Editor’s Note: This story was updated Jul 21, 2017, with comments from Tina Tan, MD, MPH, New Jersey state epidemiologist.In June 2016, the US Centers for Disease Control and Prevention (CDC) issued a clinical alert about an emerging multidrug-resistant fungus causing serious and frequently deadly invasive infections in healthcare settings around the world. The warning was intended as a message to healthcare providers to keep an eye out for Candida auris, which at that point had been found in only a handful of US patients.More than a year later, the CDC has identified 98 clinical C auris infections in nine states, some of them dating back to 2013, and the fungus has been isolated from an additional 110 patients. That’s not a lot, but it’s more than CDC officials wanted to see.”We were really hoping it wasn’t here yet, to be honest with you,” Tom Chiller, MD, MPHTM, chief of the Mycotic Diseases Branch at the CDC, said in an interview.Gaining hospital footholdsCandida infections are not uncommon in US hospitals, and they’re often associated with high morbidity and mortality. But C auris is different, and it doesn’t act like a “typical Candida,” Chiller said. Most Candida infections are isolated incidents that occur in patients who carry the yeast in their gut. But what Chiller had learned from his conversations with colleagues in countries like Pakistan and the United Kingdom was that C auris was being transmitted in hospitals.”That’s what caused us to put out the alert,” Chiller said. “That was enough evidence to push us over the edge and say, ‘yeah, this is definitely a hospital-transmitted organism.'”So far, C auris appears to be following that pattern in the United States, with clear indications of hospital transmission. While six states have reported only one clinical case, New York and New Jersey have reported 68 and 20, respectively, and whole-genome sequencing has revealed that the isolates within each state appear highly related to one another. Furthermore, the epidemiology indicates that many of the New York and New Jersey patients had overlapping stays at interconnected long-term–care facilities and acute care hospitals.”To say that transmission is occurring in these settings is definitely the case,” Chiller said.That’s confirmed by Tina Tan, MD, MPH, New Jersey state epidemoliogist. “Among our cases…what we’re commonly seeing is that there has been healthcare exposure,” Tan said in an interview.Hospital transmission is occurring because C auris likes to stay on skin and is hard to kill when it gets on hospital surfaces. And once it gets into a healthcare facility, it tends to stay. “It’s a lot more challenging once it’s got a foothold,” Chiller said.But what’s not clear is exactly how the fungus is being transmitted, whether patients are acquiring it from hospital bedding or bed rails, for example, or from healthcare workers who’ve had contact with infected or colonized patients. “We know those are all ways in which typical hospital bacteria is transmitted, so we’re tackling them all,” Chiller added.In response, the CDC is recommending that all infected or colonized patients be placed in a single-patient room under standard and contact precautions, and that those rooms are disinfected daily. The agency also recommends screening close contacts of C auris patients for potential colonization and informing receiving healthcare facilities when an infected or colonized patient is being transferred.Tan said her department is also focusing on opportunities to improve and reinforce hand hygiene in affected facilities, not only among staff but also among patients and visitors. “That’s really important as well, to ensure that visitors are aware of some of the considerations related to infection control and hand hygiene,” she said. Concerns over high resistanceCDC investigators have also found worrisome evidence of another trend seen in international C auris cases—resistance to the three major classes of antifungals used to treat Candida infections.In the May 19 Morbidity and Mortality Weekly Report (MMWR), investigators reported that antifungal susceptibility tests of the first 35 clinical isolates showed that 86% were resistant to fluconazole, 43% were resistant to amphotericin B, and 3% were resistant to echinocandins.Chiller called the evidence of multidrug resistance “super concerning.”Preventing spillover to healthier populationsAlso unclear is just how deadly the fungal pathogen is. C auris, which was originally identified in the ear of a patient in Japan in 2009, can cause serious invasive infections that affect the bloodstream, heart, brain, ear, and bones, and Chiller said the mortality rate has been high. But to this point, the cases have involved patients with multiple underlying health conditions, which makes it difficult to know whether the infection is killing patients.”These patients are very complicated, so it’s hard to tease apart,” Chiller said. “A lot of the times they’re sick with other things, and then they get Candida auris on top of that.”A CDC fact sheet estimates that more than 1 in 3 patients with invasive C auris infection die. But Chiller said that a recent review by colleagues in Pakistan of 100 candidemia patients indicated that at least half died from the infection. In addition, some of the patients were relatively healthy. The spread of C auris into healthier populations is a scenario Chiller is hoping to prevent in US hospitals.”We want to keep it a rare infection,” he said. “I’m just concerned that if it spills over into the general realm of Candida infections, like it has in some of these other countries, then we are dealing with the potential for a highly resistant bug to really take off.” See also:Jul 17 CIDRAP News story “CDC reports uptick in Candida auris cases”May 19 MMWR Notes from the Field
THREE-MAN access platforms designed and built by LH Access Technology can be demounted from Mercedes-Benz Unimog road-rail vehicles when not in use, allowing the host chassis to be used with alternative equipment.The platform has a working height of 10m with a reach of 7m; it can carry up to 350 kg and rotate through 360í. The modular design enables the access platform to be securely fitted to the U400 chassis using twist locks, which permit rapid removal. The vehicles are designed to work in tandem with a Unimog 4 tonne drum carrier. LH Access Technology is currently developing demountable legs which will enable the access module and drum carrier to be swapped without using lifting equipment. On November 9 Network Rail took delivery of the last of 12 of the vehicles which it had ordered for use on the UK rail network.LH Access Technology, UK
178 Views no discussions Share Share Share Tweet Sharing is caring! LocalNews Book penned in honor of Nathalie Murphy by: Dominica Vibes News – December 4, 2015 President Charles Savarin receives a copy of the book from Mrs MurphyA book has been penned in honor of the Executive Director of the Dominica Association of Persons with Disabilities (DAPD), Nathalie Murphy.The book, entitled ‘Treasure In Our Midst’ was written by Roman Catholic Priest, Reverend Father Clement Jolly. It was launched during a ceremony to mark International Day for People with Disabilities on Thursday 3 December 2015 at the DAPD’s headquarters in Goodwill.Fr Jolly said the story of persons with disabilities has been a very long and painful one, particularly the visually challenged, who have suffered terribly. “At first they were treated as sub-human beings, people to be despised, to be shunned and at best to be pitied. They were often made to live a life alone. Later in the west, particularly under the influence of Christianity, some care and assistance was given to them. Even so, they were marginalized and isolated. They were made to live a life away from other people.” Author of ‘Treasure In Our Midst’, Father Clement JollyFr Jolly described Mrs. Murphy as being a light and blessing to Dominica and the rest of the world. “We seem to ignore the fact that there are things greater than material achievement. What shines out in Nathalie, is first of all self-mastery and self-conquest. To my mind, she has done more than to climb Mount Everest, or swim across the English Channel; she has given us a true display of self-conquest and has done it brilliantly”.Mrs. Murphy said she felt “real honoured” for the auspicious occasion. “I want in particular to extend my profound thanks and appreciation to Fr Clement Jolly for taking on this project and writing the book so that others out there will know about some of the things that have happened to me over the years”. She noted that the book is very interesting with a lot of information covering the history of blindness.Copies of the Book can be purchased at the DAPD’S office on Canal Lane, Goodwill.
Car Rental Market According to a new report published by Allied Market Research, titled, Car Rental Market: Global Opportunity Analysis and Industry Forecast, 2014 – 2022, the global car rental market was valued at $79,648 million in 2015, and is expected to reach $164,335 million by 2022, growing at a CAGR of 11.6% during the forecast period. The economical car segment is anticipated to dominate the market throughout the analysis period. North America accounted for approximately 40% share of the global market in 2015.Access Full Summary at :https://www.alliedmarketresearch.com/car-rental-market With growth in pollution level and population, the car rental industry has experienced a drastic transformation over the past few years, and is one of the most prominent industries in fleet transportation. Manufacturers and consumers rely on different car rental schemes, which are cost-effective. In addition, car rentals are majorly contributing to curb the pollution level of the atmosphere by reducing the volumetric sales of owned vehicles. Moreover, with increase in air traffic and growth in rise in trend of online booking in travel industry, car rentals are the preferred options to travel, as cars are the most economical and faster mode of transportation. These advantages are promoting the growth of the car rental industry at an exponential rate.By the type of car, the car rental market is categorized into luxury car, executive car, economical car, sports utility vehicle (SUV), and multi utility vehicle (MUV). The economical car segment accounted for the highest revenue in 2015, is anticipated to grow at a CAGR of 12.5%, owing to high rate of adoption of economy cars in the emerging economies of Asia-Pacific and LAMEA.By rental category, the car rental market is befitted into on-airport and off-airport. The off-airport category is further divided into local usage, outstation, and others. In 2015, the off-airport rental category segment accounted for over 61% of the market share, and is anticipated to register a CAGR of 12.0%. This is attributed to the development of travel industry and rise in disposable income globally. The outstation off-airport rental category is anticipated to witness fastest growth, registering a CAGR of 12.8%, due to improvement in road infrastructure globally.Furthermore, North America accounted for the highest revenue in 2015, and is anticipated to grow at a CAGR of 8.8%, owing to the rise in disposable income of people in countries such as the U.S. and Canada. Asia-Pacific is projected to grow at the highest CAGR of 16.5% owing to high rate of adoption of economy and executive cars.Key Findings of the Car Rental MarketIn 2015, the economical car segment led the overall car rental market, generating revenue of $22,802 million in 2015, and is estimated to grow at a CAGR of 12.5%.Off-airport rental category is anticipated to grow at the highest CAGR of 12.0% during the forecast period.In 2015, the local usage segment led the off-airport market, accounting for $19,073 million, and is expected to lose the highest market share to outstation off-airport rental category in 2019.North America led the market, generating revenue of $32,248 million in 2015, and is projected to grow at a CAGR of 8.8%.Asia-Pacific is anticipated to take over the major market share post 2017, owing to the rise in sales of vehicles.The key players operating in the market include Avis Budget Group, Inc., Carzonrent India Pvt Ltd., Enterprise Holdings Inc., Europcar, The Hertz Corporation, Sixt Rent a Car, Uber Technologies Inc., Localiza, Eco Rent a Car, Budget Rent a Car System, Inc., German Rent a Car, Tempest Car Hire, DTG Operations, Inc., and Alamo.Request Sample Report: https://www.alliedmarketresearch.com/request-sample/2073About Us:Allied Market Research provides global enterprises as well as medium and small businesses with unmatched quality of “Market Research Reports” and “Business Intelligence Solutions.” AMR has a targeted view to provide business insights and consulting to assist its clients to make strategic business decisions and achieve sustainable growth in their respective market domain.We are in professional corporate relations with various companies and this helps us in digging out market data that helps us generate accurate research data tables and confirms utmost accuracy in our market forecasting. Each and every data presented in the reports published by us is extracted through primary interviews with top officials from leading companies of domain concerned. Our secondary data procurement methodology includes deep online and offline research and discussion with knowledgeable professionals and analysts in the industry.Contact:Dhananjay Potle5933 NE Win Sivers Drive#205, Portland, OR 97220United StatesToll Free: +1-800-792-5285UK: + 44-845-528-1300Hong Kong: + 852-301-84916India (Pune): +91 20 66346060Fax: +1⟨855⟩email@example.comWeb: https://www.alliedmarketresearch.com