Healthcare-associated bacterial infections in the paediatric ICU.

BACKGROUND: An estimated 3.2 million patients annually develop healthcare-associated infections (HCAIs) in Europe alone amid the major challenge of increasing antimicrobial resistance. Critically ill children warrant specific evaluation because of differences in epidemiology, causative organisms and infection sites. OBJECTIVES: To examine the prevalence and antimicrobial susceptibility patterns of three types of HCAI in critically ill children and determine the effect on their disease course. MATERIALS AND METHODS: Retrospective cohort review of critically ill children admitted to a general paediatric ICU (PICU) at a regional academic tertiary referral centre over a 3 year period. RESULTS: There were 1930 admissions with a median age of 38 months. Children with HCAIs had a higher incidence of comorbidities (74% versus 24%) and a longer median length of stay (8 days versus 3 days). We identified 26 positive isolates (blood, lower respiratory and urine) taken 48 h or more after admission. The combined incidence was 1.34%. Hospital-acquired pneumonia accounted for 58% of HCAIs, urinary tract infections for 31% and bloodstream infections for 11%. The majority (61.5%) of HCAIs were caused by Gram-negative organisms. Seven isolates were resistant to antimicrobials used to treat HCAI. All of these were Gram-negative organisms (Pseudomonas aeruginosa, Klebsiella oxytoca and Escherichia coli). CONCLUSIONS: These data revealed a low incidence of HCAIs, 27% of which were resistant Gram-negative organisms. Critically ill children with HCAIs were more likely to have comorbidities and an increased length of stay. These factors may increasingly impact on PICU bed availability, an already limited resource.Action for Medical Researc

A case of Pasteurella multocida peritoneal dialysis-associated peritonitis and review of the literature

AbstractObjectives: Two episodes of peritoneal dialysis-associated peritonitis, which occurred four months apart and were both due to Pasteurella multocida, were noted in a 73 year old woman. This report aims to describe the clinical history of these episodes and the microbiological investigations that were undertaken. The relevant literature will also be discussed.Methods and results: Basic microbiological tests identified the organism as Pasteurella multocida, and further work at a specialist laboratory classified it as Pasteurella multocida subsp. multocida. Pulsed field gel electrophoresis confirmed that the strains isolated from the two clinical episodes originated from the same clone. A literature search was performed, looking particularly for patients who experienced more than one episode of peritonitis caused by Pasteurella spp, whether due to recurrence or re-infection.Conclusions: It is likely that the infection resulted from a domestic cat, as there was evidence of a cat bite to the dialysis tubing in the period between the two episodes. Re-infection with two identical strains of pasteurella is more probable than relapse, for reasons discussed. Strict hygiene and avoiding contact between dialysis tubing and domestic animals must be emphasised to try to prevent pasteurella and other animal-associated infections in this already vulnerable population

Multimodal discrimination of immune cells using a combination of Raman spectroscopy and digital holographic microscopy

This work was supported by the UK Engineering and Physical Sciences Research Council under grant EP/J01771X/1, A European Union FAMOS project (FP7 ICT, 317744), and the ’BRAINS’ 600th anniversary appeal, and Dr. E. Killick. We would also like to thank The RS Macdonald Charitable Trust for funding support. KD acknowledges support of a Royal Society Leverhulme Trust Senior Fellowship. This work was also supported by the PreDiCT-TB consortium [IMI Joint undertaking grant agreement number 115337, resources of which are composed of financial contribution from the European Union’s Seventh Framework Programme (FP7/2007-2013) and EFPIA companies’ in kind contribution (www.imi.europa.eu)]The ability to identify and characterise individual cells of the immune system under label-free conditions would be a significant advantage in biomedical and clinical studies where untouched and unmodified cells are required. We present a multi-modal system capable of simultaneously acquiring both single point Raman spectra and digital holographic images of single cells. We use this combined approach to identify and discriminate between immune cell populations CD4+ T cells, B cells and monocytes. We investigate several approaches to interpret the phase images including signal intensity histograms and texture analysis. Both modalities are independently able to discriminate between cell subsets and dual-modality may therefore be used a means for validation. We demonstrate here sensitivities achieved in the range of 86.8% to 100%, and specificities in the range of 85.4% to 100%. Additionally each modality provides information not available from the other providing both a molecular and a morphological signature of each cell.Publisher PDFPeer reviewe

Iterative focused screening with biological fingerprints identifies selective Asc-1 inhibitors distinct from traditional high throughput screening

N-methyl-d-aspartate receptors (NMDARs) mediate glutamatergic signaling that is critical to cognitive processes in the central nervous system, and NMDAR hypofunction is thought to contribute to cognitive impairment observed in both schizophrenia and Alzheimer’s disease. One approach to enhance the function of NMDAR is to increase the concentration of an NMDAR coagonist, such as glycine or d-serine, in the synaptic cleft. Inhibition of alanine–serine–cysteine transporter-1 (Asc-1), the primary transporter of d-serine, is attractive because the transporter is localized to neurons in brain regions critical to cognitive function, including the hippocampus and cortical layers III and IV, and is colocalized with d-serine and NMDARs. To identify novel Asc-1 inhibitors, two different screening approaches were performed with whole-cell amino acid uptake in heterologous cells stably expressing human Asc-1: (1) a high-throughput screen (HTS) of 3 M compounds measuring 35S l-cysteine uptake into cells attached to scintillation proximity assay beads in a 1536 well format and (2) an iterative focused screen (IFS) of a 45 000 compound diversity set using a 3H d-serine uptake assay with a liquid scintillation plate reader in a 384 well format. Critically important for both screening approaches was the implementation of counter screens to remove nonspecific inhibitors of radioactive amino acid uptake. Furthermore, a 15 000 compound expansion step incorporating both on- and off-target data into chemical and biological fingerprint-based models for selection of additional hits enabled the identification of novel Asc-1-selective chemical matter from the IFS that was not identified in the full-collection HTS

The diet of powerful owls (Ninox strenua) and prey availability in a continuum of habitats from disturbed urban fringe to protected forest environments in south-eastern Australia. Wildl Res 33

Abstract This study investigates the diet of six breeding pairs of powerful owls in the Yarra Valley Corridor Victoria and compares prey consumption with prey availability. The six sites represent a continuum of habitats, ranging from urban Melbourne, through the urban fringe interface to a more forested landscape. We found that powerful owls in the Yarra Valley Corridor are reliant almost exclusively on arboreal marsupial prey as their preferred diet, with 99% of their overall diet comprising of four arboreal marsupial species. These four species, the common ringtail possum, common brushtail possum, sugar glider and greater glider, were also the most abundant species observed while spotlighting, however, their abundance varied along the continuum. There was a strong positive relationship with the presence of these species in the diet and their site specific availability, indicating that the powerful owl is a generalist hunter, preying on the most available prey at a given site and in a given season. This study suggests that food resources are high in these disturbed urban fringe sites and it is unlikely that food availability in urban environments will limit the potential survival of urban powerful owls

Chronic breast abscess due to Mycobacterium fortuitum: a case report

<p>Abstract</p> <p>Introduction</p> <p><it>Mycobacterium fortuitum </it>is a rapidly growing group of nontuberculous mycobacteria more common in patients with genetic or acquired causes of immune deficiency. There have been few published reports of <it>Mycobacterium fortuitum </it>associated with breast infections mainly associated with breast implant and reconstructive surgery.</p> <p>Case presentation</p> <p>We report a case of a 51-year-old Caucasian woman who presented to our one-stop breast clinic with a two-week history of left breast swelling and tenderness. Following triple assessment and subsequent incision and drainage of a breast abscess, the patient was diagnosed with <it>Mycobacterium fortuitum </it>and treated with antibiotic therapy and surgical debridement.</p> <p>Conclusion</p> <p>This is a rare case of a spontaneous breast abscess secondary to <it>Mycobacterium fortuitum </it>infection. Recommended treatment is long-term antibacterial therapy and surgical debridement for extensive infection or when implants are involved.</p

Accuracy of Digital Breast Tomosynthesis for Depicting Breast Cancer Subgroups in a UK Retrospective Reading Study (TOMMY Trial).

PURPOSE: To compare the diagnostic performance of two-dimensional (2D) mammography, 2D mammography plus digital breast tomosynthesis (DBT), and synthetic 2D mammography plus DBT in depicting malignant radiographic features. MATERIALS AND METHODS: In this multicenter, multireader, retrospective reading study (the TOMMY trial), after written informed consent was obtained, 8869 women (age range, 29-85 years; mean, 56 years) were recruited from July 2011 to March 2013 in an ethically approved study. From these women, a reading dataset of 7060 cases was randomly allocated for independent blinded review of (a) 2D mammography images, (b) 2D mammography plus DBT images, and (c) synthetic 2D mammography plus DBT images. Reviewers had no access to results of previous examinations. Overall sensitivities and specificities were calculated for younger women and those with dense breasts. RESULTS: Overall sensitivity was 87% for 2D mammography, 89% for 2D mammography plus DBT, and 88% for synthetic 2D mammography plus DBT. The addition of DBT was associated with a 34% increase in the odds of depicting cancer (odds ratio [OR] = 1.34, P = .06); however, this level did not achieve significance. For patients aged 50-59 years old, sensitivity was significantly higher (P = .01) for 2D mammography plus DBT than it was for 2D mammography. For those with breast density of 50% or more, sensitivity was 86% for 2D mammography compared with 93% for 2D mammography plus DBT (P = .03). Specificity was 57% for 2D mammography, 70% for 2D mammography plus DBT, and 72% for synthetic 2D mammography plusmDBT. Specificity was significantly higher than 2D mammography (P < .001in both cases) and was observed for all subgroups (P < .001 for all cases). CONCLUSION: The addition of DBT increased the sensitivity of 2D mammography in patients with dense breasts and the specificity of 2D mammography for all subgroups. The use of synthetic 2D DBT demonstrated performance similar to that of standard 2D mammography with DBT. DBT is of potential benefit to screening programs, particularly in younger women with dense breasts. (©) RSNA, 2015.The TOMMY Trial (a comparison of digital breast tomosynthesis with mammography in the UK Breast Screening Programme) was supported by the NIHR Health Technology Assessment Programme.This is the final published version of the article. It was originally published in Radiology (Gilbert et al., Radiology, 2015, doi:10.1148/radiol.2015142566). The final version is available at http://dx.doi.org/10.1148/radiol.201514256

An evidence‐base for developing ambitious yet realistic national biodiversity targets

Biodiversity targets are a key tool, used at a global and national policy level, to align biodiversity goals, promote conservation action, and recover nature. Yet most biodiversity targets are not met. In England, the government has committed to legally-binding targets to halt and recover the decline in species abundance by 2030 and 2042. We present evidence from recent population trends of 670 terrestrial animal species (for which abundance time series are available) as a species abundance indicator, together with a synthesis of case studies on species recovery, to assess the degree to which these targets are achievable. The case studies demonstrate that recovery is possible through a range of approaches. The indicator demonstrates that theoretically targets can be achieved by addressing severe declines in a relatively small number of species, as well as creating smaller benefits for many species through landscape-scale interventions. The fact that multiple pathways exist to achieve the species abundance targets in England presents choices but also raises the possibility that targets might be reached with perverse consequences. We demonstrate that evidence on achievability is a necessary but not sufficient condition for determining what is required to deliver conservation outcomes and restore biodiversity

Accuracy of Digital Breast Tomosynthesis for Depicting Breast Cancer Subgroups in a UK Retrospective Reading Study (TOMMY Trial)

Purpose To compare the diagnostic performance of two-dimensional (2D) mammography, 2D mammography plus digital breast tomosynthesis (DBT), and synthetic 2D mammography plus DBT in depicting malignant radiographic features. Materials and Methods In this multicenter, multireader, retrospective reading study (the TOMMY trial), after written informed consent was obtained, 8869 women (age range, 29–85 years; mean, 56 years) were recruited from July 2011 to March 2013 in an ethically approved study. From these women, a reading dataset of 7060 cases was randomly allocated for independent blinded review of (a) 2D mammography images, (b) 2D mammography plus DBT images, and (c) synthetic 2D mammography plus DBT images. Reviewers had no access to results of previous examinations. Overall sensitivities and specificities were calculated for younger women and those with dense breasts. Results Overall sensitivity was 87% for 2D mammography, 89% for 2D mammography plus DBT, and 88% for synthetic 2D mammography plus DBT. The addition of DBT was associated with a 34% increase in the odds of depicting cancer (odds ratio [OR] = 1.34, P = .06); however, this level did not achieve significance. For patients aged 50–59 years old, sensitivity was significantly higher (P = .01) for 2D mammography plus DBT than it was for 2D mammography. For those with breast density of 50% or more, sensitivity was 86% for 2D mammography compared with 93% for 2D mammography plus DBT (P = .03). Specificity was 57% for 2D mammography, 70% for 2D mammography plus DBT, and 72% for synthetic 2D mammography plusmDBT. Specificity was significantly higher than 2D mammography (P < .001in both cases) and was observed for all subgroups (P < .001 for all cases). Conclusion The addition of DBT increased the sensitivity of 2D mammography in patients with dense breasts and the specificity of 2D mammography for all subgroups. The use of synthetic 2D DBT demonstrated performance similar to that of standard 2D mammography with DBT. DBT is of potential benefit to screening programs, particularly in younger women with dense breasts. © RSNA, 2015The TOMMY Trial (a comparison of digital breast tomosynthesis with mammography in the UK Breast Screening Programme) was supported by the NIHR Health Technology Assessment Programme.This is the final published version of the article. It was originally published in Radiology (Gilbert et al., Radiology, 2015, doi:10.1148/radiol.2015142566). The final version is available at http://dx.doi.org/10.1148/radiol.201514256