Adjunctive rifampicin for Staphylococcus aureus bacteraemia (ARREST): a multicentre, randomised, double-blind, placebo-controlled trial.

BACKGROUND: Staphylococcus aureus bacteraemia is a common cause of severe community-acquired and hospital-acquired infection worldwide. We tested the hypothesis that adjunctive rifampicin would reduce bacteriologically confirmed treatment failure or disease recurrence, or death, by enhancing early S aureus killing, sterilising infected foci and blood faster, and reducing risks of dissemination and metastatic infection. METHODS: In this multicentre, randomised, double-blind, placebo-controlled trial, adults (≥18 years) with S aureus bacteraemia who had received ≤96 h of active antibiotic therapy were recruited from 29 UK hospitals. Patients were randomly assigned (1:1) via a computer-generated sequential randomisation list to receive 2 weeks of adjunctive rifampicin (600 mg or 900 mg per day according to weight, oral or intravenous) versus identical placebo, together with standard antibiotic therapy. Randomisation was stratified by centre. Patients, investigators, and those caring for the patients were masked to group allocation. The primary outcome was time to bacteriologically confirmed treatment failure or disease recurrence, or death (all-cause), from randomisation to 12 weeks, adjudicated by an independent review committee masked to the treatment. Analysis was intention to treat. This trial was registered, number ISRCTN37666216, and is closed to new participants. FINDINGS: Between Dec 10, 2012, and Oct 25, 2016, 758 eligible participants were randomly assigned: 370 to rifampicin and 388 to placebo. 485 (64%) participants had community-acquired S aureus infections, and 132 (17%) had nosocomial S aureus infections. 47 (6%) had meticillin-resistant infections. 301 (40%) participants had an initial deep infection focus. Standard antibiotics were given for 29 (IQR 18-45) days; 619 (82%) participants received flucloxacillin. By week 12, 62 (17%) of participants who received rifampicin versus 71 (18%) who received placebo experienced treatment failure or disease recurrence, or died (absolute risk difference -1·4%, 95% CI -7·0 to 4·3; hazard ratio 0·96, 0·68-1·35, p=0·81). From randomisation to 12 weeks, no evidence of differences in serious (p=0·17) or grade 3-4 (p=0·36) adverse events were observed; however, 63 (17%) participants in the rifampicin group versus 39 (10%) in the placebo group had antibiotic or trial drug-modifying adverse events (p=0·004), and 24 (6%) versus six (2%) had drug interactions (p=0·0005). INTERPRETATION: Adjunctive rifampicin provided no overall benefit over standard antibiotic therapy in adults with S aureus bacteraemia. FUNDING: UK National Institute for Health Research Health Technology Assessment

UAS Literary & Arts Journal 2003

Tidal Echoes presents an annual showcase of writers and artists who share one thing in common: a life surrounded by the rainforests and waterways of Southeast Alaska.Poetry -- Sigrid -- Aurora Borealis -- My Sister's Workshop -- Sonnet -- Hand Me Downs -- Flight -- Just So You Know -- Blinding White -- Blue Hour -- Bubbles -- Wile E. Coyote -- Ode -- Gateways -- Atlantic Ocean -- Independently Linked -- Wild Alberta -- Prose -- Heaven's Border -- Adora Never Lights Her Own Cigarette -- How to Write Description -- Excerpt from House of Jade -- Homeschool-High School Is Not an Oxymoron -- An Interview with Lynn Schooler -- Naked Tree/Dusk, woodcut -- Entity, in pencil -- My Secret Aria, in ink -- Bubbles of Circu-lar-stance, in ink -- Nothing Special, woodcut -- True Self, in pencil -- Margaret, in in

Tidal Echoes 2004

Tidal Echoes 2004 features the work of the students, faculty, and staff of the University of Alaska Southeast.Chancellor John PughHomeward / Green, Charity -- Welcome / Editors -- Introduction to Poetry / Editors -- Belfast: Summer 1984 / Bausler, Katie -- Fish Pitcher with Sprayed Glazes / Weckel, Steve -- Female Figure / Hemmings, Chris -- Donegal / Doran, Tom -- Pilgrimage / Summer, Amy -- Salmon for Turkey / Grifin, Danél -- An Elegy for Alysha / Sotomayor, Ryan Adam -- Gene Puddle / Rosen, Amoeba -- untitled / Ouellette, Lisa -- You Are My Brother / Galeana, Sandra -- Dying / Ristau, Alicia -- Wash Away / Hamilton, Kaci -- Teapot / Weaver, Diana -- La Rive Meurt / Carter, Sarah -- Blue / Wargi, Stephanie -- Time of a Lifeline / Bausler, Katie -- Veil / McLean, Emily -- Northern Skies / Doran, Tom -- Draught / Sumner, Amy -- Confessions of a Future Drag Queen / Hamilton, Kaci -- Brasilliance / Weishahn, Clara -- Introduction to Non-Fiction / Editors -- The Little Bird / Olsen, Nellie -- Fireweed and Cowparsnip / Greening, Barbara -- Rhythm of the Reds / Burket, Rebekah -- Fisherman’s Boots / Green, Charity -- A Friendship That Lives On / Ashraf, Amina -- Harbor View / Eastaugh, Heather -- My Friend Mop / Branlund, William -- untitled / Grant, Ian -- Life’s Funny Little Curve Balls / Mauck, Ronda -- The Valid One / Carrillo, Karla- - Film As Art: The Target / Griffin, Danél -- Frog Pot / Brown, Tom -- Introduction to Fiction / Editors -- Bear Miss / Jones, Edward -- Vase with Cedar Bark / Steward, Marge -- Where Classics Collide / Weber, Rob -- untitled / Berner, Logan -- Going North? / Reed, Melan*e -- New Age Love / Mitchell, Holly -- Tri Lily / Hegel, Crystal -- My Grandpa and I / McLean, Emily -- Eagle-Raven Regalia Blanket / Branlund, William -- Contributor

Does a 15-minute brief mindfulness breathing exercise temporarily enhance inhibitory control and cognitive flexibility? A within-subject experimental approach

Singapore MOE Academic Research Fund Tier 1; SMU Lee Kong Chian Fund for Research Excellenc

Risk of COVID-19 after natural infection or vaccinationResearch in context

Summary: Background: While vaccines have established utility against COVID-19, phase 3 efficacy studies have generally not comprehensively evaluated protection provided by previous infection or hybrid immunity (previous infection plus vaccination). Individual patient data from US government-supported harmonized vaccine trials provide an unprecedented sample population to address this issue. We characterized the protective efficacy of previous SARS-CoV-2 infection and hybrid immunity against COVID-19 early in the pandemic over three-to six-month follow-up and compared with vaccine-associated protection. Methods: In this post-hoc cross-protocol analysis of the Moderna, AstraZeneca, Janssen, and Novavax COVID-19 vaccine clinical trials, we allocated participants into four groups based on previous-infection status at enrolment and treatment: no previous infection/placebo; previous infection/placebo; no previous infection/vaccine; and previous infection/vaccine. The main outcome was RT-PCR-confirmed COVID-19 >7–15 days (per original protocols) after final study injection. We calculated crude and adjusted efficacy measures. Findings: Previous infection/placebo participants had a 92% decreased risk of future COVID-19 compared to no previous infection/placebo participants (overall hazard ratio [HR] ratio: 0.08; 95% CI: 0.05–0.13). Among single-dose Janssen participants, hybrid immunity conferred greater protection than vaccine alone (HR: 0.03; 95% CI: 0.01–0.10). Too few infections were observed to draw statistical inferences comparing hybrid immunity to vaccine alone for other trials. Vaccination, previous infection, and hybrid immunity all provided near-complete protection against severe disease. Interpretation: Previous infection, any hybrid immunity, and two-dose vaccination all provided substantial protection against symptomatic and severe COVID-19 through the early Delta period. Thus, as a surrogate for natural infection, vaccination remains the safest approach to protection. Funding: National Institutes of Health

Risk of COVID-19 after natural infection or vaccinationResearch in context

Background: While vaccines have established utility against COVID-19, phase 3 efficacy studies have generally not comprehensively evaluated protection provided by previous infection or hybrid immunity (previous infection plus vaccination). Individual patient data from US government-supported harmonized vaccine trials provide an unprecedented sample population to address this issue. We characterized the protective efficacy of previous SARS-CoV-2 infection and hybrid immunity against COVID-19 early in the pandemic over three-to six-month follow-up and compared with vaccine-associated protection. Methods: In this post-hoc cross-protocol analysis of the Moderna, AstraZeneca, Janssen, and Novavax COVID-19 vaccine clinical trials, we allocated participants into four groups based on previous-infection status at enrolment and treatment: no previous infection/placebo; previous infection/placebo; no previous infection/vaccine; and previous infection/vaccine. The main outcome was RT-PCR-confirmed COVID-19 >7–15 days (per original protocols) after final study injection. We calculated crude and adjusted efficacy measures. Findings: Previous infection/placebo participants had a 92% decreased risk of future COVID-19 compared to no previous infection/placebo participants (overall hazard ratio [HR] ratio: 0.08; 95% CI: 0.05–0.13). Among single-dose Janssen participants, hybrid immunity conferred greater protection than vaccine alone (HR: 0.03; 95% CI: 0.01–0.10). Too few infections were observed to draw statistical inferences comparing hybrid immunity to vaccine alone for other trials. Vaccination, previous infection, and hybrid immunity all provided near-complete protection against severe disease. Interpretation: Previous infection, any hybrid immunity, and two-dose vaccination all provided substantial protection against symptomatic and severe COVID-19 through the early Delta period. Thus, as a surrogate for natural infection, vaccination remains the safest approach to protection. Funding: National Institutes of Health