Extensive outbreak of colistin resistant, carbapenemase (blaOXA-48, blaNDM) producing Klebsiella pneumoniae in a large tertiary care hospital, India

Background Extensive drug resistance in Klebsiella pneumoniae (K. pneumoniae) causing major outbreaks in large hospitals is an emerging challenge. We describe a near fatal outbreak of colistin resistant, carbapenem resistant K. pneumoniae (CRKp) producing metallo beta-lactamases (blaNDM) and blaOXA-48 in the neonatal intensive care unit (NICU) at the background of a larger outbreak involving multiple parts of the hospital and the challenges in its containment. Methods Following identification of an outbreak due to colistin resistant CRKp between April to June 2017 in the NICU, a thorough surveillance of similar cases and the hospital environment was performed to trace the source. All the isolated K. pneumoniae were tested for susceptibility to standard antibiotics by disc diffusion and microbroth dilution methods. Molecular detection of extended spectrum beta lactamases (ESBLs) and carbapenemases (classes A, B, D) genes was done. Enterobacterial repetitive intergenic consensus (ERIC) PCR and multi-locus sequence typing (MLST) was done to determine the genetic relatedness of the isolates. Characteristics of different sequence types were statistically compared (Student’s t-test). Results A total of 45 K. pneumoniae isolates were studied from NICU (14 cases of neonatal sepsis), ICU (18 cases), other wards (7 cases) along with 6 isolates from hospital environment and human colonizers. The primary case was identified in the ICU. All the K. pneumoniae from NICU and 94.4% from the ICU were colistin resistant CRKp. Majority (59.37% and 56.25%) harbored blaSHV/blaCTXM and blaOXA-48 genes, respectively. Two distinct sequence types ST5235 and ST5313 were noted with colistin resistance, distribution within the NICU and mortality as significant attributes of ST5235 (p < 0.05). The outbreak was contained with strengthening of the infection control practices and unintended short duration closure of the hospital. Conclusion Large hospital outbreaks with considerable mortality can be caused by non-dominant clones of colistin resistant CRKp harboring blaOXA-48 and blaNDM carbapenemases in endemic regions. The exact global impact of these sequence types should be further studied to prevent future fatal outbreaks.

Investigation of a Limited but Explosive COVID-19 Outbreak in a German Secondary School

The role of schools as a source of infection and driver in the coronavirus-pandemic has been controversial and is still not completely clarified. To prevent harm and disadvantages for children and adolescents, but also adults, detailed data on school outbreaks is needed, especially when talking about open schools employing evidence-based safety concepts. Here, we investigated the first significant COVID-19 school outbreak in Hamburg, Germany, after the re-opening of schools in 2020. Using clinical, laboratory, and contact data and spatial measures for epidemiological and environmental studies combined with whole-genome sequencing (WGS) analysis, we examined the causes and the course of the secondary school outbreak. The potential index case was identified by epidemiological tracking and the lessons in classrooms with presumably high virus spreading rates and further infection chains in the setting. Sequence analysis of samples detected one sample of a different virus lineage and 25 virus genomes with almost identical sequences, of which 21 showed 100% similarity. Most infections occurred in connection with two lesson units of the primary case. Likely, 31 students (12–14 years old), two staff members, and three family members were infected in the school or the typical household. Sequence analysis revealed an outbreak cluster with a single source that was epidemiologically identified as a member of the educational staff. In lesson units, two superspreading events of varying degrees with airborne transmission took place. These were influenced by several parameters including the exposure times, the use of respiratory masks while speaking and spatial or structural conditions at that time.

Estimating the transmissibility of SARS-CoV-2 VOC 202012/01 in Japan using travel history information

<abstract> <p>Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), has rapidly spread across the globe. The variant of concern (VOC) 202012/01 (B.1.1.7, also known as the alpha variant) bearing the N501Y mutation emerged in late 2020. VOC 202012/01 was more transmissible than existing SARS-CoV-2 variants and swiftly became dominant in many regions. More than 150 cases of VOC 202012/01 were reported in Japan by 26 February 2021. During the very early stage of introduction, only a subset arose from domestic transmission. If the reproduction number <italic>R</italic> (i.e., the average number of secondary transmission events caused by a single primary case) is greater than 1, the corresponding proportion should converge to 1 in a short period of time, and thus it is critical to understand the transmissibility of VOC 202012/01 based on travel history information. The present study aimed to estimate <italic>R</italic> of VOC 202012/01 using overseas travel history information. A mathematical model was developed to capture the relationship between travel history and <italic>R</italic>. We obtained travel history data for each confirmed case of VOC 202012/01 infection from 26 December 2020 to 26 February 2021. Maximum likelihood estimation was used to estimate <italic>R</italic>, accounting for right censoring during real-time estimation. In the baseline scenario, <italic>R</italic> was estimated at 2.11 (95% confidence interval: 1.63, 2.94). By 26 February 2021, an average of nine generations had elapsed since the first imported case. If the generation time of VOC 202012/01 was assumed to be longer, <italic>R</italic> was increased, consistent with estimates of <italic>R</italic> from case data. The estimated <italic>R</italic> of VOC 202012/01 in Japan exceeded 1 on 26 February 2021, suggesting that domestic transmission events caused a major epidemic. Moreover, because our estimate of <italic>R</italic> was dependent on generation time and ascertainment biases, continuous monitoring of contact tracing data is crucial to decipher the mechanisms of increased VOC 202012/01 transmissibility.</p> </abstract>

Pharmacological Potential of Natural Herbs against Covid-19: A Review

The unknown coronavirus has been unfold all over within the world. The primary case was declared in Dec 2019, and this coronavirus malady has become a virulent disease. Infection of this virus is directly attacked on the system of the flesh or animals. Nowdays there’s a deficiency of correct management or vaccinum out there to stop this malady that principally attacks the system of body. Hindrance is healthier than cure. This term is extremely renowned to any or all people. Thus currently this time has come back to used for our savings of lives. Ayurveda is the ancient system of drugs which is originated in India. During this covid -19 amount boosting of our system is that the excellent thanks to fight against this corona virus. Many seasoning plants unit accessible in our shut that unit used for immunity boosting throughout Covid 19. Some seasoning plants like Tinospora cordifolia, Withania somnifera, Nyctanthes arbortristis that unit commonly used for immunity boosting. This herb contains compounds like glycosides, steroids, diterpenoid lactones, alkaloids, steroidal lactone,etc. vary of research unit accessible on Tinospora cordifolia, Ashwagandha, and Nyctanthes arbortristis to prove its immunomodulatory activity, anti-oxidant activity, anti- inflammatory activity, anti-pyretic activity. Throughout this general review we’ve a bent to targated on the role, drugs activities of Tinospora cordifolia, Withania somnifera, Nyctanthes arbortristis to prevention and treatment of COVID 19 or CORANA VIRUS infection.

Digital Pathology Using Primary Case Sign-Out

The applicability of the identified findings and the potential impact on patient outcomes for any individual diagnostic setting was unclear. In the majority of the identified studies, the authors reported diagnostic accuracy and clinical utility outcomes that supported digital pathology systems as a valuable diagnostic modality, comparable to conventional microscopy. These studies lacked statistical power calculations, making the accuracy of these statements unclear. One systematic review and 1 diagnostic study reported clinical utility outcomes of digital pathology. This evidence supported digital pathology using primary case sign-out for accurate prognosis of patient outcomes; however, the clinical utility compared to conventional microscopy was unclear in the identified evidence. One systematic review and 13 diagnostic cohort studies reported on the diagnostic accuracy of whole slide image (WSI). The identified outcomes indicated that WSI is a valuable diagnostic modality; however, a large range of diagnostic accuracy in different settings, and a lack of clear statistical power in all studies make comparator conclusions to conventional microscopy unclear. One systematic review and 4 diagnostic cohort studies reported diagnostic areas that can present challenges for a digital pathology implementation, the most common being the interpretation and grading of dysplasia. One identified systematic review stressed the importance of whole-system validation to identify strengths and weaknesses of specific digital pathology implementations. The range of diagnostic accuracy across studies also indicated that implementation of digital pathology primary case sign-out systems is associated with unclear diagnostic accuracy until appropriately validated. No relevant cost-effectiveness evidence for digital pathology using primary case sign-out was identified.

A Model of Spectral Line Broadening in Signal Forecasts for Line-intensity Mapping Experiments

Line-intensity mapping observations will find fluctuations of integrated line emission are attenuated by varying degrees at small scales due to the width of the line emission profiles. This attenuation may significantly impact estimates of astrophysical or cosmological quantities derived from measurements. We consider a theoretical treatment of the effect of line broadening on both the clustering and shot-noise components of the power spectrum of a generic line-intensity power spectrum using a halo model. We then consider possible simplifications to allow easier application in analysis, particularly in the context of inferences that require numerous, repeated, fast computations of model line-intensity signals across a large parameter space. For the CO Mapping Array Project and the CO(1–0) line-intensity field at z ∼ 3 serving as our primary case study, we expect a ∼10% attenuation of the spherically averaged power spectrum on average at relevant scales of k ≈ 0.2–0.3 Mpc−1 compared to ∼25% for the interferometric Millimetre-wave Intensity Mapping Experiment targeting shot noise from CO lines at z ∼ 1–5 at scales of k ≳ 1 Mpc−1. We also consider the nature and amplitude of errors introduced by simplified treatments of line broadening and find that while an approximation using a single effective velocity scale is sufficient for spherically averaged power spectra, a more careful treatment is necessary when considering other statistics such as higher multipoles of the anisotropic power spectrum or the voxel intensity distribution.

Increased transmissibility of SARS-CoV-2 lineage B.1.1.7 by age and viral load

New lineages of SARS-CoV-2 are of potential concern due to higher transmissibility, risk of severe outcomes, and/or escape from neutralizing antibodies. Lineage B.1.1.7 (the Alpha variant) became dominant in early 2021, but the association between transmissibility and risk factors, such as age of primary case and viral load remains poorly understood. Here, we used comprehensive administrative data from Denmark, comprising the full population (January 11 to February 7, 2021), to estimate household transmissibility. This study included 5,241 households with primary cases; 808 were infected with lineage B.1.1.7 and 4,433 with other lineages. Here, we report an attack rate of 38% in households with a primary case infected with B.1.1.7 and 27% in households with other lineages. Primary cases infected with B.1.1.7 had an increased transmissibility of 1.5–1.7 times that of primary cases infected with other lineages. The increased transmissibility of B.1.1.7 was multiplicative across age and viral load.

Supply chain strategy in the luxury fashion industry: impacts on performance indicators

PurposeThe purpose of this paper was to investigate what types of supply chain strategies (SCS) are implemented within luxury fashion companies, according to the drivers that regulate competitiveness in this sector (brand positioning, distribution channel, type and line of product). Moreover, the objective was to define which key performance indicators (KPIs) should be measured according to the chosen strategy, and finally to evaluate the alignment of luxury fashion companies with the proposed indicators.Design/methodology/approachThe literature review was the first step performed. Thereafter, a case study was conducted and the sample, composed of six companies, was selected, a questionnaire was then developed to guide the interviews, after which the data were collected. From the data, a primary case analysis was conducted, from which cross-case patterns were also researched.FindingsFrom the results obtained, it was possible to state that companies involved in the case study adopted different SCS within the same company according to the drivers that regulate the sector competitiveness. As a result, the product line was shown to be the only driver that affected both the alignment between the expected and implemented SCS, respectively, and the alignment with the selected KPIs.Originality/valueThe paper provides valuable insights to companies that are trying to align SCS and KPIs. The close link between these aspects had not yet been explored previously. In particular, there were no indications about the KPIs that have to be measured for a specific SCS.

Educating to belong: Policy and practice of mother-tongue instruction for migrant students in the Danish welfare state

This article explores how the development of mother-tongue instruction (MTI) policies in the Danish welfare state have created varying notions of difference and sameness in the schooling of migrant students and how they experience these notions locally in practice. Based on an analysis of MTI’s policy history and oral history interviews with former migrant students, we analyse MTI policy development within the Danish welfare state as a primary case and discusses whether these developments seem to be unique to the Danish welfare state by considering (West) Germany, the Netherlands and Sweden as a comparative perspective. Noting the paradoxes and dynamics of the welfare-state policy of ‘school for all under one roof’ at the intersections between the policy and practice level, we posit that migrant students are regulated as a homogeneous group that is expected to be ‘the same’ but is simultaneously considered to be ‘different’ from other, majority students. The findings thus reveal the paradox of welfare-state education policies and practice: while macro scale policy for migrant education aims to emphasise difference through MTI, the social consequences at the micro level show the opposite; namely, that MTI produces feelings of sameness and belonging among migrant students.

DEVELOPING PARASITIC ARCHITECTURE AS A TOOL FOR PROPAGATION WITHIN CITIES

The term ‘parasitic architecture’ is an overused, and misunderstood buzzword within the architectural and urban planning community. By breaking down, through case study, how a space is developed and evolves, reclassification of architectural parasites is possible. Focusing on how parasitic architecture has produced urban growth and development of community within Tokyo as the primary case study, the reclassification is based in pre-existing architectural development and the nature of actual, living parasites. This reclassification of architectural parasite produces three separate types of parasite; the ‘structured,’ ‘symbiotic’ and the ‘hyper transient.’ Through the use of redefinition and reclassification, parasites in an architectural or urban planning context are then able to be manipulated as a tool for propagation within the existing built environment. Space within cities and megacities are becoming more of a commodity, so by utilising these new parasitic tools, it is possible to manipulate space to allow for an increase in urban growth, whilst still being flexible enough to fit into pre-existing planning legislation globally.