Training responsiveness of cardiorespiratory fitness and arterial stiffness following moderate-intensity continuous training and high-intensity interval training in adults with intellectual and developmental disabilities.

BACKGROUND: Cardiorespiratory fitness (CRF) prompts antiatherogenic adaptations in vascular function and structure. However, there is an extraordinary interindividual variability in response to a standard dose of exercise, wherein a substantial number of adults with intellectual and developmental disabilities (IDD) do not improve CRF. We (1) evaluated the effects of 12-month of moderate-intensity continuous training (MICT) on CRF and arterial stiffness and (2) tested whether an additional 3-month of high-intensity interval training (HIIT) would add to improvements in CRF responsiveness and arterial stiffness. METHODS: Fifteen adults with mild-to-moderate IDD (male adults = 9, 30.1 ± 7.5 years old) met 3 days per week for 30 min MICT for 12 months, after which the incidence of CRF responsiveness was calculated (≥5.0% change in absolute peak VO2 ). Thereafter, responders and non-responders started HIIT for 3 months with identical daily training load/frequency. Peak VO2 , local and regional indices of arterial stiffness were assessed prior to and after each period. RESULTS: Sixty per cent of the participants were non-responders following MICT, but the incidence dropped to 20% following HIIT (P = 0.03). Absolute peak VO2 values reached significant difference from pre-intervention (+0.38 ± 0.08 L min-1 , P = 0.001) only when HIIT was added. Lower limb pulse wave velocity (PWV) decreased following MICT (-0.8 ± 1.1 m s-1 , P = 0.049), whereas central PWV only decreased following HIIT (-0.8 ± 0.9 m s-1 , P = 0.013). CONCLUSIONS: Cardiorespiratory fitness responsiveness and reductions in PWV to a 12-month MICT period in adults with IDD improved following a period of HIIT programme inducing higher metabolic stress.

Hydroxypropyl methylcellulose-based micro- and nanostructures for encapsulation of melanoidins: Effect of electrohydrodynamic processing variables on morphological and physicochemical properties.

Electrohydrodynamic processing (EHDP) allows the use of a wide range of biopolymers and solvents, including food-grade biopolymers and green solvents, for the development of micro- and nanostructures. These structures present a high surface-area-to-volume ratio and different shapes and morphologies. The aim of this work was to design and produce hydroxypropyl methylcellulose (HPMC)-based micro- and nanostructures through EHD processing using green solvents, while exploring the influence of process and solution parameters, and incorporating a bioactive extracted from a food by-product. Low (LMW) and high (HMW) molecular weight HPMC have been used as polymers. The design-of-experiments methodology was used to determine the effects of process parameters (polymer concentration, flow rate, tip-to-collector distance, and voltage) of EHDP on the particle and fibre diameter, aspect ratio, diameter distribution, aspect ratio distribution, and percentage of fibre breakage. Additionally, melanoidins extracted from spent coffee grounds were encapsulated into the HPCM-based structures at a concentration of 2.5 mg melanoidins/mL of the polymer solution. Polymer solutions were characterised regarding their viscosity, surface tension and conductivity, and showed that the incorporation of melanoidins increased the viscosity and conductivity values of the polymer solutions. The developed structures were characterised regarding their thermal properties, crystallinity and morphology before and after melanoidin incorporation and it was observed that melanoidin incorporation did not significantly influence the characteristics of the produced micro- and nanostructures. Based on the results, it is possible to envision the use of the produced micro- and nanostructures in a wide range of applications, both in food and biomedical fields.

Do basic auscultation skills need to be resuscitated? A new strategy for improving competency among nursing students.

BACKGROUND: Auscultation of heart and lung sounds is a foundational competency for Registered Nurses (RNs). Precise and timely assessments are important for the early detection and recognition of the deteriorating patient. Studies have shown that improved teaching methods that incorporate emerging technologies and address different learning styles are needed to improve competency in auscultation. METHOD: Undergraduate nursing students (n = 127) were randomized into treatment and control groups. The control group received the usual preparation in auscultation learning strategies. The treatment group received the usual training plus three auscultation learning sessions that were each 2 h in length (cardiac, pulmonary and mixed sounds). RESULTS: The virtual auscultation teaching strategy had a significant impact on undergraduate nursing student's competency in recognizing heart murmurs. The treatment group also had increased scores compared to the control group increased scores in distinguishing normal versus abnormal heart and lung sounds, identification of crackles and diminished breath sounds. CONCLUSION: Virtual auscultation as a teaching strategy was shown to have a positive impact on undergraduate student nurse competence in accurately identifying heart and lung sounds.

Reduced genetic diversity and the success of the invasive peacock bass (Cichliformes: Cichlidae).

Several species of Cichla successfully colonized lakes and reservoirs of Brazil, since the 1960's, causing serious damage to local wildlife. In this study, 135 peacock bass were collected in a reservoir complex in order to identify if they represented a single dominant species or multiple ones, as several Cichla species have been reported in the basin. Specimens were identified by color pattern, morphometric and meristic data, and using mitochondrial markers COI, 16S rDNA and Control Region (CR). Overlapping morphological data and similar coloration patterns prevented their identification using the taxonomic keys to species identification available in the literature. However, Bayesian and maximum likelihood from sequencing data demonstrated the occurrence of a single species, Cichla kelberi. A single haplotype was observed for the 16S and CR, while three were detected for COI, with a dominant haplotype present in 98.5% of the samples. The extreme low diversity of the transplanted C. kelberi evidenced a limited number of founding maternal lineages. The success of this colonization seems to rely mainly on abiotic factors, such as increased water transparency of lentic environments that favor visual predators that along with the absence of predators, have made C. kelberi a successful invader of these reservoirs.

Computer Vision Challenges for Chronic Wounds Assessment.

Chronic wound assessment and wound healing are important for diagnostic, follow up and wound treatment. However, this growing disease affecting nearly 2 thousand million and 5.7 million people in the USA and Europe, costing around $20 billion and $8 thousand million USD per year, still relies on subjective human assessment of wounds. A scoping review allowed us to identify 109 articles that map the literature on the topic of computer vision for chronic wound assessment and healing. These results were carefully analyzed and mapped into relevant clinical challenges associated with this field, identifying the maturity of each different computer vision challenge that needs addressing. Results show that wound size and tissue type classification already have interesting work, but various other clinical areas are in need of larger datasets and computer vision research efforts for achieving a relevant impact in today's clinical routine.

Teaching Cardiopulmonary Auscultation to Medical Students using a Virtual Patient Simulation Technology.

The teaching process of auscultation is complex in itself, and difficult to operate since it requires a wide spectrum of patients with the most diverse cardiopulmonary pathologies, readily available during teaching and assessment hours, for an ever-growing number of medical students. In this paper we will focus on how virtual patient technologies can promote the evolution of the current teaching methodologies, promoting better learning. The chosen methodology was: a) a review of available medical simulation technologies for auscultation teaching; b) a case study illustrating how a virtual patient simulation technology has been successfully used to teach and certify auscultation skills. Results show the positive impact and high acceptability of virtual patient simulation technologies in the teaching of auscultation to medical students.

Effect of extraction temperature on rheological behavior and antioxidant capacity of flaxseed gum.

Soluble flaxseed gum (SFG) extracted at different temperatures (25, 40, and 60 °C) was analyzed in relation to the yield, polysaccharides and phenolics composition, surface charge, color, and rheological properties. The yield of SFG extract increased as the extraction temperature increased. The SFG xylan was the main component regardless the extraction temperature, but a reduction of substituents on the xylose chain was observed when increasing the extraction temperature. The phenolic compounds were also affected by the extraction temperature, influencing the antioxidant capacity of the gum. For all the extraction temperatures, SFG aqueous solutions showed a shear time-independent and shear-thinning behavior. Furthermore, oscillatory measurements showed a prevailing viscous character, but the decrease of the extraction temperature resulted in an increase of both G' and G". Therefore, SFG extracted at low extraction temperatures showed higher viscous and elastic properties, while high extraction temperatures increased the antioxidant activity.

Nutritional value of meat lipid fraction from red-legged partridge (Alectoris rufa) obtained from wild and farmed specimens1.

The red-legged partridge (Alectoris rufa) is a feathered game species of great socioeconomic importance in its native range and also in the UK. The aim of this study was to present a detailed comparison of meat's lipid fraction obtained from wild and farm-raised specimens and simultaneously compare the breast and leg meat portions. Meat from wild specimens had a significant (P < 0.05) lower proportion of saturated fatty acid (less 5.1%) and presented better P/S and n-6/n-3 ratios, and atherogenicity index than farm-raised counterparts. The wild specimens presented significant (P < 0.001) higher contents of total vitamin E (8.8 vs. 2.2 µg/g of fresh meat), is for that reason less prone to lipid peroxidation than farm-raised specimens. Meat portions differed significantly (P < 0.05) on total lipid and total cholesterol contents and in all partial sums of fatty acids. The breast was leaner (0.86 vs. 1.47 g/100 g of meat), with lower total cholesterol (37.5 vs. 54.7 mg/100 g of meat), lower saturated fatty acid, monounsaturated fatty acid, polyunsaturated fatty acid, and n-6 polyunsaturated fatty acid (less 0.27, 0.28, 0.10, and 0.11 g/100 g of fresh meat, correspondingly). Regarding the fatty acid ratios and lipid quality indexes, breast meat presents better n-6/n-3 ratio and atherogenicity and thrombogenicity indexes.

Reduced genetic diversity and the success of the invasive peacock bass (Cichliformes: Cichlidae)

Abstract Several species of Cichla successfully colonized lakes and reservoirs of Brazil, since the 1960s, causing serious damage to local wildlife. In this study, 135 peacock bass were collected in a reservoir complex in order to identify if they represented a single dominant species or multiple ones, as several Cichla species have been reported in the basin. Specimens were identified by color pattern, morphometric and meristic data, and using mitochondrial markers COI, 16S rDNA and Control Region (CR). Overlapping morphological data and similar coloration patterns prevented their identification using the taxonomic keys to species identification available in the literature. However, Bayesian and maximum likelihood from sequencing data demonstrated the occurrence of a single species, Cichla kelberi. A single haplotype was observed for the 16S and CR, while three were detected for COI, with a dominant haplotype present in 98.5% of the samples. The extreme low diversity of the transplanted C. kelberi evidenced a limited number of founding maternal lineages. The success of this colonization seems to rely mainly on abiotic factors, such as increased water transparency of lentic environments that favor visual predators that along with the absence of predators, have made C. kelberi a successful invader of these reservoirs.

Resumo Muitas espécies de Cichla colonizaram com sucesso lagos e reservatórios do Brasil desde os anos 1960, causando graves prejuízos à vida selvagem nesses locais. Neste estudo, 135 tucunarés foram coletados em um complexo de reservatórios a fim de identificar se representavam uma espécie dominante ou múltiplas espécies, uma vez que diversas espécies de Cichla foram registradas na bacia. Os espécimes foram identificados com base na coloração, dados morfométricos e merísticos, e por marcadores mitocondriais COI, 16S rDNA e Região Controle (RC). A sobreposição dos dados morfométricos e o padrão similar de coloração impediram a identificação utilizando as chaves de identificação disponíveis na literatura. Entretanto, as análises bayesiana e de máxima verossimilhança de dados moleculares demonstraram a ocorrência de uma única espécie, Cichla kelberi. Um único haplótipo foi observado para o 16S e RC, enquanto três foram detectados para o COI, com um haplótipo dominante presente em 98,5% das amostras. A baixa diversidade nos exemplares introduzidos de C. kelberi evidenciou um número limitado de linhagens maternas fundadoras. O sucesso da invasão parece depender de fatores abióticos, como a maior transparência da água de ambientes lênticos que favorece predadores visuais que, atrelado à ausência de predadores, fez do C. kelberi um invasor bem-sucedido nesses reservatórios.

Reduced genetic diversity and the success of the invasive peacock bass (Cichliformes: Cichlidae) / Diversidade genética reduzida e o sucesso da espécie invasora tucunaré (Cichliformes: Cichlidae)

Abstract Several species of Cichla successfully colonized lakes and reservoirs of Brazil, since the 1960's, causing serious damage to local wildlife. In this study, 135 peacock bass were collected in a reservoir complex in order to identify if they represented a single dominant species or multiple ones, as several Cichla species have been reported in the basin. Specimens were identified by color pattern, morphometric and meristic data, and using mitochondrial markers COI, 16S rDNA and Control Region (CR). Overlapping morphological data and similar coloration patterns prevented their identification using the taxonomic keys to species identification available in the literature. However, Bayesian and maximum likelihood from sequencing data demonstrated the occurrence of a single species, Cichla kelberi. A single haplotype was observed for the 16S and CR, while three were detected for COI, with a dominant haplotype present in 98.5% of the samples. The extreme low diversity of the transplanted C. kelberi evidenced a limited number of founding maternal lineages. The success of this colonization seems to rely mainly on abiotic factors, such as increased water transparency of lentic environments that favor visual predators that along with the absence of predators, have made C. kelberi a successful invader of these reservoirs.

Resumo Muitas espécies de Cichla colonizaram com sucesso lagos e reservatórios do Brasil desde os anos 1960, causando graves prejuízos à vida selvagem nesses locais. Neste estudo, 135 tucunarés foram coletados em um complexo de reservatórios a fim de identificar se representavam uma espécie dominante ou múltiplas espécies, uma vez que diversas espécies de Cichla foram registradas na bacia. Os espécimes foram identificados com base na coloração, dados morfométricos e merísticos, e por marcadores mitocondriais COI, 16S rDNA e Região Controle (RC). A sobreposição dos dados morfométricos e o padrão similar de coloração impediram a identificação utilizando as chaves de identificação disponíveis na literatura. Entretanto, as análises bayesiana e de máxima verossimilhança de dados moleculares demonstraram a ocorrência de uma única espécie, Cichla kelberi. Um único haplótipo foi observado para o 16S e RC, enquanto três foram detectados para o COI, com um haplótipo dominante presente em 98,5% das amostras. A baixa diversidade nos exemplares introduzidos de C. kelberi evidenciou um número limitado de linhagens maternas fundadoras. O sucesso da invasão parece depender de fatores abióticos, como a maior transparência da água de ambientes lênticos que favorece predadores visuais que, atrelado à ausência de predadores, fez do C. kelberi um invasor bem-sucedido nesses reservatórios.

Automated topographic segmentation and transit time estimation in endoscopic capsule exams.

Endoscopic capsule is a recent medical technology with important clinical benefits but suffering from a practical handicap: long exam annotation times. This paper proposes and compares two approaches (Bayesian and support vector machines) that can be used to segment the gastrointestinal tract into its four major topographic areas, allowing the automatic estimation of the clinically relevant gastric and intestinal sections and corresponding transit times. According to medical specialists, this can reduce exam annotation times by up to 12% (15 min). This automatic tool has been integrated into our CapView annotation software that is currently being used by three medical institutions.

Xylo-oligosaccharides display a prebiotic activity when used to supplement wheat or corn-based diets for broilers.

It is now well established that exogenous ß-1,4-xylanases improve the nutritive value of wheat-based diets for poultry. Among other factors, the mechanism of action of exogenous enzymes may involve a microbial route resulting from the generation of prebiotic xylo-oligosaccharides (XOS) in the birds' gastro-intestinal (GI) tract. In a series of three experiments, the effect of XOS on the performance of broilers fed wheat or corn-based diets was investigated. In experiment 1, birds receiving diets supplemented with XOS displayed an increased weight gain (P = 0.08). The capacity of XOS to improve the performance of animals during a longer trial (42 d) was investigated (Experiment 2). The data revealed that diet supplementation with XOS, tested at two incorporation rates (0.1 and 1 g/kg), or with an exogenous ß-1,4-xylanase resulted in an increased nutritive value of the wheat-based diet. An improvement in animal performance was accompanied by a shift in the microbial populations colonizing the upper portions of the GI tract. XOS were also able to improve the performance of broilers fed a corn-based diet, although the effects were not apparent at incorporation rates of 10 g/kg. Together these studies suggest that in some cases the capacity of ß-1,4-xylanases to improve the nutritive value of wheat-based diets is more related to their ability to produce prebiotic XOS than to their ability to degrade arabinoxylans. The extremely low quantities of XOS used in this study also challenge the depiction of a prebiotic being a quantitatively fermented substrate. These data also bring into question the validity of the "cell wall" mechanism, as XOS elicited an effect with clearly no action on endosperm cell wall integrity and yet the performance effects noted were equivalent or superior to the added enzymes.

Chromosome instability in industrial strains of Saccharomyces cerevisiae batch cultivated under laboratory conditions.

Industrial ethanol fermentation is a complex microbiological process to which yeast cells must adapt for survival. One of the mechanisms for adaptation is thought to involve chromosome rearrangements. We found that changes in chromosome banding patterns measured by pulsed-field gel electrophoresis can also be produced in laboratory media under simulated industrial conditions. Based on analysis of their generational variation, we found that these chromosome changes were specific to the genetic backgrounds of the initial strains. We conclude that chromosome rearrangements could be one of the factors involved in yeast cell adaptation to the industrial environment.

A comparative study of electronic stethoscopes for cardiac auscultation.

There are several electronic stethoscopes available on the market today, with a very high potential for healthcare namely telemedicine, assisted decision and education. However, there are no recent comparatives studies published about the recording quality of auscultation sounds. In this study we aim to: a) define a ranking, according to experts opinion of 6 of the most relevant electronic stethoscopes on the market today; b) verify if there are any relations between a stethoscope's performance and the type of pathology present; c) analyze if some pathologies are more easily identified than others when using electronic auscultation. Our methodology consisted in creating two study groups: the first group included 18 cardiologists and cardiology house officers, acting as the gold standard of this work. The second included 30 medical students. Using a database of heart sounds recorded in real hospital environments, we applied questionnaires to observers from each group. The first group listened to 60 cardiac auscultations recorded by the 6 stethoscopes, and each one was asked to identify the pathological sound present: aortic stenosis, mitral regurgitation or normal. The second group was asked to choose, between two auscultation recordings, using as criteria the best sound quality for the identification of pathological sounds. Results include a total of 1080 evaluations, in which 72% of cases were correctly diagnosed. A detailed breakdown of these results is presented in this paper. As conclusions, results showed that the impact of the differences between stethoscopes is very small, given that we did not find statistically significant differences between all pairs of stethoscopes. Normal sounds showed to be easier to identify than pathological sounds, but we did not find differences between stethoscopes in this identification.

The effect of data exchange protocols on decision support systems for heart sounds.

Heart auscultation is one of the basic exams performed during a patient physical examination, but it is also one that has a high skill ceiling. Decision support systems can provide physicians with a tool that can help to reduce the demanding skill requirements of this exam. Nevertheless, this second opinion needs to be delivered in a timely interval in order to be truly useful for a physician. To do this we need not only optimized algorithms, but also a well designed system. In this paper, we have studied how two different data exchange protocols, that define how data should be transferred from an acquisition to a process module, can impact the celerity of delivering second opinion to a physician. With data collected from real exams, acquired in a field hospital initiative in Brazil, we recreated two use cases that allowed us to measure performance in the form of time and resources spent, as well as power consumption. Results have shown that different data exchange protocols can have a significant impact on a decision support system response time.

Measuring the intuitive response of users when faced with different interactive paradigms to control a gastroenterology CAD system.

The gastroenterology specialty could benefit from the introduction of Computer Assisted Decision (CAD) systems, since gastric cancer is a serious concern in which an accurate and early diagnosis usually leads to a good prognosis. Still, the way doctors interact with these systems is very important because it will often determine its embracement or rejection, as any gains in productivity will frequently hinge on how comfortable they are with it. Using other types of interaction paradigms such as voice and motion control, is important in a way that typical inputs such as keyboard and mouse are sometimes not the best choice for certain clinical scenarios. In order to ascertain how a doctor could control a hypothetical CAD system during a gastroenterology exam, we measured the natural response of users when faced with three different task requests, using three types of interaction paradigms: voice, gesture and endoscope. Results fit in what was expected, with gesture control being the most intuitive to use, and the endoscope being on the other edge. All the technologies are mature enough to cope with the response concepts the participants gave us. However, when having into account the scenario context, better natural response scores may not always be the best choice for implementation. That way, simplification or reduction of tasks, along with a well tought-out interface, or even mixing more oriented paradigms for particular requests, could allow for better system control with fewer inconveniences for the user.

Teaching cardiopulmonary auscultation in workshops using a virtual patient simulation technology - A pilot study.

Auscultation is currently both a powerful screening tool, providing a cheap and quick initial assessment of a patient's clinical condition, and a hard skill to master. The teaching of auscultation in Universities is today reduced to an unsuitable number of hours. Virtual patient simulators can potentially mitigate this problem, by providing an interesting high-quality alternative to teaching with real patients or patient simulators. In this paper we evaluate the pedagogical impact of using a virtual patient simulation technology in a short workshop format for medical students, training them to detect cardiac pathologies. Results showed a significant improvement (+16%) in the differentiation between normal and pathological cases, although longer duration formats seem to be needed to accurately identify specific pathologies.

Alpha-SM actin expression as prognostic indicator in IgA nephropathy (Berger's disease).

Recent studies have demonstrated that alpha-Smooth Muscle actin expression in glomerular and tubulointerstitial compartments of renal tissue could represent a prognostic marker in several renal diseases. Our objective was to identify the prognostic value of alpha-SM actin actin expression on the evolution of renal damage in Primary IgA nephropathy (Berger's disease). 43 patients followed up from 1988 to 1999 at the University Hospital, Faculty of Medicine of Ribeirão Preto, University of Sao Paulo, Brazil, was studied. Clinical-laboratory data were obtained from the medical records of the patients using a protocol containing name, race, gender, origin, profession, age at clinical presentation of the disease and personal and family history. The parameters assessed in the approach to IgA nephropathy were serum creatinine, creatinine clearance, serum albumin, total serum protein, 24 hours proteinuria, glycaemia, serum sodium, potassium, calcium and phosphorus ions, analysis of urinary sediment, serum complement profile, blood count, and renal biopsy. Morphological evaluation was performed by renal biopsy using common light and immunofluorescence microscopy. Immunohistochemical studies were performed using a murine monoclonal antibody to alpha-SM actin. Our data showed that alpha-SM actin expression in the glomerular and tubulointerstitial compartments are not correlated with unfavorable clinical course of primary IgA nephropathy.

Structural differentiation of uronosyl substitution patterns in acidic heteroxylans by electrospray tandem mass spectrometry.

The structures of two oligomers of acidic xylo-oligosaccharides (XOS) of the same molecular weight (634 Da), Xyl(2)MeGlcAHex and Xyl(2)GlcA(2) were differentiated by electrospray tandem mass spectrometry (ESI-MS/MS). These oligomers were present in a mixture of XOS obtained by acid hydrolysis of heteroxylans extracted from Eucalyptus globulus wood (Xyl(2)MeGlcAHex) and Olea europaea olive fruit (Xyl(2)GlcA(2)). In the ESI-MS spectra of the XOS, ions at m/z 657 and 652 were observed and assigned to [M + Na](+) and [M + NH(4)](+), respectively. The ESI-MS/MS spectrum of [M + Na](+) ion of Xyl(2)MeGlcAHex showed the loss of Hex residue from the reducing end followed by the loss of MeGlcA moiety. Simultaneously, the loss of a Xyl residue from either the reducing or the non-reducing ends was detected. On the other hand, the fragmentation of Xyl(2)GlcA(2) occurs mainly by the loss of one and two GlcA residues or by the loss of the GlcAXyl moiety, due to the glycosidic bond cleavage between the two Xyl residues. Loss of one and two CO(2) molecules was only observed for this oligomer, where the GlcA are in vicinal Xyl residues. The ESI-MS/MS spectra of [M + NH(4)](+) of both oligomers showed the loss of NH(3), resulting in the protonated molecule, where the presence of ions assigned as protonated molecules of aldobiuronic acid residues, [MeGlcA - Xyl + H](+) and [GlcA - Xyl + H](+), are diagnostic ions of the presence of MeGlcA and GlcA moieties in XOS. Since these structures occur in small amounts in complex acidic XOS mixtures and are very difficult, if possible, to isolate, tandem mass spectrometry revealed to be a powerful tool for the characterization of these types of substitution patterns present in heteroxylans.

Clonal spread of methicillin-resistant Staphylococcus aureus in a large geographic area of the United States.

Methicillin resistance in Staphylococcus aureus has rapidly increased over the last two decades. This increase is paralleled by the emergence of unique multi-resistant MRSA clones. In Brazil, Argentina, Uruguay, Portugal and Czech Republic a specific MRSA clone is widely spread, the so-called Brazilian epidemic clone. Another epidemic clone, the Iberian clone, is disseminated in Spain, Portugal, Belgium, Scotland, Italy, Germany and New York. Thus, a large number of hospital-acquired infections have been caused by specific MRSA clones. Using different molecular techniques for MRSA typing, we verified that two unique epidemic clones are spread over large geographic area in the US. In addition, we showed that a previously described MRSA clone type, the New York clone (I::A:A), is widely spread beyond the New York frontiers.