Francisella tularensis Transmission by Solid Organ Transplantation, 20171.

In July 2017, fever and sepsis developed in 3 recipients of solid organs (1 heart and 2 kidneys) from a common donor in the United States; 1 of the kidney recipients died. Tularemia was suspected only after blood cultures from the surviving kidney recipient grew Francisella species. The organ donor, a middle-aged man from the southwestern United States, had been hospitalized for acute alcohol withdrawal syndrome, pneumonia, and multiorgan failure. F. tularensis subsp. tularensis (clade A2) was cultured from archived spleen tissue from the donor and blood from both kidney recipients. Whole-genome multilocus sequence typing indicated that the isolated strains were indistinguishable. The heart recipient remained seronegative with negative blood cultures but had been receiving antimicrobial drugs for a medical device infection before transplant. Two lagomorph carcasses collected near the donor's residence were positive by PCR for F. tularensis subsp. tularensis (clade A2). This investigation documents F. tularensis transmission by solid organ transplantation

Construing the child reader: a cognitive stylistic analysis of the opening to Neil Gaiman’s The Graveyard Book

Neil Gaiman’s The Graveyard Book (2009) charts the story of Nobody Owens, a boy who is adopted by supernatural entities in the local graveyard after his family is murdered. This article draws on the notion of the “construed reader,” and combines two cognitive stylistic frameworks to analyse the opening section of the novel. In doing so, the article explores the representation and significance of the family home in relation to what follows in the narrative. The analysis largely draws on Text World Theory (Werth, 1999; Gavins, 2007), but also integrates some aspects of Cognitive Grammar (Langacker, 2008), which allows for a more nuanced discussion of textual features. The article pays particular attention to the way Gaiman frames his narrative and positions his reader to view the fictional events from a distinctive vantage point and subsequently demonstrates that a stylistic analysis of children’s literature can lay bare how such writing is designed with a young readership in mind

Retreatment for hepatitis C virus direct-acting antiviral therapy virological failure in primary and tertiary settings: The REACH-C cohort

Virological failure occurs in a small proportion of people treated for hepatitis C virus (HCV) with direct-acting antiviral (DAA) therapies. This study assessed retreatment for virological failure in a large real-world cohort. REACH-C is an Australian observational study (n = 10,843) evaluating treatment outcomes of sequential DAA initiations across 33 health services between March 2016 to June 2019. Virological failure retreatment data were collected until October 2020. Of 408 people with virological failure (81% male; median age 53; 38% cirrhosis; 56% genotype 3), 213 (54%) were retreated once; 15 were retreated twice. A range of genotype specific and pangenotypic DAAs were used to retreat virological failure in primary (n = 56) and tertiary (n = 157) settings. Following sofosbuvir/velpatasvir/voxilaprevir availability in 2019, the proportion retreated in primary care increased from 21% to 40% and median time to retreatment initiation declined from 294 to 152 days. Per protocol (PP) sustained virological response (SVR12) was similar for people retreated in primary and tertiary settings (80% vs 81%; p = 1.000). In regression analysis, sofosbuvir/velpatasvir/voxilaprevir (vs. other regimens) significantly decreased likelihood of second virological failure (PP SVR12 88% vs. 77%; adjusted odds ratio [AOR] 0.29; 95%CI 0.11–0.81); cirrhosis increased likelihood (PP SVR12 69% vs. 91%; AOR 4.26; 95%CI 1.64–11.09). Indigenous Australians had lower likelihood of retreatment initiation (AOR 0.36; 95%CI 0.15–0.81). Treatment setting and prescriber type were not associated with retreatment initiation or outcome. Virological failure can be effectively retreated in primary care. Expanded access to simplified retreatment regimens through decentralized models may increase retreatment uptake and reduce HCV-related mortality

Paratextual subversion: Herrera and his poetry in the anotaciones

The year 1580 saw the publication of the Anotaciones a las obras de Garcilaso de la Vega by the critic and poet Fernando de Herrera (c. 1534–97). This study develops previous scholarship on the paratextual strategies employed by Herrera, especially with regard to the inclusion of his own poetry within the Anotaciones. Two Garcilasian sonnets, ‘D’aquella vista pura i ecelente’ (VIII) and ‘Si para refrenar este desseo’ (XII), in conjunction with Herrera’s poetic responses, lie at the heart of this investigation, representing two respectively dominant cultural currents of the period: Neoplatonism and Classical mythography. It will be shown how Herrera exploits Counter-Reformation attitudes towards secularity and mythography to engage in a critique that goes deeper than the attacks previously noted by Navarrete’s 1991 study. Indeed, Herrera’s lyric occupies a central role in a complete re-evaluation of Garcilasian lyric that not only moves to subvert the supremacy of the Toledan but also the hegemonic rule of intellectuals from Castile. Herrera presents himself as a learned Andalusian model for Neoplatonic poetics and as the model for imitation for Spanish letters in the wake of the Counter-Reformation. En 1580 el poeta y crítico Fernando de Herrera (c. 1534–97) publicó sus Anotaciones a las obras de Garcilaso de la Vega. Este artículo desarrolla estudios anteriores sobre esta obra en relación con las estrategias paratextuales empleadas por Herrera, sobre todo por lo que respecta a la inclusión de su propia poesía en el texto de las Anotaciones. Este trabajo se centra en dos sonetos de Garcilaso, ‘D’aquella vista pura i ecelente’ (VIII) y ‘Si para refrenar este deseo’ (XII), en conjunción con otros tantos textos poéticos de Herrera, teniendo en cuenta sus deudas con dos corrientes culturales contemporáneas: el neoplatonismo y la mitología clásica. Las actitudes hacia el amor neoplatónico y la mitología fueron explotadas por Herrera de una manera más profunda de lo que se suele creer. En efecto, la poesía de Herrera ocupa un papel central en la reevaluación completa de Garcilaso que no sólo subvierte la posición del poeta en el canon literario sino también la hegemonía de los intelectuales de Castilla. Herrera se presenta como un andaluz sabio y defensor de la poesía neoplatónica y como el modelo de referencia para la imitación poética en la nueva era que se abre con la Contrarreforma.This is the author accepted manuscript. The final version is available from Maney via http://dx.doi.org/10.1179/1468273715Z.00000000012

Poor immunization outcomes: Overcoming provider barriers.

This research consists of three separate but related papers on barriers to immunization services and health policy. Although these issues are relevant for all immunization services, the focus is on hepatitis A (HAV) and hepatitis B (HBV). There are supply barriers, which inhibit providers of care from reaching those in need of immunization, and demand barriers, which prevent patients from accessing services. These papers address aspects of supply barriers. The first paper addresses the question of who should be immunized against HAV when target groups are not clearly identified. Various risk groups were analyzed regarding the comparative risk of contracting and transmitting hepatitis A. This analysis recommends that the following groups be prioritized for HAV vaccine programs: sewage workers, residents of institutional communities, residents of Native American reservations (and other high-risk communities), overseas travelers and workers, and the military. The second paper discusses the results of a survey designed to determine the attitudes of nursing personnel in newborn nurseries who took on new duties of obtaining consent from parents and providing HBV vaccine to newborns. Among other findings, nursing staff need more training, including education about vaccine efficacy and appropriateness. Health care personnel who have to implement a new immunization program, not just those who decide on such policies need significant education in order to successfully fulfill their new duties. The third paper reports the results of the use of an alternative schedule for administering HBV vaccine to adolescents. The 0, 2, 4 month immunization schedule for adolescents is an alternative for adolescents, but there had been no studies to confirm the effectiveness of this schedule. Students who completed the series provided serological samples to determine the rate of seroconversion. This study found that the alternative schedule is quite effective in achieving protective antibody titers. Because of difficulties in reaching this age cohort and older teenagers, use of this modified immunization schedule may permit school-based or other public health programs to immunize a larger number of adolescents at risk in a shorter time frame.Dr.P.H.Health and Environmental SciencesPublic healthUniversity of Michigan, Horace H. Rackham School of Graduate Studies, School of Public Healthhttp://deepblue.lib.umich.edu/bitstream/2027.42/132052/2/9957658.pd

Medical encounters for opioid-related intoxications in Southern Nevada: sociodemographic and clinical correlates

Despite today's heightened concern over opioid overdose, the lack of population-based data examining clinical and contextual factors associated with opioid use represents a knowledge gap with relevance to prevention and treatment interventions. We sought to quantify rates of emergency department (ED) visits and inpatient hospitalizations for harmful opioid effects and their sociodemographic differentials as well as clinical correlates in Southern Nevada, using ED visit and hospital inpatient discharge records from 2011 to 2013. Methods: Cases were identified by ICD-9-CM diagnosis codes for opioid poisoning and opioid-type drug dependence and abuse as well as poisoning and adverse effect E-codes. Comorbid conditions, including pain-related diagnoses, major chronic diseases, affective disorders, sleep disorders, sexually transmitted infections and viral hepatitis were assessed from all available diagnosis fields. Counts by age-race per zip code were modeled by negative binomial regression. Opioid injuries were further examined as a function both of neighborhood income and individual characteristics, with mixed-effects logistic regression to estimate the likelihood for an adverse outcome. Results: Opioid intoxications and comorbidities were more common in low-income communities. The multivariable-adjusted rate for opioid-related healthcare utilization was 42 % higher in the poorest vs. richest quartile during the study period. The inter-quartile (quartile 1 vs. 4) rate increases for chronic bodily pains (44 %), hypertension (89 %), renal failure/ diabetes (2.6 times), chronic lower respiratory disease (2.2 times), and affective disorders (57 %) were statistically significant. Chronic disease comorbidity was greater among non-Hispanic blacks, whereas abuse/ dependence related disorders, alcohol or benzodiazepine co-use, chronic bodily pains, and affective disorders were more prevalent among non-Hispanic whites than nonwhites. Conclusions: There were consistent patterns of disparities in healthcare utilization across sociodemographic groups for opioid-associated disorders. Further initiatives to evaluate the determinants of overdose and abuse and to implement targeted response efforts are needed

On the mediation of everything: ICA presidential address 2008

As our field moves beyond the traditional dualism of mass and interpersonal forms of communication to encompass new, interactive, networked forms of communication whose influence may be traced across multiple spheres of modern life, it is commonly claimed that ‘everything is mediated’ and that this represents a historically significant change. This article inquires into these rhetorically grand claims, first noting the parallels with other processes of mediation (e.g. language, money, myths), second raising questions of value since, unlike for other forms of mediation, the media’s role is typically construed as negative than positive and, third observing that the difficulties of translating ‘mediation’ into a range of languages reveals some conceptual confusions. As a step towards clarification, I contrast the terms ‘mediation’ and ‘mediatization’, these roughly, mapping onto situational and historical influences, conceived primarily at micro and macro levels of analysis respectively. I then argue for a broad conception of mediation that encompasses those processes variously referred to as mediatization, mediazation or medialization. The analysis is illustrated by unpacking the claim that ‘childhood is mediated’, before concluding that distinct aspects of the concept of mediation invite communication scholars to attend to the specific empirical, historical and political implications of the claim that ‘everything is mediated’