Shedding of Staphylococcus aureus and methicillin-resistant Staphylococcus aureus from adult and pediatric bathers in marine waters

<p>Abstract</p> <p>Background</p> <p><it>Staphylococcus aureus </it>including methicillin resistant <it>S. aureus</it>, MRSA, are human colonizing bacteria that commonly cause opportunistic infections primarily involving the skin in otherwise healthy individuals. These infections have been linked to close contact and sharing of common facilities such as locker rooms, schools and prisons Waterborne exposure and transmission routes have not been traditionally associated with <it>S. aureus </it>infections. Coastal marine waters and beaches used for recreation are potential locations for the combination of high numbers of people with close contact and therefore could contribute to the exposure to and infection by these organisms. The primary aim of this study was to evaluate the amount and characteristics of the shedding of methicillin sensitive <it>S. aureus</it>, MSSA and MRSA by human bathers in marine waters.</p> <p>Results</p> <p>Nasal cultures were collected from bathers, and water samples were collected from two sets of pools designed to isolate and quantify MSSA and MRSA shed by adults and toddlers during exposure to marine water. A combination of selective growth media and biochemical and polymerase chain reaction analysis was used to identify and perform limited characterization of the <it>S. aureus </it>isolated from the water and the participants. Twelve of 15 MRSA isolates collected from the water had identical genetic characteristics as the organisms isolated from the participants exposed to that water while the remaining 3 MRSA were without matching nasal isolates from participants. The amount of <it>S. aureus </it>shed per person corresponded to 10⁵to 10⁶CFU per person per 15-minute bathing period, with 15 to 20% of this quantity testing positive for MRSA.</p> <p>Conclusions</p> <p>This is the first report of a comparison of human colonizing organisms with bacteria from human exposed marine water attempting to confirm that participants shed their own colonizing MSSA and MRSA into their bathing milieu. These findings clearly demonstrate that adults and toddlers shed their colonizing organisms into marine waters and therefore can be sources of potentially pathogenic <it>S. aureus </it>and MRSA in recreational marine waters. Additional research is needed to evaluate recreational beaches and marine waters as potential exposure and transmission pathways for MRSA.</p

Evaluation of an Ultrasensitive p24 Antigen Assay as a Potential Alternative to Human Immunodeficiency Virus Type 1 RNA Viral Load Assay in Resource-Limited Settings

An inexpensive enzyme-linked immunosorbent assay method for human immunodeficiency virus type 1 quantitation, ultrasensitive p24 antigen assay (Up24), was compared with RNA viral load assay (VL). Up24 had 100% sensitivity of detection at a viral load of ≥30,000, with sensitivity of 46.4% at a viral load o

The Edgewater Coolside process demonstration

The Edgewater Coolside process demonstration met the program objectives which were to determine Coolside SO[sub 2] removal performance, establish short-term process operability, and evaluate the economics of the process versus a limestone wet scrubber. On a flue gas produced from the combustion of 3% sulfur coal, the Coolside process achieved 70% SO[sub 2] removal using commercially-available hydrated lime as the sorbent. The operating conditions were Ca/S mol ratio 2.0, Na/Ca mol ratio 0.2, and 20[degree]F approach to adiabatic saturation temperature ([del]T). During tests using fresh plus recycle sorbent, the recycle sorbent exhibited significant capacity for additional SO[sub 2] removal. The longest steady state operation was eleven days at nominally Ca/S = 2, Na/Ca = 0.22, [del]T = 20--22[degree]F, and 70% SO[sub 2] removal. The operability results achieved during the demonstration indicate that with the recommended process modifications, which are discussed in the Coolside process economic analysis, the process could be designed as a reliable system for utility application. Based on the demonstration program, the Coolside process capital cost for a hypothetical commercial installation was minimized. The optimization consisted of a single, large humidifier, no spare air compressor, no isolation dampers, and a 15 day on-site hydrated lime storage. The levelized costs of the Coolside and the wet limestone scrubbing processes were compared. The Coolside process is generally economically competitive with wet scrubbing for coals containing up to 2.5% sulfur and plants under 350 MWe. Site-specific factors such as plant capacity factor, SO[sub 2] emission limit, remaining plant life, retrofit difficulty, and delivered sorbent cost affect the scrubber-Coolside process economic comparison

Mobile Learning Module Improves Knowledge of Medical Shock for Forward Surgical Team Members

Acute trauma care is characterized by dynamic situations that require adequate preparation to ensure success for military health professionals. The use of mobile learning in this environment can provide a solution that standardizes education and replaces traditional didactic lectures. A comparative evaluation with a pre-post test design regarding medical shock was delivered via either a didactic lecture or a mobile learning video module to U.S. Army Forward Surgical Team (FST) members. Participants completed a pretest, were randomly assigned to treatment group by FST, and then completed the post-test and scenario assessment. One-hundred and thirteen FST members participated with 53 in the mobile learning group and 60 in the lecture group (control). The percent mean score for the mobile learning group increased from 43.6 to 70 from pretest to post-test, with a scenario mean score of M = 56.2. The percent mean score for the control group increased from 41.5 to 72.5, with a scenario mean score of M = 59.7. The two-way analysis of variance mean score difference was 26.4 for the mobile learning group and 31.0 for the control, F = 2.18, (p = 0.14). Mobile learning modules, coupled with a structured assessment, have the potential to improve educational experiences in civilian and military settings

Use of mobile learning module improves skills in chest tube insertion

Just-In-Time Learning is a concept increasingly applied to medical education, and its efficacy must be evaluated. A 3-minute video on chest tube insertion was produced. Consenting participants were assigned to either the video group, which viewed the video on an Apple® iPod Touch immediately before chest tube insertion, or the control group, which received no instruction. Every participant filled out a questionnaire regarding prior chest tube experience. A trained clinician observed participants insert a chest tube on the TraumaMan® task simulator, and assessed performance using a 14-item skills checklist. Overall, 128 healthcare trainees participated, with 50% in the video group. Participants included residents (34.4%, n = 44), medical students (32.8%, n = 42), and U.S. Army Forward Surgical Team members (32.8%, n = 42). Sixty-nine percent of all participants responded that they had never placed a chest tube, but 7% had placed more than 20. Only 25% of the participants had previously used TraumaMan®. Subjects who viewed the video scored better on the skills checklist than the control group (11.09 ± 3.09 versus 7.17 ± 3.56, P < 0.001, Cohen's D = 1.16). Medical students (9.33 ± 2.65 versus 4.52 ± 3.64, P < 0.001), Forward Surgical Team members (10.07 ± 2.52 versus 8.57 ± 3.22, P < 0.001), anesthesia residents (8.25 ± 2.56 versus 5.9 ± 2.23, P = 0.017), and subjects who had placed fewer than 10 chest tubes (9.7 ± 3 versus 6.6 ± 3.9, P < 0.001) performed significantly better with the video. The procedural animation video is an effective medium for teaching procedural skills. Embedding the video on a mobile device, and allowing trainees to access it immediately before chest tube insertion, may enhance and standardize surgical education for civilians and military personnel