Analysis of clonality and antibiotic resistance among early clinical isolates of Enterococcus faecium in the United States.

BACKGROUND: The Enterococcus faecium genogroup, referred to as clonal complex 17 (CC17), seems to possess multiple determinants that increase its ability to survive and cause disease in nosocomial environments. METHODS: Using 53 clinical and geographically diverse US E. faecium isolates dating from 1971 to 1994, we determined the multilocus sequence type; the presence of 16 putative virulence genes (hyl(Efm), esp(Efm), and fms genes); resistance to ampicillin (AMP) and vancomycin (VAN); and high-level resistance to gentamicin and streptomycin. RESULTS: Overall, 16 different sequence types (STs), mostly CC17 isolates, were identified in 9 different regions of the United States. The earliest CC17 isolates were part of an outbreak that occurred in 1982 in Richmond, Virginia. The characteristics of CC17 isolates included increases in resistance to AMP, the presence of hyl(Efm) and esp(Efm), emergence of resistance to VAN, and the presence of at least 13 of 14 fms genes. Eight of 41 of the early isolates with resistance to AMP, however, were not in CC17. CONCLUSIONS: Although not all early US AMP isolates were clonally related, E. faecium CC17 isolates have been circulating in the United States since at least 1982 and appear to have progressively acquired additional virulence and antibiotic resistance determinants, perhaps explaining the recent success of this species in the hospital environment.

Effect of sedation level on the prevalence of delirium when assessed with CAM-ICU and ICDSC

Purpose We hypothesized that reduced arousability (Richmond Agitation Sedation Scale, RASS, scores −2 to −3) for any reason during delirium assessment increases the apparent prevalence of delirium in intensive care patients. To test this hypothesis, we assessed delirium using the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) and Intensive Care Delirium Screening Checklist (ICDSC) in intensive care patients during sedation stops, and related the findings to the level of sedation, as assessed with RASS score. Methods We assessed delirium in 80 patients with ICU stay longer than 48 h using CAM-ICU and ICDSC during daily sedation stops. Sedation was assessed using RASS. The effect of including patients with a RASS of −2 and −3 during sedation stop (“light to moderate sedation”, eye contact less than 10 s or not at all, respectively) on prevalence of delirium was analyzed. Results A total of 467 patient days were assessed. The proportion of CAM-ICU-positive evaluations decreased from 53 to 31 % (p < 0.001) if assessments from patients at RASS −2/−3 (22 % of all assessments) were excluded. Similarly, the number of positive ICDSC results decreased from 51 to 29 % (p < 0.001). Conclusions Sedation per se can result in positive items of both CAM-ICU and ICDSC, and therefore in a diagnosis of delirium. Consequently, apparent prevalence of delirium is dependent on how a depressed level of consciousness after sedation stop is interpreted (delirium vs persisting sedation). We suggest that any reports on delirium using these assessment tools should be stratified for a sedation score during the assessment.

Análisis experimental del efecto de las presiones hidrostáticas en la plastificación de materiales metálicos

El presente trabajo fin de máster tiene como objetivo comprobar experimentalmente el efecto de la presión hidrostática en la plastificación de materiales metálicos. Para ello basándose en el artículo de Aretz que analiza los ensayos de tracción y compresión llevados a cabo por Spitzig y Richmond (1984), donde se constata la respuesta plástica sensible a la presión hidrostática, se realizan sendos ensayos de tracción y torsión con probetas de acero, aluminio y fundición. Posteriormente se analiza la influencia de la presión a través de las curvas tensión equivalente- deformación equivalente de los materiales. Y por último se construyen las expresiones analíticas de Ramberg-Osgood de los materiales.

Exploring three approaches to offer distance learning courses through a social network of health researchers in three African countries

The Institute of Tropical Medicine in Antwerp hereby presents the results of two pilot distance learning training programmes, developed under the umbrella of the AFRICA BUILD project (FP7). The two courses focused on evidence-based medicine (EBM): with the aim of enhancing research and education, via novel approaches and to identify research needs emanating from the field. These pilot experiences, which were run both in English-speaking (Ghana), and French-speaking (Mali and Cameroon) partner institutions, produced targeted courses for the strengthening of research methodology and policy. The courses and related study materials are in the public domain and available through the AFRICA BUILD Portal (http://www.africabuild.eu/taxonomy/term/37); the training modules were delivered live via Dudal webcasts. This paper assesses the success and difficulties of transferring EBM skills with these two specific training programmes, offered through three different approaches: fully online facultative courses, fully online tutor supported courses or through a blended approach with both online and face-to-face sessions. Key factors affecting the selection of participants, the accessibility of the courses, how the learning resources are offered, and how interactive online communities are formed, are evaluated and discussed.

Capacity Building through education, research and collaboration: AFRICA BUILD, an eHealth Case Study

AFRICA BUILD (AB) is a Coordination Action project under the 7th European Framework Programme having the aim of improving the capacities for health research and education in Africa through Information and Communication Technologies (ICT). This project, started in 2012, has promoted health research, education and evidence-based practice in Africa through the creation of centers of excellence, by using ICT,?know-how?, eLearning and knowledge sharing, through Web-enabled virtual communities.

BALAÃO – O QUE OUVE AS PALAVRAS DE EL, TEM O CONHECIMENTO DE ELYON E VÊ A VISÃO DE SHADDAI: UM ESTUDO DE NÚMEROS 22-24

A presente pesquisa busca avaliar exegeticamente o texto que se encontra na Bíblia, especificamente no livro de Números capítulos 22-24 que relata sobre um personagem conhecido como Balaão. A pesquisa tem também como objeto o estudo sobre o panteão de divindades relatado no mesmo texto, assim como também o estudo dos textos descobertos em Deir Alla, na Jordânia, que apresentam um personagem designado como Balaão, possivelmente o mesmo personagem de Nm 22-24. A motivação que levou ao desenvolvimento dessa pesquisa foi o fato de se ter deparado com os conceitos dos diversos nomes divinos exibidos no texto, além da questão do profetismo fora de Israel, assim como as possibilidades hermenêuticas que se abrem para a leitura desse texto bíblico. O conceito geral sempre foi o de que Israel era a única nação onde existiam “verdadeiros” profetas e uma adoração a um único Deus, o “monoteísmo”. O que despertou interesse foi perceber, especialmente por meio da leitura dos livros bíblicos, que o profetismo não se restringiu somente a Israel. Ele antecede à formação do antigo Israel e já existia no âmbito das terras do antigo Oriente Médio, e que Israel ainda demorou muito tempo para ser monoteísta. Quem é esse Balaão, filho de Beor? Estudaremos sobre sua pessoa e sua missão. Examinaremos os textos de Deir Alla sobre Balaão e sua natureza de personagem mediador entre o divino e o humano. Esse personagem é apresentado como um grande profeta e que era famoso como intérprete de presságios divinos. Analisaremos a importante questão sobre o panteão de deuses que são apresentados na narrativa de Balaão nomeados como: El, Elyon Elohim e Shaddai, além de Yahweh. Entendemos, a princípio, que o texto possui uma conexão com a sociedade na qual foi criado e usando da metodologia exegética, faremos uma análise da narrativa em questão, buscando compreender o sentido do texto, dentro de seu cenário histórico e social. Cenário este, que nos apresentou esse profeta, não israelita, que profere bênçãos dos deuses sobre Israel e que, além disso, pronuncia maldições sobre os inimigos desse mesmo Israel. Percebemos que, parte do texto pesquisado é apresentado sob a ótica de Israel sobre as outras nações. A pesquisa defende, portanto, que o texto de Nm 22-24, além de nos apresentar um profeta fora de Israel igual aos profetas da Bíblia, defende que, o panteão de divindades também era adorado por Israel e que tais nomes são epítetos de uma mesma divindade, no caso YHWH. Defende, também, um delineamento de um projeto de domínio político e militar de Israel sobre as nações circunvizinhas.

Divergent and conserved features in the spatial expression of the Drosophila pseudoobscura esterase-5B gene and the esterase-6 gene of Drosophila melanogaster

The regulatory regions of homologous genes encoding esterase 6 (Est-6) of Drosophila melanogaster and esterase 5B (Est-5B) of Drosophila pseudoobscura show very little similarity. We have undertaken a comparative study of the pattern of expression directed by the Est-5B and Est-6 5′-flanking DNA to attempt to reveal conserved elements regulating tissue-specific expression in adults. Esterase regulatory sequences were linked to a lacZ reporter gene and transformed into D. melanogaster embryos. Est-5B, 5′ upstream elements, give rise to a β-galactosidase expression pattern that coincides with the wild-type expression of Est-5B in D. pseudoobscura. The expression patterns of the Est-5B/lacZ construct are different from those of a fusion gene containing the upstream region of Est-6. Common sites of expression for both kinds of constructs are the third segment of antenna, the maxillary palps, and salivary glands. In vitro deletion mutagenesis has shown that the two genes have a different organization of regulatory elements controlling expression in both the third segment of antenna and maxillary palps. The results suggest that the conservation of the expression pattern in genes that evolved from a common ancestor may not be accompanied by preservation of the corresponding cis-regulatory elements.

Negative pH, efflorescent mineralogy, and consequences for environmental restoration at the Iron Mountain Superfund site, California

The Richmond Mine of the Iron Mountain copper deposit contains some of the most acid mine waters ever reported. Values of pH have been measured as low as −3.6, combined metal concentrations as high as 200 g/liter, and sulfate concentrations as high as 760 g/liter. Copious quantities of soluble metal sulfate salts such as melanterite, chalcanthite, coquimbite, rhomboclase, voltaite, copiapite, and halotrichite have been identified, and some of these are forming from negative-pH mine waters. Geochemical calculations show that, under a mine-plugging remediation scenario, these salts would dissolve and the resultant 600,000-m3 mine pool would have a pH of 1 or less and contain several grams of dissolved metals per liter, much like the current portal effluent water. In the absence of plugging or other at-source control, current weathering rates indicate that the portal effluent will continue for approximately 3,000 years. Other remedial actions have greatly reduced metal loads into downstream drainages and the Sacramento River, primarily by capturing the major acidic discharges and routing them to a lime neutralization plant. Incorporation of geochemical modeling and mineralogical expertise into the decision-making process for remediation can save time, save money, and reduce the likelihood of deleterious consequences.

Mapping nucleosome position at single base-pair resolution by using site-directed hydroxyl radicals.

A base-pair resolution method for determining nucleosome position in vitro has been developed to com- plement existing, less accurate methods. Cysteaminyl EDTA was tethered to a recombinant histone octamer via a mutant histone H4 with serine 47 replaced by cysteine. When assembled into nucleosome core particles, the DNA could be cut site specifically by hydroxyl radical-catalyzed chain scission by using the Fenton reaction. Strand cleavage occurs mainly at a single nucleotide close to the dyad axis of the core particle, and assignment of this location via the symmetry of the nucleosome allows base-pair resolution mapping of the histone octamer position on the DNA. The positions of the histone octamer and H3H4 tetramer were mapped on a 146-bp Lytechinus variegatus 5S rRNA sequence and a twofold-symmetric derivative. The weakness of translational determinants of nucleosome positioning relative to the overall affinity of the histone proteins for this DNA is clearly demonstrated. The predominant location of both histone octamer and H3H4 tetramer assembled on the 5S rDNA is off center. Shifting the nucleosome core particle position along DNA within a conserved rotational phase could be induced under physiologically relevant conditions. Since nucleosome shifting has important consequences for chromatin structure and gene regulation, an approach to the thermodynamic characterization of this movement is proposed. This mapping method is potentially adaptable for determining nucleosome position in chromatin in vivo.

Análise da possível expansão internacional de empresas brasileiras de real estate residencial para o mercado costarriquenho, uma abordagem SWOT.

Devido ao crescimento e à experiência adquirida pelas empresas brasileiras de real estate residencial nos últimos anos, e às características próprias desse setor, os mercados internacionais poderiam ser considerados como possíveis alvos para essas empresas. Por exemplo, no mercado residencial costarriquenho, incentivos para projetos residenciais de alta densidade populacional, reformas nos processos para a obtenção dos alvarás de construção e mudanças demográficas e culturais, parecem propiciar um ambiente favorável para empresas dessa indústria. Portanto, o objetivo do presente trabalho é estudar uma possível expansão geográfica de empresas brasileiras de real estate no mercado residencial costarriquenho, a partir da estruturação de uma análise de abordagem SWOT dos elementos necessários para tal incursão. Para isso, realizou-se uma revisão bibliográfica na busca dos elementos estratégicos do ambiente interno de empresas de real estate residencial que devem ser considerados para processos de internacionalização, identificando-se 12 forças e 10 fraquezas desta revisão. Ademais, analisou-se: o mercado residencial; a macroeconomia, e as conjunturas político-legais e socioculturais da Costa Rica, na procura de fatores que devem ser tomados em conta por parte de empresas de real estate ao ingressar nesse país, distinguindo-se 24 oportunidades e 20 ameaças dessa análise. Para complementar o estudo, foi avaliada a atratividade do mercado residencial costarriquenho para receber investimentos por onze importantes empresas do setor de real estate residencial brasileiro, por meio de um questionário estruturado com os elementos identificados na primeira parte do trabalho. Os resultados mostraram que, no momento da avaliação, as empresas entrevistadas deram maior atenção ao tamanho do mercado e às características do sistema financeiro para o setor residencial, e identificaram a carência do conhecimento local e sua cultura empresarial, como os elementos que dificultariam sua internacionalização. Conclui-se sobre a possível internacionalização de empresas brasileiras de real estate residencial para o mercado da Costa Rica, que elementos desde uma perspectiva econômica racional e principalmente contingencial definem essa estratégia, não sendo viável nem vantajoso idealizar um processo de internacionalização nesse mercado, devido às atuais condições de seus mercados locais e aos elementos do ambiente interno que várias dessas empresas apresentam.

Hacia una definición actual del concepto de «diagnóstico social». Breve revisión bibliográfica de su evolución

Este documento es un artículo inédito que ha sido aceptado para su publicación. Como un servicio a sus autores y lectores, Alternativas. Cuadernos de trabajo social proporciona online esta edición preliminar. El manuscrito puede sufrir alteraciones tras la edición y corrección de pruebas, antes de su publicación definitiva. Los posibles cambios no afectarán en ningún caso a la información contenida en esta hoja, ni a lo esencial del contenido del artículo.

Letters from Daniel Bates to William Jenks, May 1795-September 1798

Daniel Bates wrote these five letters to his friend and classmate, William Jenks, between May 1795 and September 1798. In a letter written May 12, 1795, Bates informs Jenks, who was then employed as an usher at Mr. Webb's school, of his studies of Euclid, the meeting of several undergraduate societies, and various sightings of birds, gardens and trees. In a letter written in November 1795 from Princeton, where he was apparently on vacation with the family of classmate Leonard Jarvis, he describes playing the game "break the Pope's neck" and tells Jenks what he was reading (Nicholson, Paley?, and Thompson) and what his friend's father was reading (Mirabeau and Neckar).

New Hampshire, 1816 (Image 4 of 6) (Raster Image)

This layer is a georeferenced raster image of the historic paper map entitled: New Hampshire by recent survey : made under the supreme authority and published according to law by Philip Carrigain ; J.J. Barralet, del. ; W. Harrison, sct., Philada. It was published by Philip Carrigain in 1816. Scale [ca. 1:200,000]. This layer is image 4 of 6 total images, representing the southwest portion of the six sheet source map. The image inside the map neatline is georeferenced to the surface of the earth and fit to the New Hampshire State Plane coordinate system (NAD 1983 in Feet) (Fipszone 2800). All map collar and inset information is also available as part of the raster image, including any inset maps, profiles, statistical tables, directories, text, illustrations, index maps, legends, or other information associated with the principal map. This map shows features such as roads, drainage, public buildings, schools, churches, industry locations (e.g. mills, factories, mines, etc.), selected private buildings with names of property owners, town boundaries, land grants, and more. Relief shown pictorially and by hachures. Includes area notes, text, and table of population. Also includes illustrations: View of the Great Boars Head and Hampton Beach -- The Cap of the White Mountains -- View of the White Mountains from Shelburne; inset maps: States of the Union east of the Hudson with the adjacent British colonies. Scale [ca. 1:1,920,000] -- The middle, southern and western sections of the United States with the territories. Scale [ca. 1:4,900,000]. Includes: ms. additions with updated county boundary & township names.This layer is part of a selection of digitally scanned and georeferenced historic maps of New England from the Harvard Map Collection. These maps typically portray both natural and manmade features. The selection represents a range of regions, originators, ground condition dates, scales, and map purposes.