Characterization of coagulase-negative staphylococcal isolates from blood with reduced susceptibility to glycopeptides and therapeutic options

<p>Abstract</p> <p>Background</p> <p>Coagulase-negative staphylococci (CoNS) are a major cause of nosocomial blood stream infection, especially in critically ill and haematology patients. CoNS are usually multidrug-resistant and glycopeptide antibiotics have been to date considered the drugs of choice for treatment. The aim of this study was to characterize CoNS with reduced susceptibility to glycopeptides causing blood stream infection (BSI) in critically ill and haematology patients at the University Hospital Tor Vergata, Rome, Italy, in 2007.</p> <p>Methods</p> <p>Hospital microbiology records for transplant haematology and ICU were reviewed to identify CoNS with elevated MICs for glycopeptides, and isolates were matched to clinical records to determine whether the isolates caused a BSI. The isolates were tested for susceptibility to new drugs daptomicin and tigecycline and the genetic relationship was assessed using f-AFLP.</p> <p>Results</p> <p>Of a total of 17,418 blood cultures, 1,609 were positive for CoNS and of these, 87 (5.4%) displayed reduced susceptibility to glycopeptides. Clinical review revealed that in 13 cases (7 in haematology and 6 in ICU), CoNS with reduced susceptibility to glycopeptides were responsible for a BSI. <it>Staphylococcus epidermidis </it>was the causative organism in 11 instances and <it>Staphylococcus haemolyticus </it>in 2. The incidence of oxacillin resistance was high (77%), although all isolates remained susceptible to linezolid, daptomycin and tigecycline. Fingerprinting of CoNS identified one clonal relationship between two isolates.</p> <p>Conclusion</p> <p>Multi-resistant CoNS with reduced susceptibility to glycopeptides, although still relatively infrequent in our hospital, are emerging pathogens of clinical concern. Surveillance by antibiotyping with attention to multi-resistant profile, and warning to clinicians, is necessary.</p

Empirical fragility curves for macro-elements and single mechanisms of churches damaged during the 2016-2017 Central Italy seismic sequence

The churches represent the most widespread building typology within the monumental masonry heritage present in the Italian territory. A special attention needs to be paid to the assessment of the vulnerability of these structures because of the particular architectural features (slender walls with large openings, wide halls and huge vaults, large façades, etc…). This paper presents several statistical analyses carried out on a wide database that collects damage information and structural characteristics of a large sample of masonry churches (2884) inspected after the 2016-2017 Central Italy seismic sequence. The collected information is used for developing empirical fragility curves starting from the damage probability matrices (DPMs) for discrete intervals of PGA (peak ground acceleration), with reference to the following three damage estimates: i) the global damage referred to the whole church, ii) the damage referred to single macro-elements, and iii) the damage referred to single mechanisms. The fragility functions are determined via the maximum likelihood estimation method and adopt a lognormal cumulative function to define the exceedance probabilities for the five damage levels provided by the European macro-seismic (EMS) scale. The fragility curves related to the three damage estimates are compared to each other to identify the weight of specific macro-elements and mechanisms in determining the global damage level and eventually to point out proper and specific interventions to reduce the vulnerability of the whole church

Threat to Face and equivocation in televised interviews in Italy’s politicians for and against the 2016 Constitutional Referendum

On December 4, 2016, a constitutional referendum took place in Italy, aiming at completely changing the structure of governmental institutions. During the electoral campaign, televised interviews of political leaders played an important role guaranteeing the dissemination of information to citizens. The present study analyzed a sample of these interviews. Four reliable observers coded 32 h of interviews from nine broadcasts by four different national channels to identify types of coercive questions, face-threatening (or conflict) questions, and equivocal answers. These included 79 politicians from 18 political parties. Results showed that: (a) many aspects characterized the interviews that took place during different party campaigns; (b) channels and the majority of interviewers did not discriminate between politicians who favored and opposed the referendum, remaining almost neutral; and (c) no evidence was found indicating that answer equivocations arose from face-threatening questions. Therefore, particular use of questions and answers, absence of partisan bias, and disavowal of the main prediction of Equivocation Theory, marked this electoral campaign as unique. These results are illustrated by excerpts from our corpus of data

Social support in rural communities in Manabi province, Ecuador

Introduction: Social support has been found in many contexts, and in urban Ecuador, to be protective of health, particularly in the context of disaster. Fewer studies have explored the presence and impact of social support in rural Ecuador. This study engages a rural community in Ecuador to examine the general levels of social support, differences in social support based on different demographic groupings and relationships among social support and health outcomes and protective health behaviors. Methods: A cross-sectional design was used to survey 416 people in a rural Ecuadorian community that had recently experienced an earthquake. Spanish-language versions of the Multidimensional Scale of Perceived Social Support and the Interpersonal Support Evaluation List-12 were applied, as well as questions about demographics and risk reduction behaviors. Body mass index, blood pressure, and cholesterol and blood sugar levels were assessed. Analysis of variance assessed differences in social support among demographic groupings, risk reduction behaviors, and health outcomes. Results: Levels of social support were moderate. Few statistically significant (ie p\u3c0.05) differences in amount of social support received or in sources of social support were found. Men, people 80 years or older, divorced or widowed people, and people living in peripheral areas received less social support than women, people of all other ages, married/cohabitating people, and people living within the village, respectively. Effect sizes of these differences were small. No relationship between social support and health outcomes were found, and few were found for risk reduction factors. Conclusion: These findings indicate that social support may function differently in rural Ecuador than in urban contexts. Those promoting social support in rural communities may wish to focus on community-level, not individual-level, interventions. Limitations of applying an assessment of social support from urban Ecuadorian contexts to rural Ecuadorian contexts are discussed

Empirical fragility curves for masonry churches and their macro-elements using a large database: Proposal of a new likelihood function

Several earthquakes have highlighted over time the high vulnerability of masonry churches to horizontal actions, so that more and more research is being devoted to the assessment of their seismic response and to the design of strengthening interventions to guarantee their preservation. This paper analyses in detail the damage suffered by a large sample of 2870 masonry churches hit by the 2016–17 Central Italy seismic sequence, using the damage data extracted from the DaDO Web GIS. Fragility curves based on the empirical/observational approach are elaborated starting from the damage probability matrices (DPMs) in terms of global damage, both for the whole database and for some subsets of churches with homogeneous characteristics, in order to analyze the influence of some typological features. In particular, it is highlighted that the subset of small churches with rectangular plan and single nave show a generally lower vulnerability compared with those of the whole database. Moreover, the damage observed in the most common macro-elements detectable in masonry churches is examined by defining specific damage indices for macro-elements. The fragility curves for the macro-elements are, then, compared with those referring to the global damage, evidencing some interesting aspects useful both in the survey phase and for planning specific interventions. One of the main outcomes is that the seismic responses of the ‘Façade’ and ‘Principal nave’ macro-elements may closely approximate the global response of the church. Finally, the paper presents a new fitting procedure of the observational damage data aimed to build fragility curves for subsets of churches characterized by a reduced number of data falling in some PGA ranges. A ‘weighting’ procedure is, indeed, proposed in order to give less relevance to small groups of churches falling in the less populated PGA ranges

A qualitative exploration of knowledge of Chagas disease among adolescents in rural Ecuador

Introduction: Chagas disease (CD) is a neglected tropical disease that affects 6 to 7 million people worldwide. In South America, CD is a major health problem in several regions, causing more than 12 000 deaths per year. CD is caused by a parasite called Trypanosoma cruzi, mostly transmitted through the contaminated feces of certain species of triatomine bug, commonly known as the ‘kissing bug’. CD is endemic in Loja province in the southern region of Ecuador, where triatomines have been found in 68% of communities. Previous promotion of healthy practices in Loja province have included educational programs directed toward youth to affirm cultural and social norms that support health and prevent CD transmission. The present study was designed to evaluate current knowledge related to CD among youth in the three communities of Loja province following previous intervention programs. Methods: A descriptive, qualitative approach was applied using individual semi-structured interviews with 14 young people (eight females, six males) from three rural communities in Loja province. Interviews assessed knowledge about CD transmission, knowledge about the parasite–vector–disease pathway, and the role of youth in preventing Chagas disease in their communities. Results: Following a thematic analysis of the data, the study results showed there is cursory knowledge of the triatomine insect that can carry the causative parasite for CD. Participants were able to generally talk about the vector, habitat and prevention practices for triatomine infestation. Nevertheless, limited understanding of transmission dynamics in the parasite–vector–disease pathway itself was found. One major finding was that prevention practices were not correctly applied or followed, increasing the risk of exposure in the community. Youth also articulated that CD is stigmatized in their communities, which may be a barrier for prevention efforts. Conclusion: Gaps in knowledge about the parasite–vector–disease pathway were identified among youth. Overall, youth responses indicated positive regard for prevention practices and a desire to be involved in prevention programs. Developing educational programs focusing on CD transmission may be needed to improve control and prevention of this parasitic disease. The implications of these findings are discussed for developing effective control programs in the region