Community-associated Clostridium difficile infection in emergency department patients in Western Australia

Clostridium difficile infection (CDI) is primarily associated with hospitalised patients, however, community-associated CDI (CA-CDI) has increased in Australia. We aimed to investigate the epidemiology and outcomes of CA-CDI cases presenting to hospital emergency departments in Western Australia (WA). A retrospective case-control study of CA-CDI cases presenting at six emergency departments in WA from July 2013 to June 2014 was performed. Clinical signs, recent medication, hospitalisations and potential risk factors for CA-CDI were investigated for cases (n = 34) and unmatched controls (n = 62) who were infected with another gastrointestinal pathogen, including Campylobacter spp., Salmonella spp., Aeromonas spp., Shigella sonnei and Escherichia coli O157. Elevated white cell count (31.3% vs 8.2%, p < 0.01), female gender (67.6% vs 41.9%, p < 0.05), age =65 years (41.2% vs 21.0%, p < 0.05) and antimicrobial use in the previous month (41.2% vs 11.3%, p < 0.01) were significantly more frequent among cases compared to controls. After multivariable analysis, antibiotic use (odds ratio 8.49, 95% confidence interval 2.75–26.21) and age =65 years (3.03, 1.05–8.75) were significantly associated with CA-CDI. Ribotype (RT) 014/020 was most common (40.7%) among 27 C. difficile isolates followed by RTs 002 (14.8%), 001, 056 and 244 (all 7.4%). CA-CDI was associated with advanced age and recent antibiotic use compared to those infected with other gastrointestinal pathogens. RT 014 has also recently been found at high prevalence in public lawn spaces, and previously RT 014 strains from humans and pigs in Australia were closely genetically related, suggesting CA-CDI may be linked with these community reservoirs

Adolescent substance use: a prospective longitudinal model of substance use onset among South African adolescents

Substance use onset among Colored adolescents between eighth and ninth grades in an urban area of Cape Town, South Africa was examined using latent transition analysis. Longitudinal self-report data regarding substance use (N = 1118, 50.9% female) were collected in 2004 and 2005. Results indicated that the pattern of onset was similar across genders; adolescents first tried either alcohol or cigarettes, followed by both, then dagga (cannabis), and then inhalants. The prevalence of lifetime cigarette use was slightly greater for females; dagga (cannabis) and inhalant use were greater for males. The similarity of developmental onset in the current sample to previous international work supports the promise of adapting prevention programs across contexts. The study’s limitations are noted.Web of Scienc

Do statins delay onset or slow progression of Alzheimer's dementia?

Statins (coenzyme-A reductase inhibitors) should not be used with the single intent to delay the onset or slow the progression of dementia. Large randomized control trials (RCTs) found that the administration of a statin had no significant effect on preventing or slowing all-cause cognitive decline (strength of recommendation [SOR]: A, based on large RCTs with narrow confidence interval). Specifically, there is insufficient evidence that statins delay the onset or slow the progression of Alzheimer's dementia (SOR: B, based on systematic review with heterogeneity). While 3 epidemiologic studies have found a decreased incidence of dementia among those taking statins, these studies have significant methodological shortcomings and do not show a causal relationship (SOR: C, based on poor-quality studies)

Evaluation of Pneumonia Virus of Mice as a Possible Human Pathogen

Pneumonia virus of mice (PVM), a relative of human respiratory syncytial virus (RSV), causes respiratory disease in mice. There is serologic evidence suggesting widespread exposure of humans to PVM. To investigate replication in primates, African green monkeys (AGM) and rhesus macaques (n=4) were inoculated with PVM by the respiratory route. Virus was shed intermittently at low levels by a subset of animals, suggesting poor permissiveness. PVM efficiently replicated in cultured human cells and inhibited the type I interferon (IFN) response in these cells. This suggests that poor replication in nonhuman primates was not due to a general nonpermissiveness of primate cells or poor control of the IFN response. Seroprevalence in humans was examined by screening sera from 30 adults and 17 young children for PVM-neutralizing activity. Sera from a single child (6%) and 40% of adults had low neutralizing activity against PVM, which could be consistent with increasing incidence of exposure following early childhood. There was no cross-reaction of human or AGM sera between RSV and PVM and no cross-protection in the mouse model. In native Western blots, human sera reacted with RSV but not PVM proteins under conditions in which AGM immune sera reacted strongly. Serum reactivity was further evaluated by flow cytometry using unfixed Vero cells infected with PVM or RSV expressing green fluorescent protein (GFP) as a measure of viral gene expression. The reactivity of human sera against RSV-infected cells correlated with GFP expression, whereas reactivity against PVM-infected cells was low and uncorrelated with GFP expression. Thus, PVM specificity was not evident. Our results indicate that the PVM-neutralizing activity of human sera is not due to RSV- or PVM-specific antibodies but may be due to low-affinity, polyreactive natural antibodies of the IgG subclass. The absence of PVM-specific antibodies and restriction in nonhuman primates makes PVM unlikely to be a human pathogen

Translational research in South Africa: evaluating implementation quality using a factorial design

Background: HealthWise South Africa: Life Skills for Adolescents (HW) is an evidence- based substance use and sexual risk prevention program that emphasizes the positive use of leisure time. Since 2000, this program has evolved from pilot testing through an efficacy trial involving over 7,000 youth in the Cape Town area. Beginning in 2011, through 2015, we are undertaking a new study that expands HW to all schools in the Metro South Education District. Objective: This paper describes a research study designed in partnership with our South African collaborators that examines three factors hypothesized to affect the quality and fidelity of HW implementation: enhanced teacher training; teacher support, structure and supervision; and enhanced school environment. Methods: Teachers and students from 56 schools in the Cape Town area will participate in this study. Teacher observations are the primary means of collecting data on factors affecting implementation quality. These factors address the practical concerns of teachers and schools related to likelihood of use and cost-effectiveness, and are hypothesized to be "active ingredients" related to high-quality program implementation in real-world settings. An innovative factorial experimental design was chosen to enable estimation of the individual effect of each of the three factors. Results: Because this paper describes the conceptualization of our study, results are not yet available. Conclusions: The results of this study may have both substantive and methodological implications for advancing Type 2 translational research

The Micro-Randomized Trial for Developing Digital Interventions: Data Analysis Methods

Although there is much excitement surrounding the use of mobile and wearable technology for the purposes of delivering interventions as people go through their day-to-day lives, data analysis methods for constructing and optimizing digital interventions lag behind. Here, we elucidate data analysis methods for primary and secondary analyses of micro-randomized trials (MRTs), an experimental design to optimize digital just-in-time adaptive interventions. We provide a definition of causal "excursion" effects suitable for use in digital intervention development. We introduce the weighted and centered least-squares (WCLS) estimator which provides consistent causal excursion effect estimators for digital interventions from MRT data. We describe how the WCLS estimator along with associated test statistics can be obtained using standard statistical software such as SAS or R. Throughout we use HeartSteps, an MRT designed to increase physical activity among sedentary individuals, to illustrate potential primary and secondary analyses

A Conceptual Framework for Adaptive Preventive Interventions

Recently, adaptive interventions have emerged as a new perspective on prevention and treatment. Adaptive interventions resemble clinical practice in that different dosages of certain prevention or treatment components are assigned to different individuals, and/or within individuals across time, with dosage varying in response to the intervention needs of individuals. To determine intervention need and thus assign dosage, adaptive interventions use prespecified decision rules based on each participant's values on key characteristics, called tailoring variables. In this paper, we offer a conceptual framework for adaptive interventions, discuss principles underlying the design and evaluation of such interventions, and review some areas where additional research is needed.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/45501/1/11121_2004_Article_490385.pd

Youths’ Substance Use and Changes in Parental Knowledge-Related Behaviors During Middle School: A Person-Oriented Approach

Parental knowledge is a key protective factor for youths’ risky behavior. Little is known about how longitudinal combinations of knowledge-related behaviors are associated with youths’ substance use. This longitudinal study uses Latent Transition Analysis to identify latent patterns of parental knowledge-related behaviors occurring in mother-youth dyads during middle school and to investigate how changes in knowledge-related patterns are associated with youths’ substance use in Grade 6 and the initiation of substance use from Grade 6 to 8. Using a sample of 536 rural dyads (53% female, 84% White), we assessed mother and youths’ reports of parental knowledge, active parental monitoring efforts, youth disclosure, and parent-youth communication to identify six latent patterns of knowledge-related behaviors: High Monitors, Low Monitors, Communication-Focused, Supervision-Focused, Maternal Over-Estimators, and Youth Over-Estimators. Fifty percent or more of dyads in the High Monitors, Communication-Focused and Youth Over-Estimators were in the same status in both 6th and 8th grade: 98% of Low Monitors in Grade 6 were also in this status in Grade 8. The initiation of alcohol, smoking, and marijuana was associated significantly with transitions between patterns of knowledge-related behaviors. The initiation of alcohol and smoking were associated with increased odds of transitions into the Low Monitors from the Communication-Focused, Supervision-Focused, and Maternal Over-Estimators. However, the initiation of substance use was associated with decreased odds of transitions from the High Monitors to the Low Monitors and with increased odds of transitions from High Monitors to Supervision-Focused. The discussion focuses on the value of using a person-oriented dyadic approach with multiple reporters to study changes in knowledge-related behaviors over the middle school period

STS in management education: connecting theory and practice

This paper explores the value of science and technology studies (STS) to management education. The work draws on an ethnographic study of second year management undergraduates studying decision making. The nature and delivery of the decision making module is outlined and the value of STS is demonstrated in terms of both teaching method and module content. Three particular STS contributions are identified and described: the social construction of technological systems; actor network theory; and ontological politics. Affordances and sensibilities are identified for each contribution and a discussion is developed that illustrates how these versions of STS are put to use in management education. It is concluded that STS has a pivotal role to play in critical management (education) and in the process offers opportunities for new forms of managin