Interspecies transfer of blaimp-4 in a patient with prolonged colonization by IMP-4-producing enterobacteriaceae

A patient was colonized by IMP-4-producing Enterobacter cloacae and Escherichia coli strains for 7 months. IMP-4-producing E. cloacae strains were first and last isolated at day 33 and at 8 months after admission, respectively. IMP-4-producing E. coli strains were first and last isolated at days 88 and 181 after admission, respectively. The E. cloacae and E. coli isolates shared identical genetic features in terms of bla(IMP-4), bla(TEM-1), qnrB2, aacA4, HI2 plasmids, and ISCR1. This study shows the first prolonged colonization with in vivo interspecies transfer of bla(IMP-4)

Diagnostic Yield of Dental Radiography and Cone-Beam Computed Tomography for the Identification of Anatomic Structures in Cats

The objective of this study was to evaluate the diagnostic yield of dental radiography (DR) and 3 cone-beam computed tomography (CBCT) methods for the identification of predefined anatomic structures in cats. For 5 feline cadaver heads and 22 client-owned cats admitted for evaluation and treatment of dental disease, a total of 22 predefined anatomic structures were evaluated separately by use of the DR method and 3 CBCT software modules [multiplanar reconstructions (MPR), tridimensional (3-D) rendering, and reconstructed panoramic views (Pano)]. A semi quantitative scoring system was used, and mean scores were calculated for each anatomic structure and imaging method. The Friedman test was used to evaluate values for significant differences in diagnostic yield. For values that were significant the Wilcoxon signed rank test was used with the Bonferroni-Holm multiple comparison adjustment to determine significant differences among each of the possible pairs of diagnostic methods. Differences of diagnostic yield among the DR and 3 CBCT methods were significant for 17 of 22 anatomic structures. For these structures, DR scores were significantly higher than scores for Pano views for 2 of 17 structures, but DR scores were significantly lower than scores for Pano views for 6 anatomic structures, tridimensional rendering for 10 anatomic structures, and MPR for 17 anatomic structures. In conclusion, it was found that CBCT methods were better suited than DR for the identification of anatomic structures in cats. Results of this study can serve as a basis for CBCT evaluation of dentoalveolar and other maxillofacial bony lesions in cats

Novel Human Parechovirus 3 Diversity, Recombination, and Clinical Impact Across 7 Years: An Australian Story

BACKGROUND A novel human parechovirus 3 Australian recombinant (HPeV3-AR) strain emerged in 2013 and coincided with biennial outbreaks of sepsis-like illnesses in infants. We evaluated the molecular evolution of the HPeV3-AR strain and its association with severe HPeV infections. METHODS HPeV3-positive samples collected from hospitalized infants aged 5-252 days in 2 Australian states (2013-2020) and from a community-based birth cohort (2010-2014) were sequenced. Coding regions were used to conduct phylogenetic and evolutionary analyses. A recombinant-specific polymerase chain reaction was designed and utilized to screen all clinical and community HPeV3-positive samples. RESULTS Complete coding regions of 54 cases were obtained, which showed the HPeV3-AR strain progressively evolving, particularly in the 3' end of the nonstructural genes. The HPeV3-AR strain was not detected in the community birth cohort until the initial outbreak in late 2013. High-throughput screening showed that most (>75%) hospitalized HPeV3 cases involved the AR strain in the first 3 clinical outbreaks, with declining prevalence in the 2019-2020 season. The AR strain was not statistically associated with increased clinical severity among hospitalized infants. CONCLUSIONS HPeV3-AR was the dominant strain during the study period. Increased hospital admissions may have been from a temporary fitness advantage and/or increased virulence

Partnerships with children

Partnerships with childre

Parenting in a crisis: conceptualising mothers of children with cancer

Much research on the experiences of parents of children with cancer has been conducted within a discourse of psycho-pathology, or has tended to see parents mostly as a proxy source of information on the well-being of their children. Using empirical data from semi-structured interviews with 20 mothers of a child with cancer, in one area of the UK, we draw on sociological literatures on motherhood, childhood, caring, and chronic illness to suggest a more helpful and informative way of understanding their experiences. We suggest that mothers, although not ill themselves, experience many of the consequences of chronic illness. Biographical disruption begins for them when they first notice something wrong with their child, and intensifies with diagnosis, altering their sense of self and their social identity. The diagnosis brings with it a set of new responsibilities and role expectations, including an obligation of 'proximity'--being physically close to their child at all times to provide 'comfort' and 'keep-watch'. For mothers, caring evokes an intense emotional interdependence with their sick child, and involves a range of technical tasks and emotional work, including acting as 'brokers' of information for their child and managing their cooperation with treatment. Managing these obligations was achieved at high cost to the mothers themselves, and resulted in severe role strain by compromising their ability to function in other roles, including their role as the mother of their other children. Against the backdrop of a severe and life-threatening illness, everyday concerns about their child's diet or appropriate discipline take on a new significance and carry a heightened potential for generating conflict and distress for mothers. In presenting their accounts, mothers draw on prevailing cultural discourses about motherhood, childhood and cancer, and these clearly influence the context in which they care for their child, and shape their reflexive constructions of their experiences. Caring for a child with cancer had many adverse implications for the quality of life of the women we studied. Mothers of a child with cancer warrant study in their own right, and such study benefits from interpretive perspectives.Cancer Children Mothers UK

Teaching and addressing health disparities through the family medicine social and community context of care project.

By training future physicians to care for patients with backgrounds different from their own, medical schools can help reduce health disparities. To address the need for education in this area, the leaders of the Family Medicine Clerkship at the Warren Alpert Medical School of Brown University developed the Social and Community Context of Care project, required of all medical students rotating through this clerkship. Students develop a hypothetical intervention addressing a health issue seen at their preceptor site, and are assessed on their grasp of the social and contextual issues affecting that health issue in their particular community. Some interventions are actualized in later clerkships or independent study projects; one example, a health class for pregnant and parenting teens at Central Falls High School, is described here. If made a routine part of medical education, projects such as these may help medical students address the health disparities they will encounter in future practice

Diagnostic Yield of Dental Radiography and Cone-Beam Computed Tomography for the Identification of Anatomic Structures in Cats.

The objective of this study was to evaluate the diagnostic yield of dental radiography (DR) and 3 cone-beam computed tomography (CBCT) methods for the identification of predefined anatomic structures in cats. For 5 feline cadaver heads and 22 client-owned cats admitted for evaluation and treatment of dental disease, a total of 22 predefined anatomic structures were evaluated separately by use of the DR method and 3 CBCT software modules [multiplanar reconstructions (MPR), tridimensional (3-D) rendering, and reconstructed panoramic views (Pano)]. A semi quantitative scoring system was used, and mean scores were calculated for each anatomic structure and imaging method. The Friedman test was used to evaluate values for significant differences in diagnostic yield. For values that were significant the Wilcoxon signed rank test was used with the Bonferroni-Holm multiple comparison adjustment to determine significant differences among each of the possible pairs of diagnostic methods. Differences of diagnostic yield among the DR and 3 CBCT methods were significant for 17 of 22 anatomic structures. For these structures, DR scores were significantly higher than scores for Pano views for 2 of 17 structures, but DR scores were significantly lower than scores for Pano views for 6 anatomic structures, tridimensional rendering for 10 anatomic structures, and MPR for 17 anatomic structures. In conclusion, it was found that CBCT methods were better suited than DR for the identification of anatomic structures in cats. Results of this study can serve as a basis for CBCT evaluation of dentoalveolar and other maxillofacial bony lesions in cats

Managing communication with young people who have a potentially life-threatening chronic illness: qualitative study of patients and parents

Objectives: To examine young people's and parents' accounts of communication about cancer in childhood. Design: Semistructured interviews analysed using the constant comparative method. Setting: Paediatric oncology unit. Participants: 13 families, comprising 19 parents (13 mothers, six fathers) and 13 patients aged 8­-17 years, recruited from one paediatric oncology unit. The patients had cancer or brain tumour. Results: Most parents described acting in an executive-­like capacity, managing what and how their children were told about their illness, particularly at the time of diagnosis. Their accounts were shaped by concerns to manage their identity as strong and optimistic parents and to protect their child's wellbeing. The patients identified elements of their parents' role that both facilitated and constrained their communication, and while they welcomed their parents' involvement, some expressed unease with the constraining aspects of their parents' role. Some young people described feeling marginalised in consultations and pointed to difficulties they experienced in encounters with some doctors. Conclusions: There are difficulties in managing communication with young people who have a chronic, life threatening illness. Health professionals need to be aware of how the social positioning of young people (relative to adults) and the executive role of parents can contribute to the marginalisation of young people and hamper the development of successful relationships between themselves and young patients

The Diagnostic Yield of Dental Radiography and Cone-Beam Computed Tomography for the Identification of Dentoalveolar Lesions in Cats.

The objective of this study was to evaluate the diagnostic yield of dental radiography (DR) and 3 cone-beam computed tomography (CBCT) software modules for the identification of 32 pre-defined dentoalveolar lesions in cats. For 5 feline cadaver heads and 22 client-owned cats admitted for evaluation and treatment of dental disease, 32 predefined dentoalveolar lesions were evaluated separately and scored by use of dental radiography and 3 CBCT software modules [multiplanar reconstructions (MPR), tridimensional (3-D) rendering, and reconstructed panoramic views]. A qualitative scoring system was used. Dentoalveolar lesions were grouped into 14 categories for statistical analysis. Point of reference for presence or absence of a dentoalveolar lesion was determined as the method that could be used to clearly identify the disorder as being present. Accuracy, sensitivity, specificity, and positive and negative predictive values were calculated with the McNemar χ2 test of marginal homogeneity of paired data. When all 3 CBCT software modules were used in combination, the diagnostic yield of CBCT was significantly higher than that of dental radiography for 4 of 14 categories (missing teeth, horizontal bone loss, loss of tooth integrity, feline resorptive lesions), and higher, although not significantly so, for 9 categories (supernumerary teeth, supernumerary roots, abnormally shaped roots, vertical bone loss, buccal bone expansion, periapical disease, inflammatory root resorption, and external replacement root resorption). In conclusion, we found that CBCT provided more clinically relevant detailed information as compared to dental radiography. Therefore, CBCT should be considered better suited for use in diagnosing dentoalveolar lesions in cats