The Clinical and Laboratory Standards Institute (CLSI) has revised several breakpoints since 2010 for bacteria that grow aerobically. In 2019, these revisions include changes to the ciprofloxacin and levofloxacin breakpoints for the Enterobacteriaceae and Pseudomonas aeruginosa, daptomycin breakpoints for Enterococcus spp., and ceftaroline breakpoints for Staphylococcus aureus. Implementation of the revisions is a challenge for all laboratories, as not all systems have FDA clearance for the revised (current) breakpoints, compounded by the need for laboratories to perform validation studies and to make updates to laboratory information system/electronic medical record builds in the setting of limited information technology infrastructure. This minireview describes the breakpoint revisions in the M100 supplement since 2010 and strategies for the laboratory on how to best adopt these in clinical testing.
African climate is generally considered to have evolved towards progressively drier conditions over the past few million years, with increased variability as glacial-interglacial change intensified worldwide. Palaeoclimate records derived mainly from northern Africa exhibit a 100,000-year (eccentricity) cycle overprinted on a pronounced 20,000-year (precession) beat, driven by orbital forcing of summer insolation, global ice volume and long-lived atmospheric greenhouse gases. Here we present a 1.3-million-year-long climate history from the Lake Malawi basin (10°-14° S in eastern Africa), which displays strong 100,000-year (eccentricity) cycles of temperature and rainfall following the Mid-Pleistocene Transition around 900,000 years ago. Interglacial periods were relatively warm and moist, while ice ages were cool and dry. The Malawi record shows limited evidence for precessional variability, which we attribute to the opposing effects of austral summer insolation and the temporal/spatial pattern of sea surface temperature in the Indian Ocean. The temperature history of the Malawi basin, at least for the past 500,000 years, strongly resembles past changes in atmospheric carbon dioxide and terrigenous dust flux in the tropical Pacific Ocean, but not in global ice volume. Climate in this sector of eastern Africa (unlike northern Africa) evolved from a predominantly arid environment with high-frequency variability to generally wetter conditions with more prolonged wet and dry intervals.
Because ocean circulation impacts global heat transport, understanding the relationship between deep ocean circulation and climate is important for predicting the ocean's role in climate change. A common approach to reconstruct ocean circulation patterns employs the neodymium isotope compositions of authigenic phases recovered from marine sediments. In this approach, mild chemical extractions of these phases is thought to yield information regarding the ε Nd of the bottom waters that are in contact with the underlying sediment package. However, recent pore fluid studies present evidence for neodymium cycling within the upper portions of the marine sediment package that drives a significant benthic flux of neodymium to the ocean. This internal sedimentary cycling has the potential to obfuscate any relationship between the neodymium signature recovered from the authigenic coating and the overlying neodymium signature of the seawater. For this manuscript, we present sedimentary leach results from three sites on the Oregon margin in the northeast Pacific Ocean. Our goal is to examine the potential mechanisms controlling the exchange of Nd between the sedimentary package and the overlying water column, as well as the relationship between the ε Nd composition of authigenic sedimentary coatings and that of the pore fluid. In our comparison of the neodymium concentrations and isotope compositions from the total sediment, sediment leachates, and pore fluid we find that the leachable components account for about half of the total solid-phase Nd, therefore representing a significant reservoir of reactive Nd within the sediment package. Based on these and other data, we propose that sediment diagenesis determines the ε Nd of the pore fluid, which in turn controls the ε Nd of the bottom water. Consistent with this notion, despite having 1 to 2 orders of magnitude greater Nd concentration than the bottom water, the pore fluid is still <0.001% of the total Nd reservoir in the upper sediment column. Therefore, the pore fluid reservoir is too small to maintain a unique signature, and instead must be controlled by the larger reservoir of Nd in the reactive coatings. In addition, to achieve mass balance, we find it necessary to invoke a cryptic radiogenic (ε Nd of +10) trace mineral source of neodymium within the upper sediment column at our sites. When present, this cryptic trace metal results in more radiogenic pore fluid.
The ability to reconstruct past ocean currents is essential for determining ocean circulation's role in global heat transport and climate change. Our understanding of the relationship between circulation and climate in the past allows us to predict the impact of future climatedriven circulation changes. One proposed tracer of past ocean circulation is the neodymium isotope composition (e Nd ) of ancient water masses. However, ambiguities in what governs the e Nd distribution in the modern ocean hamper interpretations of this tracer. Here we present e Nd values for marine pore fluids, sediments, and the overlying water column for three sites in the North Pacific. We find that ocean bottom water e Nd (e Nd BW ) in the northeast Pacific lies between the value expected for the water mass (-3.3) and the measured e Nd of sediment pore fluid (e Nd PW ; -1.8). Moreover, e Nd PW resembles the e Nd of the sediment. Combined, these findings are consistent with recent assessments that sediment pore fluids may be a major source of rare earth elements to the ocean and suggest that the benthic flux of Nd from pore fluids exerts the primary control over the deep ocean distribution of e Nd .as helped out during the field and/or laboratory portions of this research; Geomatics Research provided software development to aid in data processing; and Andy Ungerer provided ICP-MS facility support at Oregon State University's W.M. Keck Collaboratory. Editor Ellen Thomas and three anonymous reviewers provided thoughtful and constructive comments that improved the text.
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