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GpsB links peptidoglycan synthases to other proteins that determine the shape of the respiratory pathogen Streptococcus pneumoniae (pneumococcus; Spn) and other low‐GC Gram‐positive bacteria. GpsB is also required for phosphorylation of proteins by the essential StkP(Spn) Ser/Thr protein kinase. Here we report three classes of frequently arising chromosomal duplications (≈21–176 genes) containing murZ (MurZ‐family homolog of MurA) or murA that suppress ΔgpsB or ΔstkP. These duplications arose from three different repeated sequences and demonstrate the facility of pneumococcus to modulate gene dosage of numerous genes. Overproduction of MurZ or MurA alone or overproduction of MurZ caused by ΔkhpAB mutations suppressed ΔgpsB or ΔstkP phenotypes to varying extents. ΔgpsB and ΔstkP were also suppressed by MurZ amino‐acid changes distant from the active site, including one in commonly studied laboratory strains, and by truncation or deletion of the homolog of IreB(ReoM). Unlike in other Gram‐positive bacteria, MurZ is predominant to MurA in pneumococcal cells. However, ΔgpsB and ΔstkP were not suppressed by ΔclpCP, which did not alter MurZ or MurA amounts. These results support a model in which regulation of MurZ and MurA activity, likely by IreB(Spn), is the only essential requirement for StkP‐mediated protein phosphorylation in exponentially growing D39 pneumococcal cells.

Two defining features of the nursing home industry are the tremendous churn in chain ownership and the perception of low-quality care at many facilities. We examined whether nursing homes that underwent chain-related transactions, such as mergers and acquisitions, experienced a larger number of health deficiency citations than nursing homes that maintained common ownership over the same period. Using facility-level data for the period 1993-2010, we found that those nursing homes that underwent chain-related transactions had more deficiency citations in the years preceding and following a transaction than those nursing homes that maintained common ownership. Thus, we did not find that these transactions led to a decline in quality. Instead, we found that chains targeted nursing homes that were already having quality problems and that these problems persisted after the transaction. Given the high frequency of nursing home chain transactions, policy makers will need to continue to invest in tracking, reporting, and overseeing these transactions. One important step would be to report more detailed data on chain ownership, transactions, and aggregate chain quality on the Nursing Home Compare website, the federal government's online report card for nursing homes.

The ASAT offers a web-enabled, version-controlled instrument for the assessment of antimicrobial stewardship in acute hospitals. It may offer a sensitive instrument to assess longitudinal progress on antimicrobial stewardship in an individual institution or act as a benchmark with similar organizations. Further work is ongoing to evaluate and further refine the ASAT.