Molecular identification of CTX-M, TEM and SHV β-lactamases in �Klebsiella pneumoniae isolated from respiratory system of patients in the ICU of educational hospitals in Tehran

Background: Extended-spectrum beta-lactamases (ESBL) producing isolates of Klebsiella pneumoniae which have been increased in the hospitals were resulting in limitation of therapeutic options. The aims of this study were to evaluate the antibiotic susceptibility pattern and presence of ESBL genes in clinical isolates of Klebsiella pneumoniae from patients admitted to the intensive care units (ICUs). Materials and Methods: In this descriptive cross-sectional study, a total of 65 Klebsiella pneumoniae strains were isolated from ICUs of educational hospitals in Tehran. Identification was performed using biochemical tests and the antimicrobial susceptibility was performed as recommended by the Clinical and Laboratory Standards Institute (CLSI). Molecular analysis of the ESBL genes was performed by Multiplex PCR (M-PCR). Results: Most of the isolates were resistant to Cotrimoxazole (72.3), Gentamicin (67.7) and Ampicillin (69.2) and the highest susceptibility was seen for Ciprofloxacin (50.8) Tetracycline (49.2), Imipenem (46.3) and Ceftriaxone (43.1). Among the ESBL-producing genes, blaCTX-M (55.3 ) was the most prevalent, followed by blaTEM (41.5 ) and blaSHV (10.7 ). The results showed that 1.5 of the isolates had concurrently blaTEM/ blaSHV and blaSHV/ blaCTX-M genes and 21.6 of isolates the blaTEM/ blaCTX-M genes. Conclusion: These findings reveal the high prevalence of multi drug resistant and ESBL-producing Klebsiella pneumoniae in patients hospitalized in ICUs and emphasize the need for appropriate infection control policies

Joint perception: gaze and social context

We found that the way people looked at images was influenced by their belief that others were looking too. If participants believed that an unseen other person was also looking at what they could see, it shifted the balance of their gaze between negative and positive images. The direction of this shift depended upon whether participants thought that later they would be compared against the other person or would be collaborating with them. Changes in the social context influenced both gaze and memory processes, and were not due just to participants' belief that they are looking at the same images, but also to the belief that they are doing the same task. We believe that the phenomenon of joint perception reveals the pervasive and subtle effect of social context upon cognitive and perceptual processes

The Role of Health Systems Factors in Facilitating Access to Psychotropic Medicines: A Cross-Sectional Analysis of the WHO-AIMS in 63 Low- and Middle-Income Countries

In a cross-sectional analysis of WHO-AIMS data, Ryan McBain and colleagues investigate the associations between health system components and access to psychotropic drugs in 63 low and middle income countries

Comparison of Contaminant Transport in Agricultural Drainage Water and Urban Stormwater Runoff

<div><p>Transport of nitrogen and phosphorus from agricultural and urban landscapes to surface water bodies can cause adverse environmental impacts. The main objective of this long-term study was to quantify and compare contaminant transport in agricultural drainage water and urban stormwater runoff. We measured flow rate and contaminant concentration in stormwater runoff from Willmar, Minnesota, USA, and in drainage water from subsurface-drained fields with surface inlets, namely, Unfertilized and Fertilized Fields. Commercial fertilizer and turkey litter manure were applied to the Fertilized Field based on agronomic requirements. Results showed that the City Stormwater transported significantly higher loads per unit area of ammonium, total suspended solids (TSS), and total phosphorus (TP) than the Fertilized Field, but nitrate load was significantly lower. Nitrate load transport in drainage water from the Unfertilized Field was 58% of that from the Fertilized Field. Linear regression analysis indicated that a 1% increase in flow depth resulted in a 1.05% increase of TSS load from the City Stormwater, a 1.07% increase in nitrate load from the Fertilized Field, and a 1.11% increase in TP load from the Fertilized Field. This indicates an increase in concentration with a rise in flow depth, revealing that concentration variation was a significant factor influencing the dynamics of load transport. Further regression analysis showed the importance of targeting high flows to reduce contaminant transport. In conclusion, for watersheds similar to this one, management practices should be directed to load reduction of ammonium and TSS from urban areas, and nitrate from cropland while TP should be a target for both.</p></div

Daily flow depth for City Stormwater and Fertilized Field (excluding 2008 and 2013) used for the paired <i>t</i>-test, and daily precipitation at the City Stormwater.

<p>Daily flow depth for City Stormwater and Fertilized Field (excluding 2008 and 2013) used for the paired <i>t</i>-test, and daily precipitation at the City Stormwater.</p

Cumulative flow depth from April to October of 2007 to 2012 (excluding 2008), and paired <i>t</i>-test comparison between Stormwater and Fertilized Field after adjusting for serial correlation (n = 792).

<p>Cumulative flow depth from April to October of 2007 to 2012 (excluding 2008), and paired <i>t</i>-test comparison between Stormwater and Fertilized Field after adjusting for serial correlation (n = 792).</p

Relationship between daily nitrate load and daily flow depth over the period of the study for City Stormwater (n = 479), Fertilized Field (n = 907), and Unfertilized Field (n = 663).

<p>The lines represent the loads at constant nitrate concentration of 1 and 10 mg-N L^-1.</p

Daily flow depth for Unfertilized and Fertilized Fields used for the paired <i>t</i>-test, and daily precipitation at the Fertilized Field.

<p>Daily flow depth for Unfertilized and Fertilized Fields used for the paired <i>t</i>-test, and daily precipitation at the Fertilized Field.</p