advertisement Trending Videos We encourage all readers to share their views on our articles using Facebook commenting Visit our FAQ page for more information. RELATED TAGSCadillacSedanLuxuryLuxury CarsLuxury VehiclesNew Vehicles2020Cadillacct4v-series Cadillac’s super-smart Super Cruise finds even more roadsThese PR photos show a set of analog gauges bookending a TFT screen as in the XT5 and XT6. It would be nice for Cadillac to offer something like Audi’s Virtual Cockpit, something which may happen with the arrival of Super Cruise. Buy It! Princess Diana’s humble little 1981 Ford Escort is up for auction An engagement gift from Prince Charles, the car is being sold by a Princess Di “superfan” ‹ Previous Next › The Rolls-Royce Boat Tail may be the most expensive new car ever The 2020 CT4 will be available for ordering later this year. COMMENTSSHARE YOUR THOUGHTS The CT4’s profile is decidedly rear-wheel-drive, with a good dash-to-axle ratio creating a long proboscis. “We developed CT4 to appeal to youthful buyers in the luxury market who may be new to the Cadillac brand,” said Andrew Smith, executive director of global Cadillac design.Three trims, in addition to the V, will be offered at launch: Luxury, Premium Luxury and Sport. The latter will have darker accents and performance-inspired details like unique fascias while the others are going to ladle on the chrome in varying amounts.Sport and V-Series models will have Brembo-branded front brakes, while rear-drive Vs will have GM’s trick Magnetic Ride Control. All-wheel-drive will be available in Canada on all models. Available Continental self-sealing tires are said to be a segment-first, and the company says Super Cruise is going to be available in the 2020 calendar year.CT4’s interior will look familiar to anyone who’s been inside a Cadillac in the last year, with a tablet-style 8-inch infotainment system that is appended by twin physical knobs (thank you, Cadillac) and two rows of buttons for ventilation and other controls.RELATED PlayThe Rolls-Royce Boat Tail may be the most expensive new car everPlay3 common new car problems (and how to prevent them) | Maintenance Advice | Driving.caPlayFinal 5 Minivan Contenders | Driving.caPlay2021 Volvo XC90 Recharge | Ministry of Interior Affairs | Driving.caPlayThe 2022 Ford F-150 Lightning is a new take on Canada’s fave truck | Driving.caPlayBuying a used Toyota Tundra? Check these 5 things first | Used Truck Advice | Driving.caPlayCanada’s most efficient trucks in 2021 | Driving.caPlay3 ways to make night driving safer and more comfortable | Advice | Driving.caPlayDriving into the Future: Sustainability and Innovation in tomorrow’s cars | Driving.ca virtual panelPlayThese spy shots get us an early glimpse of some future models | Driving.ca See More Videos Trending in Canada Underscoring its assertion a brand needn’t live on SUVs alone, Cadillac today introduced the new 2020 CT4 sedan. This means there will be a trio of sedans in the company’s showroom, with this machine being the smallest of the three.Built on rear-drive architecture, the way nature and Alfred Sloan intended, the Cadillac CT4 will offer a selection of turbocharged engines.A 2.0-litre turbo is the standard engine, cranking out 237 horsepower and 258 lb.-ft. of torque. It is mated to an eight-speed automatic. Caddy says new V-Series’ horsepower is lower because drivers were ‘intimidated’ Further up the options sheet is a 2.7-litre turbo, whose estimated power is a sprightly 309 ponies and 348 lb.-ft. of twist in the Premium Luxury model. Alert readers will note this engine is related to the 325-horsepower engine found in the CT4-V. Ten cogs inhabit the automatic lashed to this mill. Created with Raphaël 2.1.2Created with Raphaël 2.1.2Cadillac Created with Raphaël 2.1.2Created with Raphaël 2.1.2Cadillac Created with Raphaël 2.1.2Created with Raphaël 2.1.2Cadillac Created with Raphaël 2.1.2Created with Raphaël 2.1.2Cadillac Created with Raphaël 2.1.2Created with Raphaël 2.1.2Cadillac Created with Raphaël 2.1.2Created with Raphaël 2.1.2Cadillac
Homepage BannerNews WhatsApp WhatsApp Pinterest Publicans in Republic watching closely as North reopens further Google+ Twitter Nine til Noon Show – Listen back to Monday’s Programme Pinterest RELATED ARTICLESMORE FROM AUTHOR Community Enhancement Programme open for applications Facebook Renewed calls for full-time Garda in Kilmacrennan Arranmore progress and potential flagged as population grows Previous articleSearches carried out in Derry as part of investigation into dissident activityNext articleMain Evening News, Sport and Obituaries Tuesday February 9th News Highland Loganair’s new Derry – Liverpool air service takes off from CODA Twitter By News Highland – February 9, 2021 A man wanted in the UK on multiple bestiality charges has appeared before the High Court in Dublin after being arrested in Co Donegal yesterday.Oliver Lown, a former vet with an address at Main Road, Kesgrave in Suffolk, England, is also accused of possessing extreme pornographic material.Sergeant Jim Kirwan from the Garda Extradition Unit gave evidence of calling to an address near Letterkenny, Co Donegal just after 6.30pm yesterday evening.He identified the man who answered the door as the same man who was brought before the High Court this afternoon.He told Mr J Paul Burns that he introduced himself as “Ollie Fraser Henderson” – an alias allegedly used by Oliver Lown, according to the warrant he had in his hand.The court heard there was no dispute in relation to his identification.Mr Lown is wanted in the UK for twelve offences relating to material found on a laptop in April 2019.Among the charges he’s facing are allegations of sexual activity with live animals as well as possession of extreme pornography and indecent images of children.There was no application for bail today.Mr Lown was informed of his right to consent to the extradition if he so wishes. If he chooses to fight it, a full hearing will be heard later this month. Former vet arrested in Donegal appears in court on bestiality charges Facebook Google+
carlballou/iStockBy MARK OSBORNE and MATT FOSTER, ABC News(MEIGS COUNTY, Tenn.) — At least two people have been killed in a school bus accident in Meigs County, Tennessee, according to officials.The bus, which was carrying school children home for the day, crashed into a utility service vehicle on Highway 58 in Decatur, about an hour northeast of Chattanooga, according to the Tennessee Highway Patrol.The Tennessee Highway Patrol said at least two people were killed, though it offered no specifics on whether they were students or adults.The Tennessee Department of Education said in a statement that multiple lives were lost in the accident.“I and the entire staff at the Tennessee Department of Education are deeply saddened to hear about the fatal bus crash in Meigs County earlier this afternoon. No words can express our sympathies for those lives that were lost,” Tennessee Education Commissioner Penny Schwinn said in a statement. “We send our deepest condolences to the students, families, school staff and leaders, district staff and the entire Meigs County community affected by this tragic accident and wish healing for all those injured. The department has communicated with district leaders and staff in Meigs County and surrounding areas and is mobilizing to support this community in safety response and services.”Meigs County Board of Education said all parents had been contacted and were either reunited with their children or taken to area hospitals.“I’m deeply saddened to hear the news coming out of Meigs County this evening about a serious school bus crash,” Chattanooga Mayor Andy Berke said in a statement on Twitter. “My thoughts are with these children and their families. Until we have more information, we will hope for the best and keep them in our prayers.”This is a developing story. Check back for updates.Copyright © 2020, ABC Audio. All rights reserved.
This content is for subscribers only.Subscribe Now Almost 50,000 retail stores have closed across the country, and the restaurant industry has lost $25 billion in sales since March 1, (Credit: Getty Images)April 1 is looming large for businesses and individuals across the country, as it marks the first major due date for expenses like rent, utilities and credit cards since governments imposed severe new restrictions over the coronavirus pandemic.About $20 billion in monthly retail real estate loans are due starting this week, according to the Wall Street Journal, citing data from Marcus & Millichap. Several stores and restaurants have already said they will not pay their rent for April, which in turn threatens the $3 trillion commercial mortgage market.Almost 50,000 retail stores have closed across the country, and the restaurant industry has lost $25 billion in sales since March 1, according to a National Restaurant Association survey. The Organization for Economic Cooperation and Development said Friday that economic activity in the United States and other developed countries could fall by as much as 25 percent.Fannie Mae and Freddie Mac have already said they will postpone foreclosures and offer deferrals on home mortgages. And the federal stimulus program passed last week includes $350 billion to help small businesses keep paying their employees and increases current unemployment benefits by $600 a week for four months.But many companies are still facing tough decisions as April 1 approaches.“Rent is due. Utilities are due. Credit card bills are due April 1,” Hadley Douglas, who runs the Boston liquor store The Urban Grape, told the Journal. “The deadline is looming large, and it is petrifying.” [WSJ] — Eddie SmallRead more about how coronavirus is impacting retailersNY restaurants, hotels warn of mass layoffs as US sees record jobless claimsNYC’s top chefs, restaurants are cooking up universal terms for financial reliefBar-maggedon: NYC restaurants, landlords grapple with shutdownWith curfews and public assembly restrictions, what will happen to malls?For US retailers, coronavirus concerns come home. What are their options?
Things didn’t go the way fans might have expected on the Reservation last season. Loss after loss piled up for the Port Neches-Groves football team with the only note of hope shining from the young players in the starting lineup.After the coaching staff decided to move away from spring workouts this year and wait for two-a-days in August, that left an even longer gap between the disappointing end of the 2012 campaign and when fans could see the first glimmers of the 2013 Indians appear.Luckily, there was a bridge from one season to another this summer in the form of the 7-on-7 football tournaments and games that the Indians participated in along with a number of local teams. Played without offensive or defensive linemen, with no blitzing and no running the ball, it’s a passer’s best friend. It was also just the tonic for quarterback Ky Walker, after the junior broke his hand minutes after making his first start under center for the Indians.“I’ve preferred this much better (than spring workouts),” Walker said. “We aren’t wearing pads in spring and we’ve cut down on injuries a little bit, which I like. As far as 7-on-7 goes, this is one of my favorite parts of preparation. It’s basically what I do without the pressure of a d-line. It’s fun. It’s just coming out here and having a good time.”The Indians ended their 7-on-7 season on Tuesday, playing in a bi-weekly scrimmage against area teams like Hamshire-Fannett, Little Cypress-Mauriceville and Beaumont West Brook. PN-G played in two different state qualifying tournaments, making the semifinals in Lufkin. “The preparation is important, but it’s also about the team bonding with your receivers. My recievers are at my house every night. We just like being together. It’s awesome.”That experience with teammates is exactly what should help junior running back Brant Halfin. Last season, Halfin played for the JV as a sophomore, so the time bonding with his offensive skill position teammates is a great way to prepare for two-a-days.Even if the 7-on-7 experience isn’t always a great one for running backs.“We’re bonding better,” Halfin said. “Without pads you can’t do much. Our team is bonding and our chemistry is much better than it was last year. It’s just hard to do much without pads. You can’t block, which is what I’ll be doing a lot. You can’t run the ball. I just run normal pass routes, gos and flies, but I’m more of a decoy in this offense.”The 2013 season will open for PN-G and other teams that did not participate in spring workouts on August 5. However, only teams who make it to the finals of the qualifiers get tickets to the state tournament in Leander.“The one in Lufkin, we did really well,” Walker said. “We beat Atascocita, Lufkin and Tyler John Tyler. They were all very big schools. They were big, tall and fast. John Tyler reminded me a lot of West Orange-Stark. Personally, I think we have one of the best 7-on-7 teams around.”Because 7-on-7 isn’t an official event, coaches can’t instruct players at games. But, that doesn’t mean the timing and chemistry the team builds isn’t vitally important for the approaching season.“I can’t even stress how important this is,” Walker said. “Me and my friends are out here I don’t even know how often. Even if it’s just in the yard, we’re throwing. That preparation, that timing, the more you can prepare like that, the more it carries over to Friday nights.
Pinterest Share on Facebook Share Share on Twitter In a study published in PLOS One the team have proposed an entirely new approach to risk assessment for future violence. Previous approaches have relied on looking at risk factors that happen to be linked to, but may not cause, violence, for example, being young, male, of lower social class, with previous violent convictions.The new approach is instead based on identifying risk factors that have a clear causal link to violence, and include symptoms of major mental disorder, the patient’s living condition, and whether they are taking medication.Over 300 risk assessment instruments are currently used by psychiatrists, psychologists, and probation officers to assess the risks of violence and sexual offending among psychiatric patients, prisoners, and the general population. The authors say that producing risk assessment instruments has become an ‘industry’ and new ones are being produced annually. LinkedIn QMUL researchers found that none of these instruments have any advantage over those produced before and that their best predictions for future violence are incorrect 30 per cent of the time.First author Professor Jeremy Coid from QMUL’s Wolfson Institute of Preventative Medicine said: “Researchers have become too obsessed with predicting whether a patient will be violent in the future, rather than looking for the causes of why they become violent. While it is helpful to know that a patient has a high or low risk of being violent if you release them from hospital, this is not going to tell you what you should do to stop them being violent.”“It is more important to know which factors are causally related because these are the factors that must be the targets for future treatments and management interventions if the aim is to prevent violence happening in the future.”In the study, 409 male and female patients who were discharged from medium secure services in England and Wales were followed up after release into the community. They received assessments with two ‘state-of-the-art’ assessment instruments prior to release into the community, then after six and 12 months following discharge. Information on violence was gathered via individual case notes and a search of the police national computer.The team’s analysis suggests that the standard risk factors were poor in identifying who would be violent and who would not.When the researchers used a causal approach to confirm which risk and protective factors resulted in violence, the findings were very different. Symptoms of major mental disorder, the patients’ living condition, and whether they were taking medication, were highly important factors. The effects of violent thoughts, being in an unstable life situation, being under stress and unable to cope were also three to four times stronger using the causal model than using the traditional predictive approach.Professor Jeremy Coid added: “The future direction should be to identify risk factors that have causal relationships with violent behaviour and not those which predict violent behaviour. Risk factors, such as being young, male, of lower social class, with many previous violent convictions, may be good predictors, however, none of these factors are truly causal.” Email
Our weekly wrap-up of antimicrobial stewardship & antimicrobial resistance scansFDA urges hospitals to start using duodenoscopes with disposable partsThe US Food and Drug Administration (FDA) says it will now recommend that hospitals move away from using duodenoscopes with reusable parts because of concerns about patient infections that have been linked to cleaning issues.In a safety communication issued yesterday, the FDA said it’s recommending that hospitals and endoscopy facilities transition away from fixed endcap duodenoscopes, which are used to diagnose and treat conditions of the pancreas and bile ducts, to those with newer design features that “facilitate or eliminate the need for reprocessing.” The agency says it’s working with manufacturers to increase the supply of disposable cap duodenoscopes and encourage development of innovative device designs that reduce the risk of infection, and that it recognizes a full transition away from conventional duodenoscopes will take time.Fixed endcap duodenoscopes have been linked to a number of outbreaks of multidrug-resistant bacteria at US and European hospitals in recent years, including a January 2015 carbapenem-resistant Enterobacteriaceae outbreak that resulted in two deaths at a Los Angeles hospital. Because of the complex design of the devices, they can be difficult to clean and have been found to harbor dangerous bacteria that can be transmitted to other patients, even after being properly cleaned. The FDA issued a safety warning in 2015 and device manufacturers updated their cleaning instructions, but problems have persisted.Duodenoscopes are used in more than 500,000 endoscopic retrograde cholangiopancreatography procedures each year in the United States.The FDA said that, during the transition period, hospitals and endoscopy facilities should ensure that staff members are meticulously following duodenoscope reprocessing instructions, institute quality control programs that include sampling and microbiologic culturing, and develop schedules for routine inspection. The agency also noted that patients should be aware that the risk of infection from inadequate cleaning is relatively low, and that they should discuss the risks and benefits with their providers before cancelling or delaying planned procedures.Aug 29 FDA safety communication Oral omadacycline found non-inferior to linezolid for skin infectionsDrug maker Paratek Pharmaceuticals reported yesterday in The Lancet Infectious Diseases that and oral version of omadacycline—its FDA-approved antibiotic for community-acquired and pneumonia and skin infections—was found to be non-inferior to oral linezolid in adults with acute bacterial skin and skin-structure infection (ABSSSI).In the phase 3 OASIS 2 trial, which was funded by Paratek, eligible adults with ABSSSI at 33 US hospitals were randomly assigned to receive one dose of oral omadacycline or two doses of linezolid for 7 to 14 days. The primary end points were early clinical response (48 to 72 hours after the first dose) in the modified intention-to-treat (mITT) population, and investigator-assessed clinical response at post-treatment evaluation in the mITT population and clinically evaluable population. The non-inferiority margin was 10%.Overall, 735 participants were randomly assigned, with 368 receiving omadacycline and 367 receiving linezolid. The results showed that omadacycline (315 of 360, 88%) was non-inferior to linezolid (297 of 360, 83%) for early clinical response in the mITT population (percentage-point difference 5.0; 95% confidence interval [CI], −0.2 to 10.3). For investigator-assessed clinical response at post-treatment evaluation, omadacycline (303 of 360, 84%) was non-inferior to linezolid (291 of 360 81%) in the mITT population (percentage-point difference 3.3; 95% CI, −2.2 to 9.0) and in the clinically evaluable population (278 of 284 [98%] vs 279 of 292 [96%]; percentage-point difference, 2.3; 95% CI, −0.5 to 5.8).The safety analysis showed that at least one treatment-emergent adverse event occurred in 197 of 368 omadacycline patients (54%), compared with 137 of 367 linezolid patients (37%), and that mild-to-moderate nausea and vomiting were more frequent in omadacycline patients (111 of 368 [30%] and 62 of 368 [17%], respectively) than in linezolid patients (28 of 367 [8%] and 11 of 367 [3%], respectively).The authors of the study write, “Considering the substantial burdens associated with initial inpatient management of skin infections, oral omadacycline is a new once-daily option to treat ABSSSI that might be considered as an alternative to linezolid.”Aug 29 Lancet Infect Dis study Data show vancomycin-resistant Enterococcus faecium rising in GermanyData from the German Antimicrobial Resistance Surveillance System show a 43% increase in vancomycin-resistant Enterococcus faecium (VREF) in German hospitals, according to a new study in Antimicrobial Resistance and Infection Control.For the study, researchers from Germany’s Robert Koch Institute analyzed data from routine vancomycin susceptibility testing of 35,906 clinical E faecium isolates collected from 148 hospitals from 2012 through 2017. The analysis found that the proportions of E faecium isolates exhibiting resistance to vancomycin increased from 11.2% in 2014 to 26.2% in 2017. The rise in VREF proportions was primarily seen in southern Germany, increasing from 10.8% in southwest Germany and 3.8% in southeastern Germany in 2014 to 36.7% and 36.8% in 2017, respectively.Further analysis found that VREF proportions were considerably higher in isolates from patients aged 40 to 59 years compared with younger patients, and that E faecium samples collected in specialist care hospitals and prevention and rehabilitation care hospitals were more likely to be vancomycin resistant than those from secondary care hospitals (odds ratios: 2.4 [95% CI, 1.2 to 4.6] and 2.4 [95% CI, 1.9 to 3.0], respectively).The authors of the study note that similar VREF increases have been found in countries neighboring Germany, including Denmark, Belgium, Poland, and the Czech Republic.They conclude, “Continued surveillance and implementation of effective infection prevention and control measures accounting for local resistance differences are needed to reduce the spread of vancomycin-resistant E. faecium in German hospitals.”Aug 28 Antimicrob Resist Infect Control study Israeli study finds antibiotics overused in some end-of-life patientsOriginally published by CIDRAP News Aug 28A survey of Israeli physicians and analysis of patient data has found that antibiotics are overused in patients with end-of-life advanced directives, Israeli researchers reported today in Infection Control and Hospital Epidemiology.In the descriptive cross-sectional study, the researchers administered a questionnaire to 213 physicians at four acute care and two post-acute care hospitals and collected data on 932 of their patients, all of whom had died in the 4 months preceding the survey. The data included end-of-life patient diagnoses, medical treatment, antibiotic days of therapy (DOT), and consultations with infectious disease (ID) physicians. The survey contained questions on sociodemographic and organizational factors, physician knowledge, and burnout.Of the 932 deaths, 435 of 664 were end-of-life patients with advanced directives. The rate of most treatments in end-of-life patients with advanced directives was significantly lower than in those with no advanced directives, except for antibiotics and blood products.Of the end-of-life patients with advanced directives, 74% received antibiotics; 29.9% of those who received antibiotics had cultures with multidrug-resistant organisms, and antibiotics were discontinued in only 5%. Half of the physicians lacked knowledge concerning antibiotics use issues, and physicians caring for end-of-life patients with advanced directives had significantly fewer consultations with ID physicians (mean rate, 0.27) than those caring for patients without advanced directives (mean rate, 0.47).ID physicians reported significantly higher emotional exhaustion levels (mean rate, 29) than other medical specialties (mean rate, 19.2). Antibiotic DOT was significantly higher when patients had ID consultations (mean rate, 21.6) than in patients who did not (mean rate, 16.2). Antibiotic DOT was significantly higher in post–acute-care hospitals or geriatric wards than in other types of hospitals or wards.In light of the findings, the authors of the study recommend supplementing antibiotic stewardship guidelines in Israeli hospitals with guidance on end-of-life prescribing, adding simulation-based education to deal with end-of-life issues, and encouraging providers to consult with ID physicians. Aug 28 Infect Control Hosp Epidemiol abstract Vaccine for hypervirulent Klebsiella pneumoniae shows promise in miceOriginally published by CIDRAP News Aug 28A vaccine targeting hypervirulent strains of Klebsiella pneumoniae has shown early promise in mouse experiments, researchers from the Washington University School of Medicine in St. Louis and biotechnology start-up VaxNewMo reported yesterday in the Proceedings of the National Academy of Sciences.The bioconjugate vaccine was designed to target the two most common hypervirulent serotypes of K pneumoniae, K1 and K2, which account for 70% of hypervirulent K pneumoniae cases. While most K pneumonia infections occur in hospital patients with compromised immune systems, hypervirulent strains that cause invasive infections in otherwise healthy people are on the rise, and there have been increasing reports of hypervirulent, multidrug-resistant strains that are extremely difficult to treat. The researchers believe a vaccine against these strains could help avert a serious public health threat.In preclinical studies, the researchers tested the vaccine, which was produced using genetically modified Escherichia coli cells, in four groups of five mice each, with one group receiving a placebo. After three doses, they then infected the mice with K1 and K2 strains of K pneumoniae, using an amount of bacteria that had previously been shown to be lethal in mice.The results showed that 80% of the placebo-treated mice challenged with the K1 strain died, while only 20% of the vaccine-treated mice died. Of the mice infected with the K2 strain, 30% of those who received the placebo died, compared with none of the mice who received the vaccine. The vaccine was less successful when the mice were exposed to higher doses of the K1 strain, but the vaccinated mice still had a statistically significant increase in survival compared with the placebo group.”We are very happy with how effective this vaccine was,” study co-author Mario Feldman, PhD, a professor of molecular microbiology at Washington University School of Medicine and co-founder of VaxNewMo, said in a university press release. “We’re working on scaling up production and optimizing the protocol so we can be ready to take the vaccine into clinical trials soon.”Aug 27 Proc Natl Acad Sci studyAug 27 Washington University press release New initiative aims to clean up antibiotics manufacturingOriginally published by CIDRAP News Aug 27The United Nations Development Programme (UNDP) yesterday announced a joint initiative with environmental and industry groups to reduce the amount of antibiotic discharge from pharmaceutical manufacturing facilities.The REAP (Reducing Emissions from Antibiotics Production) project will bring together organizations on the supply and demand side of antibiotics manufacturing to advocate for technologies, incentives, and policies that help the pharmaceutical industry shift to more sustainable production practices. Partners in the initiative include the Stockholm International Water Institute, Centrient Pharmaceuticals, and contract manufacturer Recipharm.The release of antibiotic residues into waterways by pharmaceutical manufacturing plants is considered one of the factors that contribute to antimicrobial resistance (AMR). Once in the water, the antibiotic residues interact with natural bacterial communities and with human and animal bacteria, and can exert selective pressure that promotes the development of AMR. Studies in parts of India where pharmaceutical manufacturing is concentrated have found high concentrations of antibiotic residues and an abundance of AMR genes in local waterways.”The UN purchases large volumes of antibiotics. Developing a Sustainable Procurement Index for Health is a way for us to promote more sustainable manufacturing and procurement,” Rosemary Kumwenda, MD, UNDP’s regional team leader for HIV, Health, and Development, said in a press release from the UN’s Sustainable Procurement in the Health Sector (SPHS) task force. “Through REAP, we can engage with manufacturers and suppliers and in the long run, incentivise a more sustainable production and procurement system.”The initiative was announced at World Water Week 2019.Aug 26 SPHS press release Study highlights regional spread of carbapenem-resistant KlebsiellaOriginally published by CIDRAP News Aug 27A genomic study of clinical isolates from long-term acute care hospitals (LTACHs) in the United States indicates patient transfer is driving regional proliferation of carbapenem-resistant K pneumoniae (CRKP), researchers reported yesterday in Antimicrobial Agents and Chemotherapy.To better understand the epidemiology of CRKP in LTACHs, which are increasingly recognized as reservoirs of multidrug-resistant organisms (MDROs) because of their critically ill patient population, the researchers performed whole-genome sequencing (WGS) on a collection of 451 CRKP isolates from LTACH patients in four geographic regions. The vast majority of the isolates (395, 87.6%) were from 11 facilities in the Los Angeles area. Patients with CRKP had a high rate of multiple comorbidities, and indwelling device and broad-spectrum antibiotic use was common.Analysis of the sequence types revealed that more than 90% of the isolates belonged to ST258, an epidemic K pneumoniae lineage that has accounted for most of the carbapenem-resistant Enterobacteriaceae infections in US hospitals, and phylogenetic reconstruction showed that dissemination of the lineage started in Los Angeles–area LTACHs with a small number of introductions in 2012, then spread among the facilities via patient transfers.A transmission map constructed from 363 isolates indicated that CRKP transmission was associated with rates of patient flow between LTACHs, with higher transmission frequencies found between geographically proximate facilities. But the CRKP prevalence at each LTACH was associated with intra-facility transmission rates, which varied according to the clinical characteristics of patients.The researchers say the study illustrates how WGS and patient-level clinical meta-data can help identify pathways and drivers of MDRO transmission in regional healthcare networks, which could aid development of targeted interventions. “The ability to tease apart the relative contributions of inter- and intra-facility transmission across regional healthcare facilities, and to identify drivers of these processes, is a critical first step in the development of effective regional interventions to control the spread of MDROs,” they write.Aug 26 Antimicrob Agents Chemother abstract Study supports multiple-bed room strategy for isolating ESBL patientsOriginally published by CIDRAP News Aug 26A study conducted in Dutch hospitals has found that an isolation strategy of contact precautions in a multiple-bed hospital room was non-inferior to a strategy of contact precautions in a single-bed room for preventing the spread of extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae, Dutch researchers reported in The Lancet Infectious Diseases.In the cluster-randomized, crossover study, medical and surgical wards at 16 Dutch hospitals applied, over two study periods, contact precautions in either a single-bed or multiple-bed hospital room as the preferred strategy for isolating patients with ESBL-producing Enterobacteriaceae cultured from a routine clinical sample. Under current European Society for Clinical Microbiology and Infectious Diseases guidelines, contact precautions (i.e., use of gloves and gowns for all direct contact with a patient) are recommended for such patients, preferably in a single room, but studies on the added benefit of a single room have been inconsistent. Compared with other multidrug-resistant pathogens, ESBL-producing Enterobacteriaceae have the highest prevalence in European hospitals and have become an increasing burden.The hospitals were assigned in a 1:1 ratio to either strategy during the first study period, then switched strategies in the second study period. The primary outcome was transmission of ESBL-producing Enterobacteriaceae to wardmates, which was defined as rectal carriage of an ESBL-producing Enterobacteriaceae isolate that was clonally related to the index patient’s isolates. The non-inferiority margin was 10%.Thirteen hospitals completed both study periods and assessed 1,652 index patients and 12,875 wardmates for eligibility from April 2011 through February 2014. Of those, 693 index patients and 9,527 wardmates were enrolled, with 463 index patients and 7,093 wardmates included in the per-protocol population. For the per-protocol population, transmission of ESBL-producing Enterobacteriaceae to at least one wardmate was identified for 11 of 275 index patients (4%) during the single-bed room strategy period and for 14 of 188 index patients (7%) during the multiple-bed room strategy period (crude risk difference 3.4%; 90% CI, −0.3 to 7.1). For both isolation strategies, the median length of hospital stay was 11 days, and the 30-day mortality was 4%.”Non-inferiority of the multiple-bed room strategy could change the current single-bed room preference for isolation of patients with ESBL-producing Enterobacteriaceae and, thus, broaden infection-control options for ESBL-producing Enterobacteriaceae in daily clinical practice,” the authors of the study conclude. Aug 23 Lancet Infect Dis study CDC update shows US Candida auris cases continue to riseOriginally published by CIDRAP News Aug 26The number of confirmed and probable Candida auris cases in the United States rose to 755 as of June 30, reflecting an increase of 39 cases, according to the most recent case-count update from the Centers for Disease Control and Prevention (CDC).Of the cases reported to the CDC, 30 are probable and 725 have been lab-confirmed. In its previous update, involving cases through May 31, the CDC reported 716 cases. An additional 1,474 patients have been found to be colonized with the multidrug-resistant yeast, as determined by targeted screening in 10 states with clinical cases.The number of states affected remains at 12, with New York (359), Illinois (199), and New Jersey (148) reporting the vast majority of C auris cases. Other states reporting cases include Florida (22), Massachusetts (8), California (5), Maryland (5), Texas (4), Oklahoma (2), Connecticut (1), Indiana (1), and Virginia (1).Since it was identified in 2009 in Japan, C auris has triggered outbreaks in healthcare facilities in 23 countries, and 13 countries have reported single cases. C auris can cause serious invasive infections in immunocompromised patients, and has shown resistance to three major antifungal drug classes. The CDC has estimated that 30% to 60% of patients with infections have died.Aug 16 CDC update Resistant Enterobacteriaceae on the rise US hospitals, study findsOriginally published by CIDRAP News Aug 26An analysis of more than a million Enterobacteriaceae isolates collected from US hospitals has found a rise in ESBL-producing and carbapenem-nonsusceptible Enterobacteriaceae, US researchers reported in BMC Infectious Diseases.In the study, researchers from Becton, Dickinson and Company and Tetraphase Pharmaceuticals analyzed the antimicrobial susceptibility of non-duplicated isolates from multiple culture sources collected from hospitalized patients at 411 US hospitals from 2013 through 2017. The resistance profiles of interest were ESBL-producing, multidrug-resistant (MDR), and carbapenem-nonsusceptible phenotypes of Enterobacteriaceae, and MDR and carbapenem-nonsusceptible Acinetobacter spp. The outcomes assessed were the rate of bacterial resistance or non-susceptibility per 100 hospital admissions and the proportion of resistant isolates for each year-quarter from Q1 2013 through Q4 2017. The analysis found that 12.05% of Enterobacteriaceae isolates were identified as ESBL phenotype, 1.21% were carbapenem-nonsusceptible, and 7.08% were MDR, with urine cultures accounting for the majority of resistant isolates. Of the more 19,000 Acinetobacter isolates tested, 37.48% were identified as carbapenem-nonsusceptible and 47.66% as MDR, and the most common source was skin/wound cultures. Trend analyses showed that the rates of ESBL-producing and carbapenem non-susceptible Enterobacteriaceae per 100 hospital admissions increased significantly between 2013 and 2017, with average slopes of 0.0089 and 0.0004 per quarter, respectively. Rates of MDR Enterobacteriaceae and carbapenem-nonsusceptible and MDR Acinetobacter spp., however, decreased during this time period.The analysis also found that trends in proportions of resistant isolates generally mirrored trends in rates per 100 hospital admissions, and that MDR Enterobacteriaceae and carbapenem-nonsusceptible and MDR Acinetobacter spp. were more common in winter than summer.The authors of the study say the observed increase in ESBL-producing and carbapenem-nonsusceptible Enterobacteriaceae supports continuing efforts by the CDC and the World Health Organization to combat these pathogens. They conclude, “Continued infection control efforts, together with diagnostic and antimicrobial stewardship and new antibiotics to expand treatment options, will be required to manage these antibiotic-resistant Gram-negative pathogens.”Aug 23 BMC Infect Dis study
U.S. SENATE News:WASHINGTON, D.C. — U.S. Sen Tom Udall (D-N.M.) joined Senators Tina Smith (D-Minn.), James Lankford (R-Okla.) and Martha McSally (R-Ariz.) to introduce bipartisan legislation to boost health resources for urban Indian health organizations (UIOs) as they respond to the COVID-19 pandemic. The senators’ legislation comes as UIOs across the country face major funding and staff shortfalls, in addition to shortages in medical equipment and Personal Protective Equipment (PPE). These hardships have forced three UIOs across the country to close their doors while pushing many other facilities to the brink.The Indian Health System is made up of the Indian Health Service, Tribal health programs, and UIOs. UIOs provide culturally competent care for the over 70 percent of American Indians and Alaska Natives who live in urban centers. Currently, providers at UIOs are not offered the same malpractice liability protection as all other Indian Health Care Providers. The Coverage for Urban Indian Health Providers Act would amend the Indian Health Care Improvement Act to create parity within the Indian Health System (I/T/U system).The legislation would expand Federal Torts Claim Act coverage (FTCA) to UIOs, which are currently required to divert already-limited resources away from patient care to cover liability costs. “Urban Indian health programs funded by the IHS are facing revenue shortfalls while ramping up services to combat the COVID-19 pandemic. And, as a result, many of these critical health care programs are struggling to keep the lights on and their doors open. They shouldn’t be the only branch of the IHS that has to divert resources away from health care services to cover exorbitant liability costs,” Udall said. “The federal government’s trust and treaty responsibilities to Native Americans do not stop at reservation boundaries. Nearly 70 percent of American Indians and Alaska Natives live in urban areas and Congress must ensure they have access to quality health care — especially during this public health crisis. This legislation is a common-sense measure to provide Urban Indian Health Programs with the same federal protections given to all other Indian Health Care Providers.”“Minnesota’s urban Indigenous community has been hit hard by the coronavirus pandemic, yet many urban Indian health organizations are often forced to spend hundreds of thousands of dollars on costly liability protection instead of being able to use those resources to provide health care to Native community members,” said Smith. “This is unacceptable. We need to make sure that urban Indian organizations can use every dollar they have to give urban Indigenous individuals the care they need. I’m glad to work in a bipartisan way to bring financial relief to these vital organizations.” “There are two prominent UIOs in Oklahoma that faithfully serve our Tribal communities’ healthcare needs in addition to the other important Tribal health facilities around the state. I am glad our bill addresses this disparity in the law to help ensure equal access to medical malpractice liability coverage for the services they offer,” said Lankford. “Federal tort law currently omits coverage for UIOs, and especially during the coronavirus pandemic, UIOs, like other already covered Tribal health facilities, need to have the peace of mind that they can utilize their funds for care, not court cases.”“Arizona is home to four Urban Indian Organizations, all of which are forced to spend hundreds of thousands of dollars annually on liability insurance that could otherwise be spent on patients,” said McSally. “Our legislation will fix this inequity by extending federal liability coverage to our urban Indian health groups, dramatically decreasing the cost of malpractice insurance while freeing up more money for patient care. Bringing parity to Urban Indian Health is an important step to improving Native American health care across the board.” The full text of this legislation is available here.
Leading electronic technology expert, Mitsubishi Electric, has announced the development of a 28 GHz High-Efficiency GaN Doherty 5G Power Amplifier (PA) using National Instruments’ NI AWR software (Which has not been acquired by Cadence). The software helps design engineers dramatically reduce development time and cost for components, circuits, systems and subsystems employed in wireless, high-speed wired, broadband, aerospace and defense, and electro-optical applications.The Ka-band is a popular frequency for millimeter-wave (mmWave) applications for 5G. High efficiency and high output power amplifiers (PAs) are required to reduce power consumption and increase data transmission distance. However, although gallium nitride (GaN) is widely used for wideband applications, most Ka-band GaN amplifiers have only 10% efficiency at backoff output power due to their Class-AB single-ended configuration.Mitsubishi Electric engineers were challenged to meet the requirements for a PA with high output power and high efficiency at back-off output power by designing a 28 GHz PA monolithic microwave integrated circuit (MMIC) using a high-efficiency Doherty architecture. The PA MMIC was to be fabricated using a 0.15 µm GaN process technology with a 50 µm silicon carbide (SiC) substrate (Figure 1).The design goals for the GaN Doherty PA MMIC were 28 GHz operation, 3 W saturated output power, and power-added efficiency (PAE) over 20% at 6-8 dB back-off output power. The designers chose NI AWR Design Environment platform for this exacting design and believe that the resulting Doherty PA device is the state of the art in 5G amplifier devices for the Ka-band.The parameters of the Doherty output combiner, which consisted of microstrip lines and metal-insulator-metal (MIM) capacitors on a 50-µm thickness SiC substrate, were calculated using Microwave Office circuit design software. Electromagnetic (EM) simulations were performed on the Doherty output combiner using the AXIEM planar EM simulator. The layout and EM simulation are shown in Figure 2.Figure 3 below provides the measured and simulated large-signal characteristics of the fabricated GaN Doherty PA MMIC. The fabricated 2-stage Doherty PA using a GaN high electron mobility transistor (HEMT) achieved a measured saturation output power of 35.6 dBm (3.6 W) and peak PAE of 26%. PAE of 23% and 20% was obtained at 6 dB and 8 dB back-off, respectively.Because the 5G market is developing rapidly, early delivery of amplifiers to market is critical. According to the Mitsubishi design team, the straightforward, integrated NI AWR software environment enabled fast development of the GaN PA MMIC while meeting all requirements. The AXIEM simulator reduced analysis time by 50%. In addition, ready access to a design kit for the Mitsubishi Electric GaN process that enabled the engineers to optimize the development environment.The speed of the circuit and EM simulation was so fast that the AXIEM simulator was able to do the required simulations very quickly and provided high accuracy results. The designers at Mitsubishi recommend NI AWR software and plan to use it from now on because of its beneficial development environment and simulation speed and accuracy.Click here to learn more about the NI AWR Design Enviornment.
At the IMS 2020 virtual event, Keysight is showcasing its innovative tools for RF & mm-Wave design, simulation, and testing. We have listed their complete IMS 2020 presentation schedule. Users do not need to log in to watch this live, but can see these on-demand any time till September 30 2020.Here is a summary of what Keysight is doing at the event:AUGUST 0410:10 AM – 11:50 AM (PDT)Multi-Channel mmWave EW Receiver Workshop (IW17ABC)This session will describe how the DDC and mm-wave bandwidth options provide a multi-channel, coherent receiver with alternatives for bandlimited, tunable applications where the full instantaneous bandwidth of the scope is not needed. Key RF performance specs will be presented, as well as techniques for linking scopes for 8, 12, or more channels of coherent acquisition. The 89601B VSA software provides a convenient and powerful radar and pulse analysis application that is tightly integrated with the scope. Several live demos will highlight the powerful features discussed. We will close with an overview of other multichannel platforms available from Keysight. Also available on-demand.12:00 PM – 1:00 PM (PDT)Simplify Mixer and Frequency Converter Characterization with New Keysight toolsTesting mixers and frequency converters for 5G and satellite applications involves many parameters including gain, phase, delay, IMD, gain compression, and noise figure. With so many parameters to capture, it can take days or even weeks to characterize complex transponders. When you finally have your test results, you need to know if spurious or phase noise at the device’s output is from the device itself or from your input signal. It’s impossible to trace the origins of errors without a consistent and reliable test setup. Learn about the latest technologies in the Keysight PNA and PNA-X that feature extremely low phase noise and spurious emissions to help you measure complex components faster.1:40 PM – 3:20 PM (PDT)Tackling Emerging Wideband mmWave Applications then Moving Beyond into 6G (IW18AB)Today’s emerging millimeter-wave applications in the 57–71 GHz, 71–76 GHz, and 81-86 GHz frequency bands demand improved system performance to achieve higher data throughput using larger contiguous swaths of spectrum and higher-order modulation. Moving beyond 110 GHz and into 6G sub-terahertz research in D-band (110–170 GHz) and G-band (140-220 GHz) presents even greater opportunities and challenges. This workshop will discuss some of the key considerations in tackling the test and measurement challenges for today’s and tomorrow’s emerging millimeter-wave applications. Also available on-demand.3:50 PM – 5:30 PM (PDT)Phase-Noise Theory and Measurement Workshop (IW20ABC)This workshop explains phase noise fundamentals, measurement, and its impact on performance of RF/microwave systems. We will compare different measurement instruments and techniques. We’ll describe the role of the phase detector and the use of cross correlation in optimizing sensitivity, and we’ll discuss the impact of reference sources on phase noise measurements. Residual and absolute phase noise examples and practical DUT measurements will be shown. Lastly, we’ll examine AM Noise measurement techniques. Also available on-demand.AUGUST 058:00 AM – 9:40 AM (PDT)Learn 5G Signals, Demodulation and Conformance Tests with the VSA (IW14)The 5G standard is both large and complex. In this workshop, we seek to demystify 5G signal construction, demodulation, analysis, measurements and conformance tests with a series of lab demonstrations, leveraging the 89600 VSA software with the UXA signal analyzer along with the Signal Studio software with the VXG signal generator. Besides serving as a world-class measurement tool, the VSA can also be used as a wonderful learning vehicle, enabling a student of a new standard to explore characteristics of his/her signal under test. We look forward to sharing the story of 5G signal construction, measurements and analysis. Also available on-demand.10:10 AM – 11:50 AM (PDT)Cryogenic Measurement Challenges for Quantum Applications (IW7ABC)Advances in quantum control used to encode information quantum processors, is critical for scaling quantum computing beyond current NISQ-era architectures. For the prevailing quantum computing paradigms, future generations of quantum control circuitry will need to operate at cryogenic temperatures. This workshop will focus on the measurement and calibration challenges encountered when performing microwave characterization of these components at cryogenic temperatures. Keysight experts will discuss typical measurements in this application space and some methods for eliminating the errors. Lake Shore Cryotronics, will share insights for wafer-level, microwave device characterization including device temperature, probing challenges, and quality of calibration at cryogenic temperatures. Also available on-demand.12:00 PM – 1:00 PM (PDT)Project ConnectJoin Joseph Kovacs, Solutions Partner Manager with Keysight, on a panel that provides under-represented minority engineering students the opportunity to attend IMS 2020 to interact with practicing engineers. Learn about the exciting new technologies being developed today that introduce students to a variety of careers in the area of microwave engineering.3:50 PM – 5:30 PM (PDT)Understanding 5G New Radio (NR) Release 15/16 Standards (IW26)5G New Radio (NR) differs significantly from previous generations of wireless standards while opening the door to new business models. It introduces a new end-to-end network architecture that promises high data throughput and ultra-reliable low latency connections. Learn about the technology and challenges associated with the implementation of the 5G NR Release 15 standard and uncover new details about its numerology, frame structure, and waveforms. We’ll discuss initial access and beamforming and find out how they work in different network architectures. We’ll review key aspects of 5G NR Release 16, so you can prepare for the new applications it enables. Also available on-demand.AUGUST 069:55 AM – 10:10 PM (PDT)USB Noise Source with Internal Current and Temperature Correction for ENR Uncertainty Improvement (THMA53)Most noise sources in the market are powered by 28V without data transfer capability. This presentation introduces Keysight’s latest USB noise source that provides ease of use in powering up the noise source and facilitating data transfer. The main issue via the USB approach is the high ENR uncertainties due to unwanted heat dissipation from switching regulators, which eventually degrades the accuracy of the actual DUT noise figure measurement. This presentation will discuss methods to reduce heat dissipation and the novel technique implemented to minimize the temperature delta caused by the voltage switching regulator. Also Available on-demand.Click here to watch Keysight’s complete virtual experience featuring webinars, demo videos, and additional resources on tackling the toughest mmWave design and test challenges.Click here to view everything RF’s coverage of Virtual IMS 2020 for more highlights from the event.