Objectives Infections caused by vancomycin-resistant Enterococcus faecium (VREfm) represent a major public health concern due to limited treatment options. Among invasive isolates of VREfm, ST117, ST80 and ST78 represent the most frequently detected STs by MLST in Germany. In this study, we investigated the genetic diversity of isolates of VREfm recovered from different nosocomial outbreaks in Bavaria, Germany, by WGS. Methods Between January 2018 and April 2019, 99 non-replicate isolates of VREfm originating from nosocomial outbreaks at eight different hospitals in Bavaria were investigated for genetic diversity by WGS. In detail, complex types (CTs) were identified by core-genome MLST. Furthermore, an SNP analysis was performed for all VREfm strains. Results Most of the isolates of this study (76%) belonged to three major clonal groups, which occurred in at least three hospitals: ST80/CT1065 vanB (n = 45; six hospitals), ST117/CT71 vanB (n = 11; four hospitals) and ST78/CT894like vanA (n = 19; three hospitals). Moreover, isolates of the predominant lineage ST80/CT1065 vanB showed a maximum difference of 36 SNPs as revealed by SNP analysis. Conclusions Whole-genome analysis of VREfm causing nosocomial outbreaks suggests the occurrence of few endemic clonal lineages in Bavarian hospital settings, namely ST80/CT1065 vanB, ST117/CT71 vanB and ST78/CT894like vanA. Further studies are needed for a better understanding of the factors affecting the successful spread of the above-mentioned lineages.

Recent studies suggest that real-time auditory feedback is an effective method to facilitate motor learning. The evaluation of the parameter mapping (sound-to-movement mapping) is a crucial, yet frequently neglected step in the development of audio feedback. We therefore conducted two experiments to evaluate audio parameters with target finding exercises designed for balance training. In the first experiment with ten participants, five different audio parameters were evaluated on the X-axis (mediolateral movement). Following that, in a larger experiment with twenty participants in a two-dimensional plane (mediolateral and anterior-posterior movement), a basic and synthetic audio model was compared to a more complex audio model with musical characteristics. Participants were able to orient themselves and find the targets with the audio models. In the one-dimensional condition of experiment one, percussion sounds and synthetic sound wavering were the overall most effective audio parameters. In experiment two, the synthetic model was more effective and better evaluated by the participants. In general, basic sounds were more helpful than complex (musical) sound models. Musical abilities and age were correlated with certain exercise scores. Audio feedback is a promising approach for balance training and should be evaluated with patients. Preliminary evaluation of the respective parameter mapping is highly advisable.

Our results suggest that early detection of ESBL-producing Enterobacteriaceae and consequent implementation of basic hygiene measures and contact isolation may reduce the transmission rate during the hospital stay.

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This paper deals with the development of an optical based scanning method for a new autonomous stair-climbing wheel chair. Therefore, two different 3D data acquisition methods are compared, a stereo camera system and a RGB-D camera (Kinect TM from Microsoft R ). After that, an image based algorithm calculates the step width and height in order to support the wheelchair with control information. As both detecting methods work on a different principle, advantages and disadvantages are discussed. The focus for comparison of both methods lies in the stair recognition under different conditions such as external lightening and material of the stairs.