The Antimicrobial Resistance Characteristics of Imipenem-Non-Susceptible, Imipenemase-6-Producing Escherichia coli

Imipenemase-6 (IMP-6) type carbapenemase-producing Enterobacteriaceae is regarded as dangerous due to its unique lack of antimicrobial susceptibility. It is resistant to meropenem (MEPM) but susceptible to imipenem (IPM). In addition to carbapenemase, outer membrane porins and efflux pumps also play roles in carbapenem resistance by reducing the antimicrobial concentration inside cells. Extended-spectrum β-lactamase (ESBL) is transmitted with IMP-6 by the plasmid and broadens the spectrum of antimicrobial resistance. We collected 42 strains of IMP-6-producing Escherichia coli and conducted a molecular analysis of carbapenemase, ESBL, porin, efflux, and epidemiological characteristics using plasmid replicon typing. Among the 42 isolates, 21 strains were susceptible to IPM (50.0%) and 1 (2.4%) to MEPM. Seventeen strains (40.5%) co-produced CTX-M-2 type ESBL. We found that the relative expression of ompC and ompF significantly correlated with the MIC of IPM (p = 0.01 and p = 0.03, respectively). Sixty-eight% of CTX-M-2-non-producing strains had IncI1, which was significantly different from CTX-M-2-producing strains (p < 0.001). In conclusion, 50.0% of our IMP-6-producing strains were non-susceptible to IPM, which is different from the typical pattern and can be attributed to decreased porin expression. Further studies investigating other types of carbapenemase are warranted.

Latent Errors and Visible Earned Value: How the Evolutionary Model Integrates Earned Value Metrics with Project System Dynamics

A project model is presented that weaves together ideas from earned value project management and systems dynamics. It is able to adjust to increasingly unhealthy actual project behaviors in ways that preserve the signature pattern of the staffing histograms observed in the real world and provide a tool for managers to correct projects that are not meeting the plan. Starting from the planned staffing histogram and the project performance baseline, the model captures the delay and cost of experience dilution, includes the unplanned-for effort that is revealed in the typical pattern of the Cost Performance Index, assesses progress using the actual cost to date and the earned value to date, and adjusts staffing, scope, or both, to complete the project on schedule. A new method of approximating work remaining, called project-to-date, is shown to track the planned staffing histogram better than the commonly used fraction-complete method.

How do spouses’ levels of ambivalent sexism predict allocations of household chores? Probing why women still perform most of the work in the U.S.

This study’s main objective was to examine whether, in a U.S. sample, ambivalent sexism would show stronger associations with heterosexual husbands and wives’ housework division (hours and proportion) than have previous gender-ideology measures. Unlike earlier conceptions of sexism emphasizing hostile and negative stereotypical views toward women, ambivalent sexism combines the two dimensions of hostile sexism and benevolent sexism (seemingly positive views and behaviors toward women that nevertheless convey underlying paternalistic and patronizing motivations). We hypothesized that male and female respondents high in both hostile and benevolent sexism would report the typical pattern of wives’ housework exceeding their husbands’, whereas those lower in hostile or benevolent sexism would report less housework being performed by wives. Married individuals (N = 249) were recruited via advertisements on Amazon.com’s Mechanical Turk (MTurk) platform and announcements at a university to complete an online survey. Several variables were measured, including own and spouse’s housework hours, hostile and benevolent sexism, and demographic control variables previously associated with housework allocation. An interaction emerged for women, in which those high in benevolent, but low in hostile, sexism reported performing the highest proportion of housework, whereas those low in both forms of sexism performed the lowest proportion. These results provided full or partial support for different aspects of our hypotheses. Men reported greater housework (hours and proportion) the more hours their wife worked outside the house. Discussion examines implications for ambivalent sexism theory, housework sharing, and conceptions of sexism.

Design and Optimization of Star Recognition Algorithm Based on Hierarchical CNN

With the rapid-development of AI technology, artificial intelligence algorithms for the aerospace applications have shown very good simulation performance in many areas. Among the spaceborne application fields, star identification can be seen as a typical pattern recognition process. It’s also the key part of attitude determination of the satellites, which requires the algorithm to be robust and efficient due to the limited computing and storing resources of the spaceborne computers. Nevertheless, most of the previous algorithms are not possible to be applied in practical due to the reasons above. This article proposes a strategy of constructing ‘net-structure’ images of stars to build the datasets for training and testing. Besides, a hierarchical convolutional neural network(CNN) with a small size is also designed. It performs good results on robustness and efficiency in the experiments. In the end, a method of fusing the Conv layers and the batch normalization (BN)layers is also adopted to further accelerate the algorithm.

Diet-related urine collections: assistance in categorization of hyperoxaluria

Hyperoxaluria, one of the major risk factors for calcium oxalate urolithiasis and nephrocalcinosis, causes significant morbidity and mortality and should therefore be detected and treated as soon as possible. An early, consequent and adequate evaluation, but also a distinction between primary (PH) and secondary hyperoxaluria (SH) is therefore essential. We evaluated the usefulness of three consecutive 24-h urine collections under different diets [usual diet, (A), low oxalate diet, (B), high oxalate diet, (C)] to prove SH, or to find evidence of PH by changes in urinary oxalate excretion (Uox). We retrospectively analyzed results from 96 pediatric patients (47 females and 49 males, age 3–18 years) who presented with a history of nephrolithiasis, nephrocalcinosis and/or persistent hematuria in whom hyperoxaluria was found in an initial urine sample. The typical pattern of SH was found in 34 patients (mean Uox (A) 0.85 ± 0.29, (B) 0.54 ± 0.15 and (C) 0.95 ± 0.28 mmol/1.73m2/d). PH was suspected in 13 patients [(A) 1.21 ± 0.75; (B) 1.47 ± 0.51 and (C) 1.60 ± 0.82 mmol/1.73m2/d], but genetically proven only in 1/5 patients examined. No hyperoxaluria was found in 16 patients. Data were inconclusive in 33 patients. Urine collection under different diets is helpful to diagnose secondary hyperoxaluria and may provide evidence, that urinary oxalate excretion is normal. We have now established this procedure as our first diagnostic step before further, more extensive and more expensive evaluations are performed.

SAPHO Syndrome Mimicking Infectious Spondylodiscitis and Bone Metastasis

The acronym SAPHO (synovitis, acne, pustulosis, hyperostosis, and osteitis) includes diseases with similar osteoarticular manifestations and skin conditions. Making this diagnosis is not always obvious, especially when the clinical presentation does not fit the typical pattern of the disease or it occurs in a particular field. We described three cases where the diagnosis was difficult. A 46 year-old woman presented with cervical pain. The cervical X-ray showed the aspect of an ivory C5 vertebra. The patient had, however, preserved general condition, no signs of underlying neoplasia, nor other joint complaints. Blood analysis was normal. Tomography did not find any suspect lesion but showed sclerosis and hyperostosis of the manubrium. Scintigraphy showed the characteristic “bullhead” appearance. A 61-year-old woman had thoracic and lumbar pain. MRI showed spondylodiscitis in D3-D4, D4-D5, D5-D6, D6-D7, and L1-L2 with paraspinal soft tissue involvement, simulating infectious spondylodiscitis. Infectious investigations and discovertebral biopsy performed twice were negative. SAPHO syndrome was then suspected. Bone scintigraphy showed uptake in the chondrosternal articulations and D4 to D7 vertebrae. The diagnosis of SAPHO was established. The third case was a 46-year-old man with a lung adenocarcinoma. Staging for metastatic disease, a TAP tomography was performed and showed osteosclerosis of D8 to D12 and intra-articular bridges in the sacroiliac joints. MRI and scintigraphy eliminated malignancy and confirmed the diagnosis of SAPHO. In our cases, imaging findings could facilitate differentiating SAPHO syndrome from other diseases.

Wood pellets transport with vibrating conveyor: experimental for DEM simulations analysis

This work presents a comprehensive overview of the mechanical-physical parameters of the transport material affecting the vibratory transport. For this purpose, spruce pellets of different lengths, oak rods and spruce crush were tested. The determined parameters were particle size distribution and shape, internal friction, static and dynamic angle of repose. The samples were transported by a patented validation vibrating conveyor. Various settings were used. The results show that by changing the shape, it is possible to reduce friction or resistance as well as energy intensity during transport. It was observed that perfect shapes and lighter particles have lower friction, but a more pronounced bounce. Therefore, it does not form a typical pattern during transport, as in the case of an imperfectly shaped one. There is also included a simulation of the discrete element method. The study shows the possibility of the vibration machine where the material can be conveyed either directionally or sorted.

Larval development of the Caribbean king crab Maguimithrax spinosissimus (Lamarck, 1818), the largest brachyuran in the western Atlantic (Crustacea: Decapoda: Majoidea)

The complete larval development of the spider crab Maguimithrax spinosissimus (Lamarck, 1818) is re-described and illustrated in detail from laboratory-reared material. The development consisted of the typical pattern reported for the Majoidea, two zoeal stages and one megalopa. The complete larval development from hatching to first crab lasted 5–6 days at temperatures that ranged between 24–28 °C. Both zoeal stages of M. spinosissimus exhibited moderate reduction in the number of setae in the maxilla and maxillipeds, from the first to the second zoeal stage, when compared with other closely related species. Maguimithrax spinosissimus can be easily distinguished from other species belonging to the closely related genus Mithrax by the (i) setation of the endopod of the maxillule, maxilla and second maxilliped in both zoeal stages; (ii) setation of the scaphognathite of the maxilla in the first zoeal stage; (iii) setation of the basis of maxilliped I in the second zoeal stage and megalopa; (iv) morphology of the antennule and antenna in the second zoeal stage; and (v) setation of the antennule, coxal endite of maxilla, and exopod of second maxilliped in the megalopa. All these characters support the recent generic status of Maguimithrax within the Mithracidae. Additional morphological details, not available previously, are provided. This study will provide support for conservation strategies in this species.

A Simplified Point-of-Care Lung Ultrasound Protocol to Detect Coronavirus Disease 2019 in Inpatients: A Prospective Observational Study

Objectives: To assess the diagnostic performance of lung point-of-care ultrasound (POCUS) compared to either a positive nucleic acid test (NAT) or a COVID-19-typical pattern on computed tomography (CT) and to evaluate opportunities to simplify a POCUS algorithm. Methods: Hospital-admitted adult inpatients with (1) either confirmed or suspected COVID-19 and (2) a completed or ordered CT within the preceding 24 hours were recruited. Twelve lung zones were scanned with a handheld POCUS machine. POCUS, CT, and X-ray (CXR) images were reviewed independently by blinded experts. A simplified POCUS algorithm was developed via machine learning. Results: Of 79 enrolled subjects, 26.6% had a positive NAT and 31.6% had a CT typical for COVID-19. The receiver operator curve (ROC) for a 12-zone POCUS protocol had an area under the curve (AUC) of 0.787 for positive NAT and 0.820 for typical CT. A simplified four-zone protocol had an AUC of 0.862 for typical CT and 0.862 for positive NAT. CT had an AUC of 0.815 for positive NAT; CXR had AUCs of 0.793 for positive NAT and 0.733 for typical CT. Performance of the four-zone protocol was superior to CXR for positive NAT (p=0.0471). Using a two-point cutoff system, the four-zone POCUS protocol had a sensitivity of 0.920 and 0.904 compared to CT and NAT, respectively, at the lower cutoff; it had a specificity of 0.926 and 0.948 at the higher cutoff, respectively. Conclusion: POCUS outperformed CXR to predict positive NAT. POCUS could potentially replace other chest imaging for persons under investigation for COVID-19.

Children with Kawasaki disease or Kawasaki-like syndrome (MIS-C/PIMS) at the time of COVID-19: are they all the same? Case series and literature review

Since the coronavirus disease 2019 (COVID-19) outbreak started, children have been considered marginally involved compared to adults, with a quite significant percentage of asymptomatic carriers. Very recently, an overwhelming inflammatory activation, which shares clinical similarities with Kawasaki disease (KD), has been described in children exposed to COVID-19. We report three KD-like cases that occurred during the pandemic of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in a highly affected area of Northern Italy. The clinical presentation was characterized by the presence of unremitting fever, diarrhea and elevated inflammatory markers. Case #1 and Case #2 occurred one week apart and shared other clinical features: laboratory tests confirmed COVID-19 exposure and high inflammatory activation with myocardial involvement. Case #3 followed a more typical pattern for KD. Interestingly, this patient showed lower levels of procalcitonin, C-reactive protein, D-dimers, and ferritin compared to the other two cases, whereas platelet count was higher. We hypothesize that SARS-CoV-2 might act in children as a trigger, either inducing a classical KD phenotype or causing a systemic inflammatory response leading to a severe KD-like phenotype, eventually characterized by myocardial impairment. We think that bringing these cases and their differences to the attention of the rheumatology community during the COVID-19 pandemic will be beneficial in order to highlight the importance of early diagnosis and to increase awareness of this new phenomenon.