FT : MRSA superbug spreading from hospitals across UK

MRSA superbug spreading from hospitals across UK
First comprehensive study discovers large number of small outbreaks

MRSA, the antibiotic-resistant superbug usually associated with hospital infections, is widespread in the general UK community, according to the first comprehensive study of the transmission of the bacteria.

Researchers at the Wellcome Trust Sanger Institute and London School of Hygiene and Tropical Medicine used new “genomic surveillance” technology to trace the spreading of MRSA (methicillin-resistant Staphyloccus aureus) in the east of England for a year. MRSA bacteria are resistant to many antibiotics and cause a wide range of diseases, from skin inflammation to fatal sepsis.

But contrary to the common idea that most MRSA transmission results from large outbreaks in hospitals, the study published in Science Translational Medicine on Wednesday showed many relatively small outbreaks “in hospitals, in the community, GP surgeries, homes and in between these places”.

“I was surprised by how many outbreaks we detected,” said Sharon Peacock, the project leader. “But the good news is that we can learn from the results to improve infection control.”


The researchers tracked everyone who tested positive for MRSA in samples submitted to the Clinical Microbiology and Public Health Laboratory in Cambridge — 1,465 people altogether. The lab serves three hospitals and 75 GP practices in the east of England.

The researchers said that sequencing of the patients’ MRSA genomes showed that the region had 173 separate infection clusters during the course of 12 months, which is “indicative of repeated lapses in infection control”. The study found that, while most of the MRSA strains were already known to circulate in the UK, some originated in other countries, such as Taiwan and the US.

“We identified a critical role for some persistent carriers who spread MRSA in multiple [hospital] wards during complex healthcare pathways,” the researchers said. “This frequently involved indirect transmission, in which apparent acquisition by a new case occurred after the index case had left the ward, which is suggestive of environmental contamination or health workers colonised [by MRSA].”

About one healthy individual in 30 in Britain and other industrialised countries is “colonised” by MRSA living harmlessly on the skin or in the nose. These “carriers” may pass the bacteria on to hospital patients who are more vulnerable, both because their immune system is weaker and because they often have a pathway for MRSA to get through the skin, such as a surgical wound, feeding tube, drip or catheter. Once MRSA is inside the body, it can quickly lead to a life-threatening infection.

Starting next year, the researchers at the Sanger Institute and London School of Hygiene and Tropical Medicine will pass on all MRSA tracking information in real time to infection control workers, who will then be able to intervene more quickly and effectively to fight outbreaks.

“Our study has shown that sequencing all MRSA samples as soon as they are isolated can rapidly pinpoint where MRSA transmission is occurring,” said Prof Peacock. “If implemented in clinical practice this would provide numerous opportunities to catch outbreaks early and target these to bring them to a close, for example by ‘decolonising’ carriers and implementing barrier nursing. 

“We have the technology in place to do this and it could have a really positive impact on public health and patient outcomes,” she added.

FT : Saudi sovereign wealth fund aims to double its assets to $400bn

Saudi sovereign wealth fund aims to double its assets to $400bn
Aramco privatisation to help fund foreign and domestic investments

Saudi Arabia’s sovereign wealth fund plans to nearly double its assets under management to $400bn by 2020 as it boosts overseas and domestic investment to kick-start weak domestic growth.

Yasir al-Rumayyan, managing director of the Public Investment Fund, told the Financial Times that funding would come from the proceeds of the privatisation of state assets, including Saudi Aramco, the oil company, government allocations, asset returns and debt.

The PIF was for years little known outside of the Gulf. But it has been garnering increasing attention as it has morphed into Crown Prince Mohammed bin Salman’s preferred vehicle to drive his planned transformation of the oil-dependent kingdom and make high profile investments overseas.

Prince Mohammed has previously said the fund could eventually reach $2tn in assets under management.

It has already paid $3.5bn for a stake in Uber, the car hailing app, and agreed to splash out $45bn in a partnership with Japan’s SoftBank to launch a technology fund, and provide half the capital for a $40bn infrastructure fund being set up by Blackstone, the US private equity firm.

Mr Rumayyan said those transactions would make up most of the fund’s international allocation. But he added that it would seek out opportunities at home and abroad.

“We are looking at companies and ventures from real estate to infrastructure,” he said. “And we have a lot more in the pipeline . . . we have too many projects.”

The fund, which has assets of about $225bn, is targeting returns of 4-5 per cent up to 2020. Overseas investment partnerships are expected to rise from 5 per cent of assets in 2017 to 25 per cent in three years, according to the fund’s plan.

But much of its focus appears to be on projects that are linked to Prince Mohammed’s ambitious reform plan, which he launched last year with the goal of creating private sector jobs and reducing the economy’s dependency on oil.

The PIF, which for decades held stakes in listed Saudi companies, plans a dramatic domestic expansion, funding megaprojects such as new resorts on the Red Sea and an entertainment complex outside Riyadh by 2022.

The fund has also said it will launch defence industries and recycling and fuel efficiency companies, as well as provide affordable housing. It has also committed half the $1bn capital required to set up Noon, an e-commerce retailer being launched to compete with Amazon in the region.

Mr Rumayyan said the PIF would work with the private sector as the government uses the fund to create “national champions” in industry.

“We are saying we want to engage the private sector with us, we are increasing business,” he said. “These are new sectors, and we need to work with others,” he said.

In recent weeks, the PIF has ploughed money into Saudi dairy producer Almarai, as the company has been hit by an economic slowdown triggered by prolonged low oil prices and weak consumer sentiment.

Still, the renewed focus on domestic activity has not prevented a who’s who of international finance, such as Blackstone and BlackRock, descending on the PIF’s investor conference in Riyadh this week in search of fundraising opportunities.

>>> Woolworths may divest Big W

Woolworths may divest Big W

Woolworths [ASX: WOW] may be moving ahead with plans for the potential divestment of its department store chain Big W, The Australian’s Dataroom reported.
According to the unsourced report, Goldman Sachs is advising Woolworths on Big W, which may interest a South African buyer eager to strengthen its presence in Australia.
The report noted that Woolworths may also be considering selling the business to a private equity firm. The paper said that Australian retail figures such as Brett Blundy or Jan Cameron may also be buyers, the paper said.

>>> Spire shareholders say Mediclinic offer undervalues company

MergerMarket

Spire shareholders say Mediclinic offer undervalues company
  • 12x to 15x EV/EBITDA appropriate valuation - shareholder
  • Shareholders highlight growing demand for private healthcare

Mediclinic’s [LON:MDC] unsolicited takeover bid for Spire Healthcare [LON:SPI] undervalues the UK-based private healthcare provider, according to a top-14 shareholder and a minority investor in the target.
A third investor, also owning a minority position, called the proposed bid “cheeky”.
Although Spire’s share price has been weighed down by legal costs related to a surgeon jailed for carrying out unnecessary operations, investors said the company’s long-term prospects were bright due to bourgeoning demand for private healthcare in the UK.
Spire rejected top shareholder Mediclinic’s offer as “severely” undervalued when the offer was made public on 23 October. Mediclinic, which already owns 29.9% of Spire, on 18 October offered to buy the remaining shares for a mixed cash and equity consideration equivalent to 298.6 pence/share based on Mediclinic's share close on 20 October.
Spire Healthcare will engage with a bidder only if an improved offer is well north of GBP 3 per share, this newswire reported earlier this week, citing a source close to the deal.
The takeover bid followed a September 2017 trading announcement that the company’s first-half profit slumped 75% due to the legal charges.
Etienne Roux, an investment analyst at Truffle Asset Management, echoed Spire’s view, saying that Mediclinic is fundamentally undervaluing Spire. Truffle Asset Management had a 1.09% stake in Spire as of 1 August, making the firm Spire’s 14th largest shareholder. Truffle is also a minority shareholder in Mediclinic.
“Our view is that there’s long-term fundamental potential for Spire in the UK market,” said Roux, adding that a funding shortfall at state-run National Health Service was driving demand for private healthcare in the UK.
“And Spire is in a good position to participate in this upside,” Roux said. The UK market presents a long-term opportunity for Mediclinic at a time when it is facing challenges in the markets it operates in – Switzerland, South Africa and the UAE, said Roux.
Mediclinic and Spire declined to comment.
“We remain positive about the long-term prospects for Spire Healthcare notwithstanding some near-term challenges,” said minority shareholder Aslam Dalvi, associate portfolio manager at Kagiso Asset Management. “As a key player in the UK private healthcare market, Spire’s future prospects therefore remain very strong, with the company well-positioned to capitalise on this fundamental transferral towards the private sector over time.”
Although shareholders would make a profit off of Spire’s 2014 listing price of 210 pence per share on the London Stock Exchange, UK institutional investors are unlikely to accept Mediclinic’s current offer, the first minority shareholder said.
Desired price
A fairer reflection of Spire’s value would be the stock’s trading level through the year, Roux said. Spire’s shares largely traded between 300 pence and 350 pence between January 2017 and the September 2017 trading update.
Mediclinic itself bought its near 30% stake in Spire at a higher price than its proposed takeover offer, said the first minority shareholder, adding that this would give Spire’s board leverage to hold out for a higher price.
Mediclinic bought its stake in Spire in a GBP 432m deal in June 2015, valuing Spire at 360 pence/share. Using Spire’s reported adjusted EBITDA for FY14, the stake acquisition valued Spire at 11.7x EV/EBITDA, according to Dealreporter analytics.
A takeover offer of 12x-15x EV/EBITDA would be appropriate for a business of Spire’s size, said the first minority shareholder.
Mediclinic’s offer reflects an EV/EBITDA valuation of 10.2x, according to Dealreporter analytics. At Spire’s 52-week high of GBP 3.85/share, it was valued at 12.33x that metric.
A bigger cash component might make the offer more attractive to shareholders, said Roux, explaining that Mediclinic equity is less desirable because its share price has been under pressure. Mediclinic shares have lost about 22% of their value this year.
However, Mediclinic is unlikely to be able to offer more cash, given its gearing, Roux said. A takeover at the current offer price could push Mediclinic’s net debt/EBITDA multiple to 3.8x from 3.3x once the company deploys GBP 421.2m in cash consideration, according to Dealreporter analytics.
Roux cautioned that there were unlikely to be large synergies from the potential combination.
For starters, there are not likely to be any back office or cost savings, he said, referring to the lack of geographical overlap between the two companies.
Mediclinic operates 50 hospitals and over two day-clinics across South Africa, and three hospitals in Namibia. The company has a stake in Switzerland's private hospital group Hirslanden AG, which operates 20 private acute care facilities and four clinics in Switzerland. Mediclinic also operates five hospitals and 40 clinics in the United Arab Emirates.
On the other hand, Spire provides in-patient, day care and out-patient care for 40 hospitals, 10 clinics and over two specialist care centres across the UK. The company owns and operates a sports medicine, physiotherapy and rehabilitation brand, besides a screening service and also has national pathology services.
There could be synergies from taking best practices from Switzerland, South Africa and the UAE to the UK, or vice versa, Roux said, adding that he wouldn’t “put a big number on it.”
by Swetha Gopinath with analytics by Amit Rawtani, CFA

>>> US Close Dow -0.48% S&P -0.47% Nasdaq -0.52% Russell -0.46%

Closing Market Summary: Wall Street Registers Second Loss of the Week

Stocks declined for the second time in three sessions on Wednesday, but an afternoon rally left the major indices a ways above their session lows. The Dow (-0.5%) and the Nasdaq (-0.5%) finished roughly in line with the S&P 500, which lost 0.5%. The benchmark index traded within a wide range, holding a loss between 0.1% and 1.0% throughout the session.

The S&P 500's telecom services sector led the retreat, finishing with a loss of 2.3%, after AT&T (T 33.49, -1.37) reported worse-than-expected earnings and revenues for the third quarter; AT&T shares lost 3.9%. Industrials also showed relative weakness, losing 1.0%. Within the group, Boeing (BA 258.42, -7.58) was among the weakest performers, shedding 2.9%, despite beating profit estimates.

As for the other sectors, most finished roughly in line with the broader market. The top-weighted technology space (-0.3%) outperformed slightly, thanks in part to Visa (V 109.49, +1.08), which added 1.0% on better-than-expected earnings and revenues. Alphabet (GOOGL 991.46, +2.97) also showed relative strength ahead of Thursday evening's earnings release.

However, the tech sector's semiconductor components struggled after Advanced Micro (AMD 12.33, -1.92) forecasted a decline in revenue for the fourth quarter. The PHLX Semiconductor Index dropped 1.3%, while AMD shares plunged 13.5%.

Chipotle Mexican Grill (CMG 277.01, -47.29) also dropped significantly on Wednesday, losing 14.6%, after posting a big miss on earnings and lowering its comparable sales guidance. However, the consumer discretionary sector (-0.4%) still beat the broader market, thanks in large part to Nike (NKE 54.94, +1.52), which jumped 2.9% after providing a solid five-year outlook at its investor day.

Dow component Coca-Cola (KO 46.05, -0.13) also reported earnings on Wednesday, beating both top and bottom line estimates, but slipped 0.3% nonetheless.

U.S. Treasuries ended on a lower note, sending yields higher across the curve; the benchmark 10-yr yield climbed four basis points to 2.44%. Speculation that Stanford University economist John Taylor, who is considered relatively hawkish, is likely to become the next Fed Chair helped fuel the sell off. 

Reviewing Wednesday's batch of economic data, which included September New Home Sales, September Durable Orders, the August FHFA Housing Price Index, and the weekly MBA Mortgage Applications Index:

  • New Home Sales in September hit an annualized rate of 667,000, which is above the revised August rate of 561,000 (from 560,000), and higher than the consensus of 555,000.
    • The key takeaway from the report is that the sales increases were broad-based, underscoring the point that the rebound in new home sales, which are counted when a contract is signed, was not just a function of a rebound from the depressed activity in the South due to the hurricanes.
  • September durable goods orders rose 2.2%, which is more than the 1.3% increase expected by the consensus. The prior month's reading was revised to +2.0% (from +1.7%). Excluding transportation, durable orders increased 0.7% (consensus +0.5%) to follow the prior month's revised uptick of 0.7% (from +0.2%).
    • The key takeaway from the report is that it is hard data that corroborates the upbeat readings in the soft manufacturing surveys; moreover, it is going to lead to stronger Q3 GDP forecasts given the 0.7% increase in shipments of nondefense capital goods excluding aircraft, which followed an upwardly revised 1.2% increase (from +0.7%) for August.
  • The FHFA Housing Price Index rose 0.7% in August (consensus 0.4%), while the July reading was revised to 0.4% from 0.2%.
  • The weekly MBA Mortgage Applications Index decreased 4.6% to follow last week's 3.6% increase.

On Thursday, investors will receive just two economic reports--weekly Initial Claims (consensus 235K) and September Pending Home Sales. The two pieces of data will cross the wires at 8:30 ET and 10:00 ET, respectively.

  • Nasdaq Composite +21.9% YTD
  • Dow Jones Industrial Average +18.1% YTD
  • S&P 500 +14.2% YTD
  • Russell 2000 +10.1% YTD

>>> BHP Billiton could explore asset divestments beyond US shale in the coming y

BHP Billiton could explore asset divestments beyond US shale in the coming years

BHP Billiton [ASX: BHP, LON:BLT] could be exploring asset divestments beyond US shale in the coming years, The Australianreported. According to the report, which did not cite sources, BHP’s chairman Ken MacKenzie and chief executive Andrew Mackenzie recently told shareholders that the group would take a close look at its portfolio of assets.
The item noted that likely divestment candidates include BHP’s stake in the Western Australia-based North West Shelf LNG venture, thermal coal assets in Colombia and Australia’s Hunter Valley, BHP’s potash project in Canada, and its Western Australia nickel operations.
The paper noted that BHP owns the Mt Arthur asset in NSW’s Hunter Valley and a stake in the Cerrejon mine in Colombia.
BHP said in August that it would sell its US shale assets.

WSJ : Vistra Energy Nears Deal to Buy Dynegy

Vistra Energy Nears Deal to Buy Dynegy
The Texas power companies, each with enterprise values north of $10 billion, could announce a deal as soon as next week

Vistra Energy Corp. VST 3.78% and Dynegy Inc., DYN 17.05% two big independent power producers, are in advanced talks to combine.

The Texas power companies, which have been in on-and-off talks since at least the spring, could announce a deal as soon as next week, people familiar with the matter said. As always, the talks could still fall apart before a deal is reached.

Even though Dynegy’s market value was just $1.2 billion Wednesday afternoon, the deal would be substantial. Including debt, the companies combined are worth more than $20 billion as both have so-called enterprise values north of $10 billion. Vistra had a market value of $8.4 billion.


The Wall Street Journal reported in May that Vistra had made a takeover approach to Dynegy and the power companies were in preliminary talks.

Dynegy is a wholesale power producer with 50 plants in 12 states around the country, producing enough energy for some 25 million homes. Customers include utilities and municipalities as well as financial players like banks and hedge funds. The Houston company also has a retail business that provides electricity to about 963,000 residential customers in Illinois, Ohio and Pennsylvania, according to its annual report.

Dallas-based Vistra operates Luminant, which produces and sells power on the open market, and retail-electricity provider TXU Energy, which serves about 1.7 million residential and business customers in Texas. Tacking on Dynegy’s power stations would broaden Vistra’s footprint to the Midwest, Northeast and other parts of the country.

Dynegy has a colorful history that includes a merger flirtation with Enron Corp. on the eve of the energy trader’s bankruptcy and its own subsequent chapter 11 case.

Vistra also has a colorful past. Investors including private-equity firms KKR & Co. KKR -1.11% and TPG bought a predecessor, TXU Corp., for $32 billion at the height of the leveraged-buyout boom that preceded the financial crisis. The deal was the largest LBO in history and a hallmark of buyout firms’ big-ticket purchases in those years.

TXU filed for chapter 11 protection in 2014 with $42 billion in debt after a decline in power prices upended its business. The operations that now form Vistra were spun out last October, a key milestone in one of the largest corporate bankruptcies in history.

The utility sector has been active despite a broader slowdown in deal making, as a slump in power prices has prompted some companies to bulk up through mergers. In August, private-equity firm Energy Capital Partners signed a deal to buy Calpine Corp. for $5.5 billion. In the same month, Sempra Energy reached a deal to buy Oncor, another TXU descendant, for $9.45 billion after swooping in to snatch the power-transmission company away from Warren Buffett’s Berkshire Hathaway Inc.