A National Survey of Skin Infections, Care Behaviors and MRSA Knowledge in the United States

A nationally representative sample of approximately 2000 individuals was surveyed to assess SSTI infections over their lifetime and then prospectively over six-months. Knowledge of MRSA, future likelihood to self-treat a SSTI and self-care behaviors was also queried. Chi square tests, linear and multinomial regression were used for analysis. About 50% of those with a reported history of a SSTI typical of MRSA had sought medical treatment. MRSA knowledge was low: 28% of respondents could describe MRSA. Use of protective self-care behaviors that may reduce transmission, such as covering a lesion, differed with knowledge of MRSA and socio-demographics. Those reporting a history of a MRSA-like SSTI were more likely to respond that they would self-treat than those without such a history (OR 2.05 95% CI 1.40, 3.01; p<0.001). Since half of respondents reported not seeking care for past lesions, incidence determined from clinical encounters would greatly underestimate true incidence. MRSA knowledge was not associated with seeking medical care, but was associated with self-care practices that may decrease transmission.</p

Finishing the euchromatic sequence of the human genome

The sequence of the human genome encodes the genetic instructions for human physiology, as well as rich information about human evolution. In 2001, the International Human Genome Sequencing Consortium reported a draft sequence of the euchromatic portion of the human genome. Since then, the international collaboration has worked to convert this draft into a genome sequence with high accuracy and nearly complete coverage. Here, we report the result of this finishing process. The current genome sequence (Build 35) contains 2.85 billion nucleotides interrupted by only 341 gaps. It covers ∼99% of the euchromatic genome and is accurate to an error rate of ∼1 event per 100,000 bases. Many of the remaining euchromatic gaps are associated with segmental duplications and will require focused work with new methods. The near-complete sequence, the first for a vertebrate, greatly improves the precision of biological analyses of the human genome including studies of gene number, birth and death. Notably, the human enome seems to encode only 20,000-25,000 protein-coding genes. The genome sequence reported here should serve as a firm foundation for biomedical research in the decades ahead

Epidemics of Community-Associated Methicillin-Resistant <i>Staphylococcus aureus</i> in the United States: A Meta-Analysis

Staphylococcus aureus is the most frequent cause of skin and soft tissue infections in humans. Methicillin-resistant strains of S. aureus (MRSA) that emerged in the 1960s presented a relatively limited public health threat until the 1990s, when novel community-associated (CA-) MRSA strains began circulating. CA-MRSA infections are now common, resulting in serious and sometimes fatal infections in otherwise healthy people. Although some have suggested that there is an epidemic of CA-MRSA in the U.S., the origins, extent, and geographic variability of CA-MRSA infections are not known. We present a meta-analysis of published studies that included trend data from a single site or region, and derive summary epidemic curves of CA-MRSA spread over time. Our analysis reveals a dramatic increase in infections over the past two decades, with CA-MRSA strains now endemic at unprecedented levels in many US regions. This increase has not been geographically homogeneous, and appears to have occurred earlier in children than adults.</p

Epidemics of community-associated methicillin-resistant Staphylococcus aureus in the United States: a meta-analysis.

Staphylococcus aureus is the most frequent cause of skin and soft tissue infections in humans. Methicillin-resistant strains of S. aureus (MRSA) that emerged in the 1960s presented a relatively limited public health threat until the 1990s, when novel community-associated (CA-) MRSA strains began circulating. CA-MRSA infections are now common, resulting in serious and sometimes fatal infections in otherwise healthy people. Although some have suggested that there is an epidemic of CA-MRSA in the U.S., the origins, extent, and geographic variability of CA-MRSA infections are not known. We present a meta-analysis of published studies that included trend data from a single site or region, and derive summary epidemic curves of CA-MRSA spread over time. Our analysis reveals a dramatic increase in infections over the past two decades, with CA-MRSA strains now endemic at unprecedented levels in many US regions. This increase has not been geographically homogeneous, and appears to have occurred earlier in children than adults

An Examination of Burnout Predictors: Understanding the Influence of Job Attitudes and Environment

Burnout amongst healthcare employees is considered an epidemic; prior research indicates a host of associated negative consequences, though more research is needed to understand the predictors of burnout across healthcare employees. All employees in a cancer-focused academic healthcare institution were invited to participate in a bi-annual online confidential employee survey. A 72% response rate yielded 9979 complete responses. Participants completed demographic items, a validated single-item measure of burnout, and items measuring eight employee job attitudes toward their jobs and organization (agility, development, alignment, leadership, trust, resources, safety, and teamwork). Department-level characteristics, turnover, and vacancy were calculated for group level analyses. A univariate F test revealed differences in burnout level by department type (F (3, 9827) = 54.35, p &lt; 0.05) and post hoc Scheffe&rsquo;s tests showed employees in clinical departments reported more burnout than other departments. Hierarchical multiple regression revealed that employee demographic and job-related variables (including department type) explained 8% of the variance of burnout (F (19, 7880) = 37.95, p &lt; 0.001), and employee job attitudes explained an additional 27% of the variance of burnout (F (8, 7872) = 393.18, p &lt; 0.001). Relative weights analysis at the group level showed that, of the constructs measured, alignment is the strongest predictor of burnout, followed by trust and leadership. The relationships are inverse in nature, such that more alignment is related to less burnout. Turnover and vacancy rates did not predict group level burnout. The results reported here provide evidence supporting a shift in the focus of research and practice from detection to prevention of employee burnout and from individual-focused interventions to organization-wide interventions to prevent burnout

Illustration of the logistic curve in modeling the fraction of the infected people in a population over time.

<p>The infection rate is assumed to grow as a non-linear function of time. The growth rate is low when only a small fraction in a society is infected. After a certain period of time, when there are sufficiently many infections circulating in the population, the number of contacts between the susceptible people (those without the disease) and those with infection increases – as a result, a period of rapid growth of infections occurs. Eventually, the growth slows down again, and the fraction of infections levels off, settling at an endemic level as the time goes on.</p

Estimated population incidence rate meta-curve, based on the two CA-MRSA population incidence studies from Chicago, IL [<b>9</b>], Maryland [<b>10</b>], the population insured under Tricare [<b>12</b>] and Pennsylvania [<b>11</b>].

<p>Only marginal changes are expected after year 2010.</p

Estimated meta-curves for studies reporting CA-MRSA as a proportion of all MRSA infections at a medical center, estimated based on: Chicago, IL data from two studies [<b>3</b>], [<b>16</b>] and our data from the University of Chicago Medical Center; Corpus Christie, TX [<b>17</b>]–[<b>18</b>]; Memphis TN [<b>19</b>]; Minneapolis, MN [<b>20</b>]; Minnesota [<b>21</b>]; San Diego, CA [<b>22</b>]; two St. Louis studies [<b>23]</b>–[<b>24</b>]; and a study from Northern California [<b>25</b>].

<p>The average pediatric CA-MRSA fraction began leveling off in about 1995, coming close to the plateau rate of 69·9%. The fraction of CA-MRSA among adult and mixed adult and pediatric MRSA cases seems to be still on the rise in almost all centers, except for the two mixed populations in San Diego, CA and Northern California. The fraction of CA-MRSA among adult MRSA cases in all centers seems to be continuing an upward trend. Our analysis predicts further increases of CA-MRSA’s share of all adult MRSA infections beyond 2010; the model estimates that the average long-term plateau of CA-MRSA to MRSA ratio among adults will be about 80%, with large variation among individual studies (56·9% to 100%).</p

Estimated population meta-curve for studies reporting CA-MRSA as a proportion of all <i>S. aureus</i> infections.

<p>The estimated limiting fraction of CA-MRSA among all <i>S. aureus</i> infections is 65%. The individual studies vary with respect to this limiting fraction: in Springfield, MA <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0052722#pone.0052722-Rossini1" target="_blank">[13]</a>, it was estimated at 78%, in Denver, CO <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0052722#pone.0052722-Clancy1" target="_blank">[14]</a> at 83% and in Morristown, NJ <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0052722#pone.0052722-Kairam1" target="_blank">[15]</a> at 50%.</p