Rapid emergence of multidrug resistant, H58-lineage Salmonella typhi in Blantyre, Malawi

INTRODUCTION: Between 1998 and 2010, S. Typhi was an uncommon cause of bloodstream infection (BSI) in Blantyre, Malawi and it was usually susceptible to first-line antimicrobial therapy. In 2011 an increase in a multidrug resistant (MDR) strain was detected through routine bacteriological surveillance conducted at Queen Elizabeth Central Hospital (QECH).

METHODS: Longitudinal trends in culture-confirmed Typhoid admissions at QECH were described between 1998-2014. A retrospective review of patient cases notes was conducted, focusing on clinical presentation, prevalence of HIV and case-fatality. Isolates of S. Typhi were sequenced and the phylogeny of Typhoid in Blantyre was reconstructed and placed in a global context.

RESULTS: Between 1998-2010, there were a mean of 14 microbiological diagnoses of Typhoid/year at QECH, of which 6.8% were MDR. This increased to 67 in 2011 and 782 in 2014 at which time 97% were MDR. The disease predominantly affected children and young adults (median age 11 [IQR 6-21] in 2014). The prevalence of HIV in adult patients was 16.7% [8/48], similar to that of the general population (17.8%). Overall, the case fatality rate was 2.5% (3/94). Complications included anaemia, myocarditis, pneumonia and intestinal perforation. 112 isolates were sequenced and the phylogeny demonstrated the introduction and clonal expansion of the H58 lineage of S. Typhi.

CONCLUSIONS: Since 2011, there has been a rapid increase in the incidence of multidrug resistant, H58-lineage Typhoid in Blantyre. This is one of a number of reports of the re-emergence of Typhoid in Southern and Eastern Africa. There is an urgent need to understand the reservoirs and transmission of disease and how to arrest this regional increase.

Designing Short Term Wave Traces to Assess Wave Power Devices

In recent years modern numerical methods have been employed in the design of Wave Energy Converters (WECs), however the high computational costs associated with their use makes it prohibitive to undertake simulations involving statistically relevant numbers of wave cycles. Experimental tests in wave tanks could also be performed more efficiently and economically if short time traces, consisting of only a few wave cycles, could be used to evaluate the hydrodynamic characteristics of a particular device or design modification. Ideally, accurate estimations of device performance could be made utilizing results obtained from investigations with a relatively small number of wave cycles. However the difficulty here is that many WECs, such as the Oscillating Wave Surge Converter (OWSC), exhibit significant non-linearity in their response. Thus it is challenging to make accurate predictions of annual energy yield for a given spectral sea state using short duration realisations of that sea. This is because the non-linear device response to particular phase couplings of sinusoidal components within those time traces might influence the estimate of mean power capture obtained. As a result it is generally accepted that the most appropriate estimate of mean power capture for a sea state be obtained over many hundreds (or thousands) of wave cycles. This ensures that the potential influence of phase locking is negligible in comparison to the predictions made. In this paper, potential methods of providing reasonable estimates of relative variations in device performance using short duration sea states are introduced. The aim of the work is to establish the shortness of sea state required to provide statistically significant estimations of the mean power capture of a particular type of Wave Energy Converter. The results show that carefully selected wave traces can be used to reliably assess variations in power output due to changes in the hydrodynamic design or wave climate. 

The influence of genotype information on psychiatrists' treatment recommendations: more experienced clinicians know better what to ignore

Objectives: To assess if psychiatrists were influenced by a patient’s genetic information, even when the patient’s response to treatment was already known to them. Methods: Sixty-seven psychiatrists were presented with patients' pre and post-treatment scores on the PANSS for two hypothetical treatments for schizophrenia. Psychiatrists were also informed whether the patient possessed a genotype linked to hyper-responsiveness to one of the treatments, and were asked to recommend one of these two treatments. Attribute non-attendance assessed whether the information on genotype influenced psychiatrists' treatment recommendations. Results: Years of experience predicted whether psychiatrists were influenced by the genetic information. Psychiatrists with one year or less of experience had a 46% probability of considering genetic information, while psychiatrists with at least 15 years of experience had a lower probability (7%). Conclusions: Psychiatrists and other clinicians should be cautious about allowing a patient's genetic information to carry unnecessary weight in their clinical decision making.