Arts and Spirituality Center's HeartSpeak Program: Analyzing Data from a Reflective Conversation

Through HeartSpeak, an arts and peace initiative of the Arts and Spirituality Center, artists provide multiple anti-violence art workshops in schools and several other venues throughout Philadelphia. This study focuses on quantitative and qualitative evaluation of the program in order to see what impact poetry in general and the specific HeartSpeak program have in helping children to thrive despite exposure to chronic community violence. This research was conducted through facilitating reflective conversations and implementing questionnaires among fourth, fifth and sixth graders at Villanova Academy for Honor Studies and fifth, eighth, and eleventh graders at Al-Aqsa Islamic Academy. The results indicate that the program is helping children to grow in confidence, express themselves, learn about their abilities and those of their classmates, and identify places of sanctuary in their lives. Having previous experience with writing poetry and feeling confident when sharing poetry with classmates were significantly related to students’ belief that the program is important. My main recommendations are for more workshops to be provided for the children, more time to be devoted to writing, more freedom in children choosing writing topics, and closer partnership between poetry instructors and the classroom teachers.M.P.H., Public Health -- Drexel University, 201

Population-based laboratory surveillance of Hafnia alvei isolates in a large Canadian health region

BACKGROUND: Hospital-based series have characterized Hafnia alvei primarily as an infrequent agent of polymicrobial nosocomial infections in males with underlying illness. METHODS: We conducted population-based laboratory surveillance in the Calgary Health Region during 2000–2005 to define the incidence, demographic risk factors for acquisition, and anti-microbial susceptibilities of Hafnia alvei isolates. RESULTS: A total of 138 patients with Hafnia alvei isolates were identified (2.1/100,000/year) and two-thirds were of community onset. Older age and female gender were important risk factors for acquisition. The most common focus of isolation was urine in 112 (81%), followed by lower respiratory tract in 10 (7%), and soft tissue in 5 (4%), and the majority (94; 68%) were mono-microbial. Most isolates were resistant to ampicillin (111;80%), cephalothin (106; 77%), amoxicillin/clavulanate (98; 71%), and cefazolin (95; 69%) but none to imipenem or ciprofloxacin. CONCLUSION: Hafnia alvei was most commonly isolated as a mono-microbial etiology from the urinary tract in women from the community. This study highlights the importance of population-based studies in accurately defining the epidemiology of an infectious disease

Population-based Laboratory Surveillance for AmpC β-Lactamase–producing Escherichia coli, Calgary

AmpC β-lactamase–producing E. coli are commonly isolated from the urinary tract of older women

Evolution of HIV-1 in the Gut

The high mutation rate of Human Immunodeficiency Virus (HIV) is a significant contributor to its ability to develop drug resistance. While much research has been directed towards developing new drugs and treatments in response to resistance, it is also critical to gain a better understanding of the nature of the virus’s replication. Previous studies (van Marle et al., 2007; van Marle et al., 2010) have demonstrated that viral replication and evolution are compartmentalized in different gut tissues. However, these studies focused on the reverse transcriptase (rt) region of the proviral DNA. This project examined whether the same patterns of viral evolution would be found in the nef (negative factor) encoding region. The Nef protein contributes to the infectivity and pathogenicity of the virus and is therefore under different selection pressures than reverse transcriptase. For this project, gut biopsy samples were taken from a patient cohort at the Southern Alberta HIV Clinic from 1993-1996 and again from 2007-2010. Proviral DNA was isolated and the nef region was subsequently sequenced and analyzed using Molecular Evolutionary Genetic Analysis (MEGA) software. The results indicated that evolution of the nef region over time is consistent with compartmentalization of the gut in each patient. Overall diversity of the Nef protein encoding region is similar among all tissue types. Finally, the majority of mutations suggest that HIV-1 is under neutral or purifying selection. These observations are consistent with the observations of the rt region, suggesting a similar evolutionary pattern for the nef region

Compartmentalization of the gut viral reservoir in HIV-1 infected patients

<p>Abstract</p> <p>Background</p> <p>Recently there has been an increasing interest and appreciation for the gut as both a viral reservoir as well as an important host-pathogen interface in human immunodefiency virus type 1 (HIV-1) infection. The gut associated lymphoid tissue (GALT) is the largest lymphoid organ infected by HIV-1. In this study we examined if different HIV-1 quasispecies are found in different parts of the gut of HIV-1 infected individuals.</p> <p>Results</p> <p>Gut biopsies (esophagus, stomach, duodenum and colorectum) were obtained from eight HIV-1 infected preHAART (highly active antiretroviral therapy) patients. HIV-1 Nef and Reverse transcriptase (RT) encoding sequences were obtained through nested PCR amplification from DNA isolated from the gut biopsy tissues. The PCR fragments were cloned and sequenced. The resulting sequences were subjected to various phylogenetic analyses. Expression of the <it>nef </it>gene and viral RNA in the different gut tissues was determined using real-time RT-PCR. Phylogenetic analysis of the Nef protein-encoding region revealed compartmentalization of viral replication in the gut within patients. Viral diversity in both the Nef and RT encoding region varied in different parts of the gut. Moreover, increased <it>nef </it>gene expression (p < 0.05) and higher levels of viral genome were observed in the colorectum (p < 0.05). These differences could reflect an adaptation of HIV-1 to the various tissues.</p> <p>Conclusion</p> <p>Our results indicated that different HIV-1 quasispecies populate different parts of the gut, and that viral replication in the gut is compartmentalized. These observations underscore the importance of the gut as a host-pathogen interface in HIV-1 infection.</p

Tackling antimicrobial resistance in lower urinary tract infections : treatment options

Urinary tract infections (UTIs) are among the most common infectious diseases occurring in either the community or healthcare settings. A wide variety of bacteria are responsible for causing UTIs, however extra-intestinal pathogenic E. coli or ExPEC) remains the most common etiological agent. Since 2000, resistance to antibiotics emerged globally among ExPEC and is causing delays in appropriate therapy with subsequent increased morbidity and mortality. For patients with acute uncomplicated lower UTIs, nitrofurantoin, trimethoprim-sulfamethoxazole, fosfomycin or pivmecillinam should be prescribed for a 1-5 day course depending on the agent used. Single-dose fosfomycin is an excellent option for uncomplicated lower UTIs and has had similar clinical and/or bacteriological efficacy for 3- or 7-day regimens for alternate agents (i.e., ciprofloxacin, norfloxacin, cotrimoxazole or nitrofurantoin). The aim of this review article is to provide an overview on the definitions, etiology, treatment guidelines (including agents for infections due to antimicrobial resistant bacteria) of lower UTIs and to highlight recent aspects on antimicrobial resistance of ExPEC.In part by a research grant from Calgary Laboratory Services (#10009392).http://www.tandfonline.com/loi/ierz202017-07-30hb2016Medical Microbiolog

Intensive care unit-acquired urinary tract infections in a regional critical care system

INTRODUCTION: Few studies have evaluated urinary tract infections (UTIs) specifically acquired within intensive care units (ICUs), and the effect of such infections on patient outcome is unclear. The objectives of this study were to describe the occurrence, microbiology, and risk factors for acquiring UTIs in the ICU and to determine whether these infections independently increase mortality. METHODS: A surveillance cohort study was conducted among all adults admitted to multi-system and cardiovascular surgery ICUs in the Calgary Health Region (CHR, population about 1 million) between 1 January 2000 and 31 December 2002. RESULTS: During the 3 years, 4465 patients were admitted 4915 times to a CHR ICU for 48 hours or more. A total of 356 ICU-acquired UTIs (defined as at least 10(5 )colony-forming units/ml of one or two organisms 48 hours or more after ICU admission) occurred among 290 (6.5%) patients, yielding an overall incidence density of ICU-acquired UTIs of 9.6 per 1000 ICU days. Four bacteremic/fungemic ICU-acquired UTIs occurred (0.1 per 1000 ICU days). Development of an ICU-acquired UTI was more common in women (relative risk [RR] 1.58; 95% confidence interval [CI] 1.43–1.75; P < 0.0001) and in medical (9%) compared with non-cardiac surgical (6%), and cardiac surgical patients (2%). The most common organisms isolated were Escherichia coli (23%), Candida albicans (20%), and Enterococcus species (15%). Antibiotic-resistant organisms were identified among 14% isolates. Although development of an ICU-acquired UTI was associated with significantly higher crude in-hospital mortality (86/290 [30%] vs. 862/4167 [21%]; RR = 1.43; 95% CI 1.19–1.73; P < 0.001); an ICU-acquired UTI was not an independent predictor for death. CONCLUSIONS: Development of an ICU-acquired UTI is common in critically ill patients. Although a marker of increased morbidity associated with critical illness, it is not a significant attributable cause of mortality

Rationale for and protocol of a multi-national population-based bacteremia surveillance collaborative

<p>Abstract</p> <p>Background</p> <p>Bloodstream infections are frequent causes of human illness and cause major morbidity and death. In order to best define the epidemiology of these infections and to track changes in occurrence, adverse outcome, and resistance rates over time, population based methodologies are optimal. However, few population-based surveillance systems exist worldwide, and because of differences in methodology inter-regional comparisons are limited. In this report we describe the rationale and propose first practical steps for developing an international collaborative approach to the epidemiologic study and surveillance for bacteremia.</p> <p>Findings</p> <p>The founding collaborative participants represent six regions in four countries in three continents with a combined annual surveillance population of more than 8 million residents.</p> <p>Conclusion</p> <p>Future studies from this collaborative should lead to a better understanding of the epidemiology of bloodstream infections.</p

Colistin non-susceptible Pseudomonas aeruginosa ST654 with blaNDM-1 arrives in North America

This study describes 3 different blaNDM-1 genetic platforms in 3 different species obtained from the same patient who was directly transferred to an institution in Calgary, Canada, following a prolonged hospital stay in India. The blaNDM-1 in the Escherichia coli was located on a 176kb IncA/C plasmid contained within an ISCR1 region. The blaNDM-1 in the Providencia rettgeri was located on a 117kb IncT plasmid contained within Tn3000, while the blaNDM-1 in Pseudomonas aeruginosa was located on the chromosome within an ISCR3 region. This report highlights the plasticity of the genetic regions and environments associated with blaNDM-1. To the best of our knowledge, this is the first report of P. aeruginosa with blaNDM-1 identified in North America and the first report of blaOXA-181in P. rettgeri. The P. aeruginosa belonged to the international high risk clone ST654 and was non-susceptible to colistin. This case emphasizes the need for appropriate infection prevention and control measures and vigilant screening for carbapenem resistant Gram negative bacteria in patients with a history of travel to endemic areas, such as the Indian subcontinent.In part by a research grant from the Calgary Laboratory Services (#10009392).http://aac.asm.org2016-09-30hb201

Human Case of Lobomycosis

We describe a 42-year-old woman with histologically confirmed lobomycosis, a cutaneous fungal infection rarely reported outside of Latin America. Our case represents the first published report of imported human lobomycosis in Canada and the fifth in an industrialized country