Search

Background: Carbapenemase-producing Enterobacteriaceae (CPE) may cause healthcare-associated infections with high mortality rates. New Delhi metallo-β-lactamase-1 (NDM-1) is among the most recently discovered carbapenemases.Aim: To report the first outbreak of NDM-1 CPE in Ireland, including microbiological and epidemiological characteristics, and assessing the impact of infection prevention and control measures.Methods: This was a retrospective microbiological and epidemiological review. Cases were defined as patients with a CPE-positive culture. Contacts were designated as roommates or ward mates.Findings: This outbreak involved 10 patients with a median age of 71 years (range: 45-90), located in three separate but affiliated healthcare facilities. One patient was infected (the index case); the nine others were colonized. Nine NDM-1-producing Klebsiella pneumoniae, an NDM-1-producing Escherichia coli and a K. pneumoniae carbapenemase (KPC)-producing Enterobacter cloacae were detected between week 24, 2014 and week 37, 2014. Pulsed-field gel electrophoresis demonstrated similarity. NDM-1-positive isolates were meropenem resistant with minimum inhibitory concentrations (MICs) ranging from 12 to 32 μg/mL. All were tigecycline susceptible (MICs ≤1 μg/mL). One isolate was colistin resistant (MIC 4.0 μg/mL; mcr-1 gene not detected). In 2015, four further NDM-1 isolates were detected.Conclusion: The successful management of this outbreak was achieved via the prompt implementation of enhanced infection prevention and control practices to prevent transmission. These patients did not have a history of travel outside of Ireland, but several had frequent hospitalizations in Ireland, raising concerns regarding the possibility of increasing but unrecognized prevalence of NDM-1 and potential decline in value of travel history as a marker of colonization risk. [ABSTRACT FROM AUTHOR]

Contaminated blood cultures represent challenges regarding diagnosis, duration of hospitalization, antimicrobial use, pharmacy and laboratory costs. Facing problematic neonatal blood culture contamination (3.8%), we instigated a successful intervention combining skin antisepsis using sterile applicators with 2% chlorhexidine gluconate in 70% isopropanol prior to phlebotomy (replacing 70% isopropanol) and staff education. In the six months prior to intervention, 364 neonatal peripheral blood samples were collected. Fourteen (3.8%) were contaminated. In the post-intervention six months, 314 samples were collected. Three (0.96%) were contaminated, representing significant improvement (Fisher's exact test: P = 0.0259). No dermatological sequelae were observed. The improvement has been sustained. [ABSTRACT FROM AUTHOR]

Summary Aim To report the first Irish outbreak of cfr -mediated linezolid-resistant Staphylococcus epidermidis . Methods Linezolid-resistant S. epidermidis isolated at University Hospital Limerick from four blood cultures, one wound and four screening swabs (from nine patients) between April and June 2013 were characterized by pulsed-field gel electrophoresis (PFGE), multi-locus sequence typing (MLST) and staphylococcal cassette chromosome (SCC mec ) typing. Antibiotic susceptibilities were determined according to the guidelines of the British Society for Antimicrobial Chemotherapy. The outbreak was controlled through prohibiting prescription and use of linezolid, adherence to infection prevention and control practices, enhanced environmental cleaning, isolation of affected patients, and hospital-wide education programmes. Findings PFGE showed that all nine isolates represented a single clonal strain. MLST showed that they belonged to ST2, and SCC mec typing showed that they encoded a variant of SCC mec III. All nine isolates were cfr positive, and eight isolates were positive for the G2576T 23S rRNA mutation commonly associated with linezolid resistance. Isolates exhibited multiple antibiotic resistances (i.e. linezolid, gentamicin, methicillin, clindamycin, ciprofloxacin, fusidic acid and rifampicin). The adopted infection prevention intervention was effective, and the outbreak was limited to the affected intensive care unit. Conclusions This is the first documented outbreak of cfr -mediated linezolid-resistant S. epidermidis in the Republic of Ireland. Despite this, and due to existing outbreak management protocols, the responsible micro-organism and source were identified efficiently. However, it became apparent that staff knowledge of antimicrobial susceptibilities and appropriate hygiene practices were suboptimal at the time of the outbreak, and that educational interventions (and re-inforcement) are necessary to avoid occurrence of antimicrobial resistance and outbreaks such as reported here. [ABSTRACT FROM AUTHOR]

The mechanism whereby thiol collectors adsorb onto a mineral surface has been widely studied. Most of these studies examine the mineral surface at equilibrium state and, often, well above monolayer coverage. However, the formation of species at the mineral surface is a complex process that is both kinetically and thermodynamically controlled. This study uses isothermal titration microcalorimetry to measure the heat evolved during the reaction of a variety of different thiol collectors and collector mixtures with a galena mineral surface. It was observed that, for ethyl xanthate (SEX) and isobutyl xanthate (SIBX), there are sequential reactions occurring at the mineral surface at sub-monolayer coverages. A proposal is put forward for the reactions based on literature and the microcalorimetric, dissolution and pH data from this investigation. DTC (isobutyl dithiocarbamate) had very similar heats of reaction to the xanthates. The major difference was that there was no secondary reaction noticed in the case of DTC. This led to the postulation that the reaction mechanism was different in the case of DTC, with DTC reacting directly with the galena surface. DTP (diethyl dithiophosphate) showed no reaction with the galena surface at all and this was confirmed with adsorption isotherm studies. Enthalpies of reaction of mixtures of SEX with DTP were an additive effect of the enthalpies of each of the pure collectors, meaning that addition of DTP lowered the enthalpy of the SEX reaction proportionally to the amount of DTP added. There was no evidence of a synergistic reaction occurring between the xanthate and the DTP as suggested by previous flotation experiments. This suggests that there is an alternative reaction mechanism occurring to explain improved flotation performance when using SEX-DTP mixtures with galena. [ABSTRACT FROM AUTHOR]

BACKGROUND: Worsening renal function (WRF) portends a poor prognosis, and recent deterioration in creatinine might identify patients with elevated intrarenal adenosine in whom adenosine A(1) antagonism may improve renal hemodynamics and function. The purpose of this pilot study was to assess whether rolofylline, an adenosine A(1) antagonist (A(1)RA), would facilitate diuresis while maintaining renal function in patients with acutely decompensated heart failure (ADHF) and recent WRF. METHODS AND RESULTS: Seventy-six patients with ADHF, volume overload, and recent renal deterioration received rolofylline (30 mg, n = 36) or placebo (n = 40) for 3 days. Rolofylline did not demonstrate a beneficial effect on the primary end points of worsening heart failure or renal function after admission or death or readmission within 30 days. Similar proportions of patients receiving rolofylline (33%) and placebo (30%) were treatment failures within 30 days. However, persistent renal impairment (through Day 14) tended to be less common with rolofylline (6%) than placebo (18%). At Day 14, 11 patients receiving placebo and 13 patients receiving rolofylline had a decrease in creatinine > or = 0.3 mg/dL. There were fewer heart failure readmissions with rolofylline (n = 2) than with placebo (n = 7) through Day 60. CONCLUSIONS: The Placebo-Controlled Study of the Effects of KW-3902 Injectable Emulsion on Heart Failure Signs and Symptoms, Diuresis, Renal Function, and Clinical Outcomes in Subjects Hospitalized with Worsening Renal Function and Heart Failure Requiring Intravenous Therapy (ie, REACH UP) study did not demonstrate any clear benefit of rolofylline in patients with ADHF and worsening renal function. However, beneficial trends raise the possibility that A(1)RAs might prevent renal dysfunction in these high risk patients. To test this hypothesis, further larger studies need to evaluate the effects of adenosine A(1) antagonists in patients with progressive renal dysfunction in the face of active heart failure therapy. [ABSTRACT FROM AUTHOR]

The Health Service Executive (HSE) highlights the need for effective patient throughput and management, whilst providing appropriate staffing and therapeutic interventions. It acknowledges that patient need is integral to the development of a nurse led service and advocates planning staffing levels to reflect arrival times of patients. An observational study of all patients who presented to the emergency department in July 2005 and February 2006 was undertaken (n=7768). The study identified 1577 patients suitable for treatment by the Advanced Nurse Practitioner (ANP) in these two months, which represents 20% of all patient attendances to the ED in this time period. A data collection tool was devised collectively by the ANPs to identify appropriate patients. The findings of the study revealed that 73% of patients suitable for the ANP service presented between the hours of 0800 and 2000, of which 54% attended between 0800 and 1600 h. Sunday emerged as the busiest day in July 2005 whereas Monday was found to be the busiest day in February 2006. Friday was found to be consistently busy for both months. [ABSTRACT FROM AUTHOR]

Auxetic behaviour, the unphysical transverse expansion during uniaxial tension, is a common and undesirable feature of classical anisotropic hyperelastic constitutive models for soft tissue. In this study we uncover the underlying mechanism of such behaviour; high levels of in-plane compaction occurs due to increasing tension in strain-stiffening fibres, leading to unphysical out-of-plane expansion. We demonstrate that auxetic behaviour is primarily influenced by the ratio of fibre to matrix stiffness, and is accentuated by strain-stiffening fibres in a constant stiffness matrix (e.g., the widely used neo-Hookean matrix with exponentially stiffening fibres). We propose a new bilinear strain stiffening fibre and matrix (BLFM) model which allows close control of the fibre-matrix stiffness ratio, thereby robustly eliminating auxetic behaviour. We demonstrate that our model provides accurate prediction of experimentally observed out-of-plane compaction, in addition to stress-stretch anisotropy, for arterial tissue subjected to uniaxial tension testing. [ABSTRACT FROM AUTHOR]

Abstract: Since the 1990s, affective neurosciences have aimed to identify the neurophysiological underpinnings of depressive disorders. Despite the large number of studies, the results have been inconclusive. We sought to test an experimental paradigm that combined emotional processing and electrophysiological response. Healthy volunteers were presented with emotional faces that depicted variable intensities of fear and their skin conductance response was recorded through digital electrodes. By using this paradigm we found a pattern of linear association between electrodermal activity and increasing intensity of negative emotional stimuli, suggesting that this paradigm may be soon employed in a clinical population and shed light on the neurophysiological substrates of affective disorders. [Copyright &y& Elsevier]

[Display omitted] • Regular solution approach shows interactions between flotation reagents. • Interactions at the air–water interface shown between dithiophosphates and alcohols. • Novel approach for a flotation application. • Valuable contribution towards understanding reagent interactions in flotation. Dithiophosphate (DTP) is classically used as a co-collector in sulfide mineral flotation to promote hydrophobicity on target particles. Notwithstanding the improved recoveries observed, DTP does not appear to behave as a conventional collector, since it has been shown that it does not adsorb onto certain sulfide mineral surfaces. Recent investigations have nevertheless indicated that when DTP does not adsorb onto the sulfide mineral surface, the presence of a non-ionic frother, such as an alcohol or polyglycol ether, activates a synergistic increase in pulp phase mineral recovery and bubble-particle attachment probability. In this paper, a regular solution approach is used to quantify the interactions between thiolate collectors and non-ionic frothers at the air–water interface, where no other methodology could demonstrate such interactions. Attractive interactions were observed between DTP and frothers, whereas no such interaction was observed between xanthate, a standard base metal sulfide collector. It is suggested that this is the first time that such interactions have been shown for the DTP-frother system and this may represent an important contribution to our understanding of the role of DTP reagents in the flotation process. [ABSTRACT FROM AUTHOR]