Associations Between Healthcare Facility Types and Healthcare-Associated Infections

Healthcare-Associated Infections (HAIs) continue to be an epidemiological issue burdening patients and public health systems worldwide. The purpose of this study was to determine if specific healthcare facility types (Acute Care Hospitals, Long Term Acute Care Hospitals, and Inpatient Rehabilitation Facilities) were associated with particular categories of HAIs: Ventilator-Associated Pneumonias (VAPs), Central Line-Associated Bloodstream Infections (CLABSIs), and Catheter-Associated Urinary Tract Infections (CAUTIs). The theoretical framework for this study was the environmental determinants of infectious disease framework. A single research question focused on whether an association existed among the specified health care facility types and HAIs. Three independent categorical variables were used, including Acute Care Hospitals, Long Term Acute Care Hospitals, and Inpatient Rehabilitation Facilities, and 3 dependent variables were used, comprising of VAPs, CAUTIs, and CLABSIs. A quantitative design engaged the chi-square test of association, using a 2012 population-level report of archival data collected by the Centers for Disease Control and Prevention\u27s National Healthcare Safety Network. Seven groups of HAIs and facility types were tested, and the results revealed that 6 groups had statistically significant differences. This study may contribute to positive social change by helping to identify whether healthcare facility types are associated with HAIs and to supply evidence to stakeholders to support standardization of best practices across all facility types, thus contributing to the reduction of HAIs in the United States

Genome-scale fitness profile of Caulobacter crescentus grown in natural freshwater

© 2018, International Society for Microbial Ecology. Bacterial genomes evolve in complex ecosystems and are best understood in this natural context, but replicating such conditions in the lab is challenging. We used transposon sequencing to define the fitness consequences of gene disruption in the bacterium Caulobacter crescentus grown in natural freshwater, compared with axenic growth in common laboratory media. Gene disruptions in amino-acid and nucleotide sugar biosynthesis pathways and in metabolic substrate transport machinery impaired fitness in both lake water and defined minimal medium relative to complex peptone broth. Fitness in lake water was enhanced by insertions in genes required for flagellum biosynthesis and reduced by insertions in genes involved in biosynthesis of the holdfast surface adhesin. We further uncovered numerous hypothetical and uncharacterized genes for which disruption impaired fitness in lake water, defined minimal medium, or both. At the genome scale, the fitness profile of mutants cultivated in lake water was more similar to that in complex peptone broth than in defined minimal medium. Microfiltration of lake water did not significantly affect the terminal cell density or the fitness profile of the transposon mutant pool, suggesting that Caulobacter does not strongly interact with other microbes in this ecosystem on the measured timescale. Fitness of select mutants with defects in cell surface biosynthesis and environmental sensing were significantly more variable across days in lake water than in defined medium, presumably owing to day-to-day heterogeneity in the lake environment. This study reveals genetic interactions between Caulobacter and a natural freshwater environment, and provides a new avenue to study gene function in complex ecosystems

A Scoping Review of Home Produced Heroin and Amphetamine Type Stimulant Substitutes: Implications for Prevention, Treatment and Policy

Several home-produced substances such as krokodil and boltushka are prevalent in many Eastern European countries. Anecdotal reports of its use have been circulating in Germany and Norway; however, this has not been confirmed. Its use has also been reported by the media in the USA, although only one confirmed report of its use exists. Home-produced drugs are associated with high levels of morbidity and a number of complex health issues such as the spread of blood borne viruses, gangrene, and internal organ damage. The high incidence of HIV rates amongst people who inject home-produced substances is a public health concern. The resulting physical health consequences of injecting these crude substances are very severe in comparison to heroin or amphetamine acquired in black markets. Due to this fact and the increased mortality associated with these substances, professionals in the area of prevention, treatment, and policy development need to be cognisant of the presentation, harms, and the dangers associated with home-produced substances globally. This scoping review aimed to examine existing literature on the subject of home-produced heroin and amphetamine-type stimulant substitutes. The review discussed the many implications such research may have in the areas of policy and practice. Data were gathered through the use of qualitative secondary resources such as journal articles, reports, reviews, case studies, and media reports. The home production of these substances relies on the utilisation of precursor drugs such as less potent stimulants, tranquillizers, analgesics, and sedatives or natural plant ingredients. The Internet underpins the facilitation of this practice as recipes, and diverted pharmaceutical sales are available widely online, and currently, ease of access to the Internet is evident worldwide. This review highlights the necessity of prevention, education, and also harm reduction related to home-produced drugs and also recommends consistent monitoring of online drug fora, online drug marketplaces, and unregulated pharmacies

Pervasive gaps in Amazonian ecological research

Biodiversity loss is one of the main challenges of our time,1,2 and attempts to address it require a clear un derstanding of how ecological communities respond to environmental change across time and space.3,4 While the increasing availability of global databases on ecological communities has advanced our knowledge of biodiversity sensitivity to environmental changes,5–7 vast areas of the tropics remain understudied.8–11 In the American tropics, Amazonia stands out as the world’s most diverse rainforest and the primary source of Neotropical biodiversity,12 but it remains among the least known forests in America and is often underrepre sented in biodiversity databases.13–15 To worsen this situation, human-induced modifications16,17 may elim inate pieces of the Amazon’s biodiversity puzzle before we can use them to understand how ecological com munities are responding. To increase generalization and applicability of biodiversity knowledge,18,19 it is thus crucial to reduce biases in ecological research, particularly in regions projected to face the most pronounced environmental changes. We integrate ecological community metadata of 7,694 sampling sites for multiple or ganism groups in a machine learning model framework to map the research probability across the Brazilian Amazonia, while identifying the region’s vulnerability to environmental change. 15%–18% of the most ne glected areas in ecological research are expected to experience severe climate or land use changes by 2050. This means that unless we take immediate action, we will not be able to establish their current status, much less monitor how it is changing and what is being lostinfo:eu-repo/semantics/publishedVersio

Pervasive gaps in Amazonian ecological research

Biodiversity loss is one of the main challenges of our time,1,2 and attempts to address it require a clear understanding of how ecological communities respond to environmental change across time and space.3,4 While the increasing availability of global databases on ecological communities has advanced our knowledge of biodiversity sensitivity to environmental changes,5,6,7 vast areas of the tropics remain understudied.8,9,10,11 In the American tropics, Amazonia stands out as the world's most diverse rainforest and the primary source of Neotropical biodiversity,12 but it remains among the least known forests in America and is often underrepresented in biodiversity databases.13,14,15 To worsen this situation, human-induced modifications16,17 may eliminate pieces of the Amazon's biodiversity puzzle before we can use them to understand how ecological communities are responding. To increase generalization and applicability of biodiversity knowledge,18,19 it is thus crucial to reduce biases in ecological research, particularly in regions projected to face the most pronounced environmental changes. We integrate ecological community metadata of 7,694 sampling sites for multiple organism groups in a machine learning model framework to map the research probability across the Brazilian Amazonia, while identifying the region's vulnerability to environmental change. 15%–18% of the most neglected areas in ecological research are expected to experience severe climate or land use changes by 2050. This means that unless we take immediate action, we will not be able to establish their current status, much less monitor how it is changing and what is being lost

Pervasive gaps in Amazonian ecological research

Biodiversity loss is one of the main challenges of our time,1,2 and attempts to address it require a clear understanding of how ecological communities respond to environmental change across time and space.3,4 While the increasing availability of global databases on ecological communities has advanced our knowledge of biodiversity sensitivity to environmental changes,5,6,7 vast areas of the tropics remain understudied.8,9,10,11 In the American tropics, Amazonia stands out as the world's most diverse rainforest and the primary source of Neotropical biodiversity,12 but it remains among the least known forests in America and is often underrepresented in biodiversity databases.13,14,15 To worsen this situation, human-induced modifications16,17 may eliminate pieces of the Amazon's biodiversity puzzle before we can use them to understand how ecological communities are responding. To increase generalization and applicability of biodiversity knowledge,18,19 it is thus crucial to reduce biases in ecological research, particularly in regions projected to face the most pronounced environmental changes. We integrate ecological community metadata of 7,694 sampling sites for multiple organism groups in a machine learning model framework to map the research probability across the Brazilian Amazonia, while identifying the region's vulnerability to environmental change. 15%–18% of the most neglected areas in ecological research are expected to experience severe climate or land use changes by 2050. This means that unless we take immediate action, we will not be able to establish their current status, much less monitor how it is changing and what is being lost

The continuing question of how fever duration is associated with patient outcome

Although fever magnitude and etiology have been associated with outcomes of critically ill patients, possible associations between fever duration and mortality remain inconclusive. Since long-lasting fever is generally attributed to severe pathologic conditions, it is expected to be an indicator of adverse outcome. It also seems plausible that persistent fever in specific patient groups, mainly those with cerebral damage or limited cardiorespiratory reserve, could lead to worsened outcomes. Existing studies on these associations have been considerably limited because of methodological flaws, which may account for controversial findings that have been reported. Well-designed, large-sample studies using diverse measures of fever duration need to be conducted. © 2012 BioMed Central Ltd

Changes in nursing practice: Associations with responses to and coping with errors

Aims and objective. To investigate emotional responses of nurses and perceived senior staff responses to errors, error-coping strategies used by nurses and how these are associated with constructive or defensive changes in nursing practice. Background. Healthcare professionals have generally reported distressing emotional responses to errors and fear concerns about their consequences. However, errors can also be part of a developmental process, by offering opportunities for learning and leading to constructive changes in clinical practice. Design. Prospective, correlational, multicentre study. Methods. Five hundred and thirty-six structured questionnaires completed from nurses employed in various hospital departments were considered eligible for data extraction. The revised questionnaire used was evaluated for content validity. Results. Data analysis indicated that positive perceived senior staff responses (p=0·030), accepting error responsibility (p=0·031) and seeking social support (p=0·019) predicted constructive changes in nursing practice, while negative perceived senior staff responses (p=0·040) and error escape-avoidance (p=0·041) predicted defensive changes. Conclusions. Errors promote constructive changes in clinical practice when nurses are encouraged to use adaptive error-coping strategies within a supportive, non-blaming culture. Relevance to clinical practice. These findings highlight the role of senior staff in the establishment of a supportive, trustful ward climate, so that nurses can learn from errors, prevent their recurrence and improve patient safety. © 2011 Blackwell Publishing Ltd