Increasing burden of community-acquired pneumonia leading to hospitalisation, 1998-2014

BACKGROUND: Community-acquired pneumonia (CAP) is a major cause of mortality and morbidity in many countries but few recent large-scale studies have examined trends in its incidence. METHODS: Incidence of CAP leading to hospitalisation in one UK region (Oxfordshire) was calculated over calendar time using routinely collected diagnostic codes, and modelled using piecewise-linear Poisson regression. Further models considered other related diagnoses, typical administrative outcomes, and blood and microbiology test results at admission to determine whether CAP trends could be explained by changes in case-mix, coding practices or admission procedures. RESULTS: CAP increased by 4.2%/year (95% CI 3.6 to 4.8) from 1998 to 2008, and subsequently much faster at 8.8%/year (95% CI 7.8 to 9.7) from 2009 to 2014. Pneumonia-related conditions also increased significantly over this period. Length of stay and 30-day mortality decreased slightly in later years, but the proportions with abnormal neutrophils, urea and C reactive protein (CRP) did not change (p>0.2). The proportion with severely abnormal CRP (>100 mg/L) decreased slightly in later years. Trends were similar in all age groups. Streptococcus pneumoniae was the most common causative organism found; however other organisms, particularly Enterobacteriaceae, increased in incidence over the study period (p<0.001). CONCLUSIONS: Hospitalisations for CAP have been increasing rapidly in Oxfordshire, particularly since 2008. There is little evidence that this is due only to changes in pneumonia coding, an ageing population or patients with substantially less severe disease being admitted more frequently. Healthcare planning to address potential further increases in admissions and consequent antibiotic prescribing should be a priority

A pathogenicity island replicon in Staphylococcus aureus replicates as an unstable plasmid

The SaPIs are 14- to 17-kb mobile pathogenicity islands in staphylococci that carry genes for superantigen toxins and other virulence factors and are responsible for the toxic shock syndrome and other superantigen-related diseases. They reside at specific chromosomal sites and are induced by certain bacteriophages to initiate an excision-replication-packaging program, resulting in their incorporation into small infective phage-like particles. These are responsible for very high transfer frequencies that often equal and sometimes exceed the plaque-forming titer of the inducing phage. The ability of the SaPIs to replicate autonomously defines them as individual replicons and, like other prokaryotic replicons, they possess replicon-specific initiation functions. In this paper, we report identification of the SaPI replication origin (ori) and replication initiation protein (Rep), which has helicase as well as initiation activity. The SaPI oris are binding sites for the respective Rep proteins and consist of multiple oligonucleotide repeats in two sets, flanking an AT-rich region that may be the site of initial melting. Plasmids containing the rep-ori complex plus an additional gene, pri, can replicate autonomously in Staphylococcus aureus but are very unstable, probably because of defective segregation

High-spin states in the odd\u2013odd nucleus 80Y

The high-spin states of 80Y have been studied with the reactions 24Mg(58Ni, pn\u3b3) at 180 MeV and 58Ni(24Mg, pn\u3b3) at 77 MeV. Gamma-ray transitions in this nucleus have been unambiguously assigned by using the GASP detector array in conjunction with the recoil mass spectrometer CAMEL and the ISIS Silicon detector ball. These transitions have been arranged into several rotational bands extending up to an excitation energy of about 12 MeV and spin 24 \u210f. The bands are discussed within the framework of the interacting boson\u2013fermion\u2013fermion and cranked shell models

High-spin structure of ^{95}Pd

The level scheme of the neutron-deficient nucleus 95Pd has been studied with the 58Ni\u2009+\u200940Ca fusion-evaporation reaction at 135 MeV with the GASP \u3b3-ray array, the ISIS silicon ball, and the N-ring neutron detector. Excited levels with spins at least up to 45/2\u210f are reported for both parities. The observed experimental data are compared to large-scale shell-model calculations

γ\gamma-ray spectroscopy of the neutron-rich nuclei 89^{89}Rb, 92^{92}Y, and 93^{93}Y with multinucleon transfer reactions

The positive-parity yrast states in the ^{89}Rb, ^{92}Y, and ^{93}Y nuclei were studied using $\gamma$-ray spectroscopy with heavy-ion induced reactions. In the multinucleon transfer reactions ^{208}Pb+^{90}Zr (590 MeV) and ^{238}U+^{82}Se (505 MeV), several $\gamma$-ray transitions were identified in these nuclei by means of coincidences between recoiling ions identified with the PRISMA spectrometer and $\gamma$ rays detected with the CLARA $\gamma$-ray array in thin target experiments. Level schemes were subsequently determined from triple- $\gamma$ coincidences recorded with the GASP array in a thick target experiment, in the reactions produced by a 470 MeV ^{82}Se beam with a ^{192}Os target. The observed level schemes are compared to shell-model calculations