation as a risk factor

Equivalence of estimates on domain and its boundary

Let Ω be a pseudoconvex domain in Cn with smooth boundary bΩ. We define general estimates (f-M)kΩ and (f-M)kbΩ on k-forms for the complex Laplacian □ on Ω and the Kohn-Laplacian □ b on bΩ. For 1 ≤ k ≤ n−2, we show that (f-M) kbΩ holds if and only if (f-M) kΩ and (f-M)n−k−1Ωhold. Our proof relies on Kohn\u27s method in Kohn (Ann. Math.156(2), 213-248, 2002)

COMPACTNESS ESTIMATES FOR square(b) ON A CR MANIFOLD

This paper aims to state compactness estimates for the Kohn-Laplacian on an abstract CR manifold in full generality. The approach consists of a tangential basic estimate in the formulation given by the first author in his thesis, which refines former work by Nicoara. It has been proved by Raich that on a CR manifold of dimension 2n - 1 which is compact pseudoconvex of hypersurface type embedded in the complex Euclidean space and orientable, the property named "(CR - P-q)" for 1 <= q <= n-1/2, a generalization of the one introduced by Catlin, implies compactness estimates for the Kohn-Laplacian square(b) in any degree k satisfying q <= k <= n - 1 - q. The same result is stated by Straube without the assumption of orientability. We regain these results by a simplified method and extend the conclusions to CR manifolds which are not necessarily embedded nor orientable. In this general setting, we also prove compactness estimates in degree k = 0 and k = n - 1 under the assumption of (CR - P-1) and, when n=2, of closed range for partial derivative(b). For n >= 3, this refines former work by Raich and Straube and separately by Straube