Clinical Epidemiology of Carbapenem-Resistant Enterobacterales in the Greater Houston Region of Texas: a 6-Year Trend and Surveillance analysis

OBJECTIVES: Carbapenem-resistant Enterobacterales (CRE) remain an urgent public health priority in the United States. CRE poses a major threat to patients in healthcare and a potential risk to the community. This study examined the epidemiological trends, clinical, and microbiological data of CRE in the Greater Houston region of Texas. METHODS: A multi-institutional retrospective observational study was conducted using surveillance data collected from 2015 to 2020. Predictors of incidence rates of CRE were determined by a negative binomial regression fit using a generalized estimation equation. RESULTS: Over a 6-year period, 4236 CRE cases were reported, of which Klebsiella pneumoniae accounted for 84.8%. The results show a steady increase in CRE cases, with a sharp rise since 2018. The majority of carbapenemase-producing Enterobacterales were Klebsiella pneumoniae carbapenemase (KPC)-producing (77.2%), followed by other rare carbapenemases, which includes OXA-48, NDM, IMP, VIM, coproduction of KPC with OXA-48, KPC with NDM, and NDM with OXA-48. Acute care hospitals (ACH) accounted for 68.5% of the source of CRE cases. The incidence rate of CRE cases reported from ACH and long-term acute care (LTAC) facilities was 1.16 times that of long-term care facilities (adjusted rate ratio [ARR] = 1.16, 95% confidence interval [CI]:1.04-1.30). The incidence rate of CRE among patients with indwelling devices was 15% (ARR = 0.85, 95% CI: 0.79-0.92) lower than that of patients without indwelling devices. CONCLUSION: The rise in the rate of CRE cases despite aggressive infection prevention and control strategies in the region is alarming. Evaluating and improving the current infection control strategies may be warranted

Clinical Outcomes associated With Co-infection of Carbapenem-Resistant Enterobacterales and Other Multidrug-Resistant organisms

BACKGROUND: Infections with carbapenem-resistant Enterobacterales (CRE) are associated with increased risk of death. Polymicrobial infections with antimicrobial-resistance may add to the burden of clinical care and patients\u27 clinical prognosis. AIM: to examine the impact of CRE co-infection with other multi-drug resistant organisms (MDRO) on patient clinical outcomes. STUDY DESIGN: A retrospective observational study was conducted to compare the clinical outcomes of CRE patients who were co-infected with carbapenem-resistant RESULTS: A total of 224 CRPA and 209 MDRA co-infections with CRE were identified from 4,236 cases from 2015-2020. The overall 90-day all-cause mortality was 21.6% but increased to 35.0% and 33.5% among patients who were co-infected with CRPA and MDRA, respectively. The odds of all-cause mortality among CRE patients who were co-infected with CRPA was twice that of patients identified with CRE alone [adjusted odds ratio (AOR) = 2.02, 95% confidence interval (CI): 1.18-3.46]. Further, the odds of all-cause mortality among CRE patients who were concomitantly identified with MRSA was more than twice that of patients who were not identified with MRSA [AOR = 2.16, 95%CI:1.31-3.56]. The clinical outcome of patients with CRE did not differ significantly depending on the presence of carbapenemase genes. CONCLUSION: The results show that CRPA and CRE co-infections have synergistic effects on clinical outcomes. Further investigation is necessary to understand the mechanism. Screening high risk patients for concomitant antimicrobial-resistant infections may have a significant clinical impact, including effective therapies, antibiotic stewardship, and infection control policies

Quantum Optics and Electronics

Contains reports on three research projects.U.S. Air Force - Office of Scientific Research (Contract F49620-79-C-0071)Joint Services Electronics Program (Contract DAAG29-78-C-0020)Joint Services Electronics Program (Contract DAAG29-80-C-0104)U.S. Navy - Office of Naval Research (Contract N00014-79-C-0694

Chandra Observations of SDSS J1004+4112: Constraints on the Lensing Cluster and Anomalous X-Ray Flux Ratios of the Quadruply Imaged Quasar

We present results from Chandra observations of SDSS J1004+4112, a strongly lensed quasar system with a maximum image separation of 15". All four bright images of the quasar, as well as resolved X-ray emission originating from the lensing cluster, are clearly detected. The emission from the lensing cluster extends out to approximately 1.5 arcmin. We measure the bolometric X-ray luminosity and temperature of the lensing cluster to be 4.7e44 erg s^-1 and 6.4 keV, consistent with the luminosity-temperature relation for distant clusters. The mass estimated from the X-ray observation shows excellent agreement with the mass derived from gravitational lensing. The X-ray flux ratios of the quasar images differ markedly from the optical flux ratios, and the combined X-ray spectrum of the images possesses an unusually strong Fe Kalpha emission line, both of which are indicative of microlensing.Comment: 9 pages, 5 figures. Accepted for publication in ApJ. Version with high-quality color figures at http://cosmic.riken.jp/ota/publications/index.htm

Are the Magellanic Clouds on their First Passage about the Milky Way?

Recent proper motion measurements of the Large and Small Magellanic Clouds (LMC and SMC, respectively) by Kallivayalil et al (2006a,b) suggest that the 3D velocities of the Clouds are substantially higher (~100 km/s) than previously estimated and now approach the escape velocity of the Milky Way (MW). Previous studies have also assumed that the Milky Way can be adequately modeled as an isothermal sphere to large distances. Here we re-examine the orbital history of the Clouds using the new velocities and a LCDM-motivated MW model with virial mass Mvir = 1e12 Msun (e.g. Klypin et al 2002). We conclude that the Clouds are either currently on their first passage about the MW or, if the MW can be accurately modeled by an isothermal sphere to distances >200 kpc (i.e., Mvir > 2e12 Msun), that their orbital period and apogalacticon distance must be a factor of two larger than previously estimated, increasing to 3 Gyr and 200 kpc, respectively. A first passage scenario is consistent with the fact that the LMC and SMC appear to be outliers when compared to other satellite galaxies of the MW: they are irregular in appearance and are moving faster. We discuss the implications of this orbital analysis for our understanding of the star formation history, the nature of the warp in the MW disk and the origin of the Magellanic Stream (MS), a band of HI gas trailing the LMC and SMC that extends roughly 100 degrees across the sky. Specifically, as a consequence of the new orbital history of the Clouds, the origin of the MS may not be explainable by current tidal and ram pressure stripping models

Use of a mixed tissue RNA design for performance assessments on multiple microarray formats

The comparability and reliability of data generated using microarray technology would be enhanced by use of a common set of standards that allow accuracy, reproducibility and dynamic range assessments on multiple formats. We designed and tested a complex biological reagent for performance measurements on three commercial oligonucleotide array formats that differ in probe design and signal measurement methodology. The reagent is a set of two mixtures with different proportions of RNA for each of four rat tissues (brain, liver, kidney and testes). The design provides four known ratio measurements of >200 reference probes, which were chosen for their tissue-selectivity, dynamic range coverage and alignment to the same exemplar transcript sequence across all three platforms. The data generated from testing three biological replicates of the reagent at eight laboratories on three array formats provides a benchmark set for both laboratory and data processing performance assessments. Close agreement with target ratios adjusted for sample complexity was achieved on all platforms and low variance was observed among platforms, replicates and sites. The mixed tissue design produces a reagent with known gene expression changes within a complex sample and can serve as a paradigm for performance standards for microarrays that target other species

Optics and Quantum Electronics

Contains table of contents for Section 2 and reports on twenty research projects.Charles S. Draper Laboratory Contract DL-H-404179Joint Services Electronics Program Contract DAALO3-89-C-0001National Sciences Foundation Grant EET 87-00474National Science Foundation Grant EET 88-15834U.S. Air Force - Office of Scientific Research Contract F49620-88-C-0089National Science Foundation Grant ECS 85-52701International Business Machines CorporationMassachusetts General Hospital Contract N00014-86K-0117National Institutes of Health Grant 2-RO1-GM35459U.S. Department of Energy Grant DE-FG02-89-ER14012Lawrence Livermore National Laboratory Subcontract B04870

Pan-Cancer Analysis of lncRNA Regulation Supports Their Targeting of Cancer Genes in Each Tumor Context

Long noncoding RNAs (lncRNAs) are commonly dys-regulated in tumors, but only a handful are known toplay pathophysiological roles in cancer. We inferredlncRNAs that dysregulate cancer pathways, onco-genes, and tumor suppressors (cancer genes) bymodeling their effects on the activity of transcriptionfactors, RNA-binding proteins, and microRNAs in5,185 TCGA tumors and 1,019 ENCODE assays.Our predictions included hundreds of candidateonco- and tumor-suppressor lncRNAs (cancerlncRNAs) whose somatic alterations account for thedysregulation of dozens of cancer genes and path-ways in each of 14 tumor contexts. To demonstrateproof of concept, we showed that perturbations tar-geting OIP5-AS1 (an inferred tumor suppressor) andTUG1 and WT1-AS (inferred onco-lncRNAs) dysre-gulated cancer genes and altered proliferation ofbreast and gynecologic cancer cells. Our analysis in-dicates that, although most lncRNAs are dysregu-lated in a tumor-specific manner, some, includingOIP5-AS1, TUG1, NEAT1, MEG3, and TSIX, synergis-tically dysregulate cancer pathways in multiple tumorcontexts

Genomic, Pathway Network, and Immunologic Features Distinguishing Squamous Carcinomas

This integrated, multiplatform PanCancer Atlas study co-mapped and identified distinguishing molecular features of squamous cell carcinomas (SCCs) from five sites associated with smokin