Evaluation of MGIT 960 and the colorimetric-based method for tuberculosis drug susceptibility testing

SETTING: Dr Cetrángolo Hospital, Buenos Aires Province, Argentina. OBJECTIVE: Evaluation of the BACTEC? Mycobacteria Growth Indicator Tube (MGIT)? 960 system and the colorimetric-based method (CMM) for fi rst- and second line drug susceptibility testing (FL-DST, SL-DST) against Mycobacterium tuberculosis. DESIGN: FL-DST was studied using SIRE MGIT 960. Minimal inhibitory concentrations (MICs) for isoniazid (INH), streptomycin, rifampicin (RMP), ethambutol (EMB) and levofl oxacin (LVX) were also determined by CMM using 3-(4,5-dimethylthiazolyl-2)-2,5-diphenyltetrazolium bromide (MTT). MICs for amikacin (AMK), kanamycin (KM), capreomycin (CPM), ethionamide (ETH), cycloserine, ofl oxacin (OFX), linezolide (LZ) and moxifl oxacin (MFX) were determined on 94 multidrug resistant M. tuberculosis isolates by MGIT 960 and CMM. Statistical methods were applied to define drug susceptible and drug-resistant isolates on the basis of the comparison between results obtained by gold standards. RESULTS: A total of 1626 clinical isolates were studied. Critical drug concentrations could be defi ned in less than 10 days for both CMM and MGIT 960. CMM was cheaper but more laborious than MGIT 960. The highest performances of both methods were achieved for AMK, RMP, OFX, LZ and MFX, followed by INH, ETH, KM, CPM and LVX (tested only by CMM). CONCLUSIONS: Both methods could be implemented as rapid diagnostic tools to detect drug-resistant isolates in clinical practice.Fil: Morcillo, N.. Provincia de Buenos Aires. Ministerio de Salud. Hospital "Dr. Antonio A. Cetrángolo"; ArgentinaFil: Imperiale, Belén Rocío. Provincia de Buenos Aires. Ministerio de Salud. Hospital "Dr. Antonio A. Cetrángolo"; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Di Giulio, B.. Provincia de Buenos Aires. Ministerio de Salud. Hospital "Dr. Antonio A. Cetrángolo"; Argentin

Evaluation of MGIT 960 and the colorimetric-based method for tuberculosis drug susceptibility testing

SETTING: Dr Cetrángolo Hospital, Buenos Aires Province, Argentina. OBJECTIVE: Evaluation of the BACTEC? Mycobacteria Growth Indicator Tube (MGIT)? 960 system and the colorimetric-based method (CMM) for fi rst- and second line drug susceptibility testing (FL-DST, SL-DST) against Mycobacterium tuberculosis. DESIGN: FL-DST was studied using SIRE MGIT 960. Minimal inhibitory concentrations (MICs) for isoniazid (INH), streptomycin, rifampicin (RMP), ethambutol (EMB) and levofl oxacin (LVX) were also determined by CMM using 3-(4,5-dimethylthiazolyl-2)-2,5-diphenyltetrazolium bromide (MTT). MICs for amikacin (AMK), kanamycin (KM), capreomycin (CPM), ethionamide (ETH), cycloserine, ofl oxacin (OFX), linezolide (LZ) and moxifl oxacin (MFX) were determined on 94 multidrug resistant M. tuberculosis isolates by MGIT 960 and CMM. Statistical methods were applied to define drug susceptible and drug-resistant isolates on the basis of the comparison between results obtained by gold standards. RESULTS: A total of 1626 clinical isolates were studied. Critical drug concentrations could be defi ned in less than 10 days for both CMM and MGIT 960. CMM was cheaper but more laborious than MGIT 960. The highest performances of both methods were achieved for AMK, RMP, OFX, LZ and MFX, followed by INH, ETH, KM, CPM and LVX (tested only by CMM). CONCLUSIONS: Both methods could be implemented as rapid diagnostic tools to detect drug-resistant isolates in clinical practice.Fil: Morcillo, N.. Provincia de Buenos Aires. Ministerio de Salud. Hospital "Dr. Antonio A. Cetrángolo"; ArgentinaFil: Imperiale, Belén Rocío. Provincia de Buenos Aires. Ministerio de Salud. Hospital "Dr. Antonio A. Cetrángolo"; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Di Giulio, B.. Provincia de Buenos Aires. Ministerio de Salud. Hospital "Dr. Antonio A. Cetrángolo"; Argentin

Awareness without learning: A preliminary study exploring the effects of beachgoer's experiences on risk taking behaviours

Most drowning deaths on Australian beaches occur in locations not patrolled by lifeguards. At patrolled locations, where lifeguards supervise flagged areas in which beachgoers are encouraged to swim between, the incidence of drowning is reduced. To date, risk prevention practices on coasts focus on patrolled beaches, deploying warning signs at unpatrolled locations with the aim of raising public awareness of risk. What remains unexplored is the potential for learning and behaviour change that can transfer from patrolled to unpatrolled beaches through beachgoer's experiences and interactions with lifeguards. The aim of this preliminary study is to explore the risk perceptions of beachgoers at a patrolled beach to establish if and how their experiences of beach risk and interactions with lifeguards affect their behaviours. Data was collected in Gerroa, Australia by engaging 49 beachgoers using a mixed survey-interview methodology. Results show that beachgoers are aware that they should ‘swim between the flags’, but many did not know the basis for the positioning of safety flags. A key finding is that beachgoer's express a clear desire for a skills-based model of community engagement that enables learning with lifeguards. This demonstrates a reflective public that desires skill-development, which may transfer from patrolled to unpatrolled beaches to affect broader risk reduction on the Australian coast. Learning how to avoid site-specific rip hazards with lifeguards at the beach presents a promising, and previously unexplored model for beach drowning risk prevention that has the potential to affect behaviour at unpatrolled beaches, providing an empirically-supported alternative to prevailing deficit-based awareness raising methods

Resilience Assessment : International Best Practice Principles

PURPOSE This document sets out international best-practice principles for resilience assessment being undertaken within an impact assessment (IA) of some project, plan, programme, or policy (in this context, its function may be different to that of a self-standing resilience assessment). Resilience assessment can contribute to impact assessment by defining specific disturbances that can lead to failure of natural, social, and engineered systems. The disturbance can be caused either by the proposed action, factors beyond the influence of proposed action, or combination of both. The impact assessment can consider all these factors within one coherent framework. It can identify synergies and knock-on effects that can cause potential system failures, and advise on interventions that avoid failures in the critical functions of the system BACKGROUND Resilience assessment evaluates the structure and function of a system of focus (hereafter ‘focal system’) and, in the context of an impact assessment, focuses on the effects of the proposed action on the resilience of that focal system. The focal system can include: socio-ecological, biophysical, engineering, technological, or other components. Resilience assessment should ideally examine the consequences of the proposed action in combination with internal or external factors that may collectively influence the resilience of the focal system (e.g., biophysical system change caused by global warming on engineered structures)

NGS transcriptomic analysis uncovers the possible resistance mechanisms of olive to Spilocea oleagina leaf spot infection

Spilocea oleagina is a dangerous obligate fungal pathogen of olive, feared in the Mediterranean countries, causing Peacock's eye or leaf spot infection, which can lead to a serious yield loss of approximately 20% or higher depending on climatic conditions. Coping with this disease is much more problematic for organic farms. To date, knowledge on the genetic control of possible mechanisms of resistance/low susceptibility is quite limited. In this work, comparative transcriptomic analysis (RNA-seq) was conducted in leaf tissues of a low susceptible cultivar Koroneiki and a high susceptible cultivar Nocellara del Belice, both tested in the field using the NaOH test, considering two stages-"zero sign of disease" and "evident sign of infection". Cultivars showed a very large number of differentially expressed genes (DEGs) in both stages. 'Koroneiki' showed an extensive hormonal crosstalk, involving Abscisic acid (ABA) and ethylene synergistically acting with Jasmonate, with early signaling of the disease and remarkable defense responses against Spilocea through the over-expression of many resistance gene analogs or pathogenesis-related (PR) genes: non-specific lipid-transfer genes (nsLTPs), LRR receptor-like serine/threonine-protein kinase genes, GDSL esterase lipase, defensin Ec-AMP-D2-like, pathogenesis-related leaf protein 6-like, Thaumatin-like gene, Mildew resistance Locus O (MLO) gene, glycine-rich protein (GRP), MADS-box genes, STH-21-like, endochitinases, glucan endo-1,3-beta-glucosidases, and finally, many proteinases. Numerous genes involved in cell wall biogenesis, remodeling, and cell wall-based defense, including lignin synthesis, were also upregulated in the resistant cultivar, indicating the possible role of wall composition in disease resistance. It was remarkable that many transcription factors (TS), some of which involved in Induced Systemic Resistance (ISR), as well as some also involved in abiotic stress response, were found to be uniquely expressed in 'Koroneiki', while 'Nocellara del Belice' was lacking an effective system of defense, expressing genes that overlap with wounding responses, and, to a minor extent, genes related to phenylpropanoid and terpenoid pathways. Only a Thaumatin-like gene was found in both cultivars showing a similar expression. In this work, the genetic factors and mechanism underlying the putative resistance trait against this fungal pathogen were unraveled for the first time and possible target genes for breeding resistant olive genotypes were found

Evaluating a Modular Decision Support Application For Colorectal Cancer Screening

BACKGROUND: There is a need for health information technology evaluation that goes beyond randomized controlled trials to include consideration of usability, cognition, feedback from representative users, and impact on efficiency, data quality, and clinical workflow. This article presents an evaluation illustrating one approach to this need using the Decision-Centered Design framework. OBJECTIVE: To evaluate, through a Decision-Centered Design framework, the ability of the Screening and Surveillance App to support primary care clinicians in tracking and managing colorectal cancer testing. METHODS: We leveraged two evaluation formats, online and in-person, to obtain feedback from a range primary care clinicians and obtain comparative data. Both the online and in-person evaluations used mock patient data to simulate challenging patient scenarios. Primary care clinicians responded to a series of colorectal cancer-related questions about each patient and made recommendations for screening. We collected data on performance, perceived workload, and usability. Key elements of Decision-Centered Design include evaluation in the context of realistic, challenging scenarios and measures designed to explore impact on cognitive performance. RESULTS: Comparison of means revealed increases in accuracy, efficiency, and usability and decreases in perceived mental effort and workload when using the Screening and Surveillance App. CONCLUSION: The results speak to the benefits of using the Decision-Centered Design approach in the analysis, design, and evaluation of Health Information Technology. Furthermore, the Screening and Surveillance App shows promise for filling decision support gaps in current electronic health records

Online teacher training in a context for forced immobility: the Case of Gaza, Palestine

This article discusses an action research study that involved the design and delivery of an online training course for teachers of Arabic to speakers of other languages in the Gaza Strip (Palestine). Grounded in Freirean pedagogy, the course aimed to respond to the employment needs of university graduates by creating opportunities for online language teaching. The action research study explored the dynamics at play within the online educational environment, to evidence elements that challenged and/or facilitated effective collaboration between trainers and trainees. This article retraces and discusses the processes through which the course moved from didacticism to engaged critical pedagogy

Lower provider volume is associated with higher failure rates for endoscopic retrograde cholangiopancreatography

BACKGROUND: Among physicians who perform endoscopic retrograde cholangiopancreatography (ERCP), the relationship between procedure volume and outcome is unknown. OBJECTIVE: Quantify the ERCP volume-outcome relationship by measuring provider-specific failure rates, hospitalization rates, and other quality measures. RESEARCH DESIGN: Retrospective cohort. SUBJECTS: A total of 16,968 ERCPs performed by 130 physicians between 2001 and 2011, identified in the Indiana Network for Patient Care. MEASURES: Physicians were classified by their average annual Indiana Network for Patient Care volume and stratified into low (<25/y) and high (≥25/y). Outcomes included failed procedures, defined as repeat ERCP, percutaneous transhepatic cholangiography or surgical exploration of the bile duct≤7 days after the index procedure, hospitalization rates, and 30-day mortality. RESULTS: Among 15,514 index ERCPs, there were 1163 (7.5%) failures; the failure rate was higher among low (9.5%) compared with high volume (5.7%) providers (P<0.001). A second ERCP within 7 days (a subgroup of failure rate) occurred more frequently when the original ERCP was performed by a low-volume (4.1%) versus a high-volume physician (2.3%, P=0.013). Patients were more frequently hospitalized within 24 hours when the ERCP was performed by a low-volume (28.3%) versus high-volume physician (14.8%, P=0.002). Mortality within 30 days was similar (low=1.9%, high=1.9%). Among low-volume physicians and after adjusting, the odds of having a failed procedure decreased 3.3% (95% confidence interval, 1.6%-5.0%, P<0.001) with each additional ERCP performed per year. CONCLUSIONS: Lower provider volume is associated with higher failure rate for ERCP, and greater need for postprocedure hospitalization