Community- versus healthcare-acquired bloodstream infections at Groote Schuur Hospital, Cape Town, South Africa

Background. Bloodstream infections (BSIs) cause considerable morbidity and mortality. The  epidemiology of bacterial infections differs in community and hospital settings. Regular surveillance and  reporting of pathogens and antimicrobial susceptibility can assist in appropriate management of BSIs.Objectives. To describe the distribution of organisms and of antibiotic susceptibility among isolates from blood cultures at a tertiary academic hospital during a 1-year period, stratifying by place of infection  acquisition.Methods. This was a retrospective descriptive study of bloodstream isolates from cultures from adults (>13 years of age) routinely submitted between 1 October 2011 and 30 September 2012 to the clinical  laboratory at Groote Schuur Hospital, Cape Town, South Africa. Community-acquired infections were compared with healthcare-acquired infections, defined as infections developing at least 48 hours after admission or within 3 months of admission to a healthcare facility. Frequencies and proportions of  infecting organisms are presented, along with susceptibility results for selected pathogens. The hospital-acquired isolates were stratified by ward (emergency, general medical or general surgical ward or intensive care unit (ICU)) to determine organism frequency and susceptibility patterns by hospital ward.Results. Among adults, 740 non-duplicate pathogens were isolated from BSIs. Nearly three-quarters of infections were healthcare acquired. Enterobacteriaceae and non-fermentative Gram-negative bacilli were predominant among healthcare-acquired pathogens (39.2% and 28.5%, respectively), while   Enterobacteriaceae and Gram-positive organisms were the most common among community-acquired pathogens (39.2% and 54.3%, respectively). The majority of community-acquired Enterobacteriaceae were highly susceptible to antibiotics (gentamicin 95.6%, ceftriaxone 96.1% and ciprofloxacin 92.2%),  whereas 64.6% of healthcare-associated isolates were susceptible to gentamicin, 58.5% to ceftriaxone and 70% to ciprofloxacin. All community-acquired Staphylococcus aureus isolates v. 52.4% of   healthcare-acquired isolates were susceptible to cloxacillin. The susceptibility of healthcare-acquired Pseudomonas aeruginosa and Acinetobacter baumanii complex isolates was <80% to all antibiotics with the exception of colistin. Klebsiella spp., S. aureus and Escherichia coli were the commonest causes of healthcareacquired infections in all areas outside of the ICUs, whereas Acinetobacter was common in the  ICUs and rare in all other areas.Conclusion. The distinction between community- and healthcare-acquired infections is critical in antibiotic selection because narrowspectrum agents can be utilised for community-acquired infections. The considerable antibiotic resistance of healthcare-acquired pathogens highlights the importance of infection prevention and control. This type of surveillance could be incorporated into routine laboratory practice

Galaxy bimodality versus stellar mass and environment

We analyse a z<0.1 galaxy sample from the Sloan Digital Sky Survey focusing on the variation of the galaxy colour bimodality with stellar mass and projected neighbour density Sigma, and on measurements of the galaxy stellar mass functions. The characteristic mass increases with environmental density from about 10^10.6 Msun to 10^10.9 Msun (Kroupa IMF, H_0=70) for Sigma in the range 0.1--10 per Mpc^2. The galaxy population naturally divides into a red and blue sequence with the locus of the sequences in colour-mass and colour-concentration index not varying strongly with environment. The fraction of galaxies on the red sequence is determined in bins of 0.2 in log Sigma and log mass (12 x 13 bins). The red fraction f_r generally increases continuously in both Sigma and mass such that there is a unified relation: f_r = F(Sigma,mass). Two simple functions are proposed which provide good fits to the data. These data are compared with analogous quantities in semi-analytical models based on the Millennium N-body simulation: the Bower et al. (2006) and Croton et al. (2006) models that incorporate AGN feedback. Both models predict a strong dependence of the red fraction on stellar mass and environment that is qualitatively similar to the observations. However, a quantitative comparison shows that the Bower et al. model is a significantly better match; this appears to be due to the different treatment of feedback in central galaxies.Comment: 19 pages, 17 figures; accepted by MNRAS, minor change

The development of a theory-based intervention to promote appropriate disclosure of a diagnosis of dementia

Background: The development and description of interventions to change professional practice are often limited by the lack of an explicit theoretical and empirical basis. We set out to develop an intervention to promote appropriate disclosure of a diagnosis of dementia based on theoretical and empirical work. Methods: We identified three key disclosure behaviours: finding out what the patient already knows or suspects about their diagnosis; using the actual words 'dementia' or 'Alzheimer's disease' when talking to the patient; and exploring what the diagnosis means to the patient. We conducted a questionnaire survey of older peoples' mental health teams (MHTs) based upon theoretical constructs from the Theory of Planned Behaviour (TPB) and Social Cognitive Theory (SCT) and used the findings to identify factors that predicted mental health professionals' intentions to perform each behaviour. We selected behaviour change techniques likely to alter these factors. Results: The change techniques selected were: persuasive communication to target subjective norm; behavioural modelling and graded tasks to target self-efficacy; persuasive communication to target attitude towards the use of explicit terminology when talking to the patient; and behavioural modelling by MHTs to target perceived behavioural control for finding out what the patient already knows or suspects and exploring what the diagnosis means to the patient. We operationalised these behaviour change techniques using an interactive 'pen and paper' intervention designed to increase intentions to perform the three target behaviours. Conclusion : It is feasible to develop an intervention to change professional behaviour based upon theoretical models, empirical data and evidence based behaviour change techniques. The next step is to evaluate the effect of such an intervention on behavioural intention. We argue that this approach to development and reporting of interventions will contribute to the science of implementation by providing replicable interventions that illuminate the principles and processes underlying change.This project is funded by UK Medical Research Council, Grant reference number G0300999. Jeremy Grimshaw holds a Canada Research Chair in Health Knowledge Transfer and Uptake. Jill Francis is funded by the Chief Scientist Office of the Scottish Government Health Directorate. The views expressed in this study are those of the authors

Randomised controlled trial of ranitidine versus omeprazole in combination with antibiotics for eradication of Helicobacter pylori.

This study compared high dose ranitidine versus low dose omeprazole with antibiotics for the eradication of H pylori. 80 patients (mean age 48 years, range 18-75) who had H pylori infection were randomised in an investigator-blind manner to either a two-week regime of omeprazole 20 mg daily, amoxycillin 500 mg tid and metronidazole 400 mg tid (OAM), or ranitidine 600 mg bd, amoxycillin 500 mg tid and metronidazole 400 mg tid (RAM), or omeprazole 20 mg daily and clarithromycin 500 mg tid (OC), or omeprazole 20 mg daily and placebo (OP). H pylori was eradicated in 6 of 19 patients in the OAM group (32%); 8 of 18 in the RAM group (44%), 4 of 15 in the OC group (27%); none of 18 in the OP group (0%). [< P0.005 for OAM, RAM, OC vs OP; P = N.S. between OAM, RAM, OC]. Overall metronidazole resistance was unexpectedly high at 58%. Eradication rates in metronidazole sensitive patients were 71% (5/7) and 100% (3/3) for OAM and RAM respectively. In conclusion, H pylori eradication rates using high dose ranitidine plus amoxycillin and metronidazole may be similar to that of low dose omeprazole in combination with the same antibiotics for omeprazole with clarithromycin. Overall eradication rates were low due to a high incidence of metronidazole resistance but were higher in metronidazole-sensitive patients. Even high dose ranitidine with two antibiotics achieves a relatively low eradication rate. These metronidazole-based regimens cannot be recommended in areas with a high incidence of metronidazole resistance

Severe and enduring anorexia nervosa:Update and observations about the current clinical reality

Several objectives underlie the current article. First, to review historical diagnostic issues and clinical strategies for treating SE-AN. Second, to provide an overview of recent evidence informed strategies and clinical innovations for the treatment of SE-AN. Third, based on the authors' collective clinical and research experience, we offer eight observations that we believe capture the current clinical experience of patients with SE-AN. Some of these observations represent empirically testable hypotheses, but all are designed to generate a meaningful discussion about the treatment of this group of individuals with eating disorders. Finally, we hope to call clinicians, scientists, professional organizations, advocates, and policy makers to action to attend to critical issues related to the care of individuals with SE-AN. We believe that an international discussion could clarify areas of need for these patients and identify opportunities for clinical innovation that would enhance the lives of individuals with SE-AN and their families

Surveillance and comparison of antimicrobial susceptibility patterns of ESKAPE organisms isolated from patients with bacteraemia in South Africa, 2016 - 2017

Background. In South Africa (SA), the National Department of Health has developed an Antimicrobial Resistance National Strategy Framework document to manage antimicrobial resistance (AMR). One of the strategic objectives is to optimise surveillance and early detection of AMR. At the National Institute for Communicable Diseases (NICD), an analysis of selected organisms and antimicrobial agents from both the public and the private sectors was conducted.Objectives. The relevance of surveillance for AMR is increasingly recognised in the light of global action plans to combat resistance. In this report, we present an overview of ESKAPE (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, Enterobacter spp.) organisms and Escherichia coli reported from public and private sector laboratories in SA for the period 2016 - 2017.Methods. Antimicrobial susceptibility testing (AST) profiles on selected ESKAPE organisms and E. coli isolated from blood cultures from the public and private sectors in 2016 and 2017 were analysed. AST data were extracted from a web-based electronic platform created by the NICD. Drug-bug combinations following the World Health Organization’s Global Antimicrobial Surveillance System guidelines were included in the analysis.Results. A total of 28 920 ESKAPE organisms and E. coli were reported in 2016 and 32 293 in 2017 across the two health sectors. Proportions of some organisms differed between the two health sectors, such as E. coli (19% in the public sector and 36% in the private sector), A. baumannii (14% public and 4% private), P. aeruginosa (7% public and 11% private) and S. aureus (27% public and 17% private). Susceptibility data indicated changing patterns in both sectors towards an increase in non-susceptibility to carbapenems in K. pneumoniae (p&lt;0.01). However, we demonstrated an increase in susceptibility to cloxacillin in S. aureus (p&lt;0.01) in both sectors.Conclusions. The key clinically important finding is the rapidly decreasing carbapenem susceptibility among Enterobacteriaceae reported in SA, irrespective of sector. In addition, the analysis provides information that could be used to monitor the effectiveness of interventions implemented at a national level under the guidance and direction of the national AMR framework.

Galaxy Zoo Builder: Four-component Photometric Decomposition of Spiral Galaxies Guided by Citizen Science

Multicomponent modeling of galaxies is a valuable tool in the effort to quantitatively understand galaxy evolution, yet the use of the technique is plagued by issues of convergence, model selection, and parameter degeneracies. These issues limit its application over large samples to the simplest models, with complex models being applied only to very small samples. We attempt to resolve this dilemma of "quantity or quality"by developing a novel framework, built inside the Zooniverse citizen-science platform, to enable the crowdsourcing of model creation for Sloan Digital Sky Survey galaxies. We have applied the method, including a final algorithmic optimization step, on a test sample of 198 galaxies, and examine the robustness of this new method. We also compare it to automated fitting pipelines, demonstrating that it is possible to consistently recover accurate models that either show good agreement with, or improve on, prior work. We conclude that citizen science is a promising technique for modeling images of complex galaxies, and release our catalog of models

An exploration of the effectiveness of artificial mini-magnetospheres as a potential solar storm shelter for long term human space missions

If mankind is to explore the solar system beyond the confines of our Earth and Moon the problem of radiation protection must be addressed. Galactic cosmic rays and highly variable energetic solar particles are an ever-present hazard in interplanetary space. Electric and/or magnetic fields have been suggested as deflection shields in the past, but these treated space as an empty vacuum. In fact it is not empty. Space contains a plasma known as the solar wind; a constant flow of protons and electrons coming from the Sun. In this paper we explore the effectiveness of a “mini-magnetosphere” acting as a radiation protection shield. We explicitly include the plasma physics necessary to account for the solar wind and its induced effects. We show that, by capturing/containing this plasma, we enhance the effectiveness of the shield. Further evidence to support our conclusions can be obtained from studying naturally occurring “mini-magnetospheres” on the Moon. These magnetic anomalies (related to “lunar swirls”) exhibit many of the effects seen in laboratory experiments and computer simulations. If shown to be feasible, this technology could become the gateway to manned exploration of interplanetary space

Irradiation-induced Ag nanocluster nucleation in silicate glasses: analogy with photography

The synthesis of Ag nanoclusters in sodalime silicate glasses and silica was studied by optical absorption (OA) and electron spin resonance (ESR) experiments under both low (gamma-ray) and high (MeV ion) deposited energy density irradiation conditions. Both types of irradiation create electrons and holes whose density and thermal evolution - notably via their interaction with defects - are shown to determine the clustering and growth rates of Ag nanocrystals. We thus establish the influence of redox interactions of defects and silver (poly)ions. The mechanisms are similar to the latent image formation in photography: irradiation-induced photoelectrons are trapped within the glass matrix, notably on dissolved noble metal ions and defects, which are thus neutralized (reverse oxidation reactions are also shown to exist). Annealing promotes metal atom diffusion, which in turn leads to cluster nuclei formation. The cluster density depends not only on the irradiation fluence, but also - and primarily - on the density of deposited energy and the redox properties of the glass. Ion irradiation (i.e., large deposited energy density) is far more effective in cluster formation, despite its lower neutralization efficiency (from Ag+ to Ag0) as compared to gamma photon irradiation.Comment: 48 pages, 18 figures, revised version publ. in Phys. Rev. B, pdf fil