The Evolution of Pacific Policy and Strategic Planning: June 1940-July1941

While U.S. policy and strategic planning were in harmony by late 1941, this foundation upon which the next 4 years\u27 war effort would be based was not the result of close coordination between strategic planners and foreign policy experts as has generally been assumed

Impact of use of Tylosin and Virginiamycin on antimicrobial agents resistance profiles of Enterococcus spp. and E. coli isolates from swine in field conditions

Enterococcus spp. and E. coli are recognized as indicator microorganisms for the human and animal intestinal flora, and are also known to be potential reservoirs of antimicrobial resistance genes. Among the various use of antimicrobial agents that can promote antibioresistance, on farm use of growth promoters raises public health concerns. The aim of this study was to evaluate the impact of the use of selected growth promoters on antimicrobial resistance profiles of Enterococcus spp. and E. coli isolates from swine in field conditions. Enterococcus and E. coli isolates obtained from pooled fecal samples of pigs receiving Tylosin (44 ppm, n = 100) and Virginiamycin (22 ppm, n=1 00) were compared to isolates obtained from a control group (n = 1 00) fed without growth promoters, in field conditions. Comparison was done between isolates obtatned in the first week of treatment and isolates obtained 1n the 15th week

Evolution of Salmonella excretion by sows during gestation in link with the faecal microbiome

Pork meat is estimated to be responsible of 10 to 20% of human salmonellosis cases. Control strategies at the farm could reduce contamination at the slaughterhouse. One of the targeted sector of the production is the maternity, where sows could be Salmonella reservoirs. The aim of this study was to characterize the faecal microbiome of sows excreting or not Salmonella during gestation phases. A total of 76 sows were selected and fecal matters were analysed at the beginning or the end of gestation period. Salmonella detection was conducted using a method including two selective enrichment media (MSRV and TBG). Nine (9) isolates per positive samples were collected. Among the 76 sows tested, 31 were shedding Salmonella. The sows in the first third of their gestation shed significantly more frequently Salmonella (22/29) than those in the last third (9/47) (χ² P \u3c 0.05). The shedding status of 19 of the sows that were previously sampled in the first third of their gestation was followed, this time in the last third, confirming reduction of the shedding. Association between changes in the intestinal microbiome and this evolution of Salmonella shedding will be explored. MiSeq sequencing is currently being conducted on the feces to identify shifts in the composition or diversity in the microbial community that could be associated to these variations. A large number of Salmonella isolates that were collected were genotyped by a high resolution melt (HRM) technique. These results showed the presence of a major HRM profile (136 isolates / 169) and two minor profiles (24 and 9 /169)

Digestive microbiota changes during application of an effective, feed presentation based, mitigation option against Salmonella shedding in pigs

If some studies have attempted to mitigate the Salmonella spp. excretion in pigs by feed related interventions, none clearly demonstrated the impact of the presentation (mash or pellet and particular size). Thus this study aimed to determine if the modification of the pigs feed presentation alone can lower the Salmonella spp. excretion

Predictors of Mortality Among U.S. Veterans With \u3cem\u3eStreptococcus Pneumoniae\u3c/em\u3e Infections

Introduction Serious Streptococcus pneumoniae infections, encompassing pneumonia, bacteremia, and meningitis, are a major cause of mortality. However, literature regarding mortality is often limited to invasive pneumococcal disease, excluding pneumonia. This study sought to identify predictors of mortality among adults with serious pneumococcal disease, including pneumonia and invasive pneumococcal disease. Methods This was a nested case-control study of unvaccinated older Veterans with positive S. pneumoniae cultures (blood, cerebrospinal fluid, respiratory) admitted to Veterans Affairs medical centers nationally between 2002 and 2011. Patients vaccinated against pneumococcal disease were excluded. Using multivariable logistic regression, predictors of 30-day mortality were identified, including patient demographics, comorbidities during admission, and medical history within the previous year. Results Among 9,468 patients, there were 9,730 serious pneumococcal infections; 1,764 (18.6%) resulted in death within 30 days (cases), whereas 7,966 did not (controls). Pneumonia accounted for half (49.4%, n=871) of all deaths. Mortality predictors consistent with vaccine recommendations included dialysis (during hospitalization, OR=3.35, 95% CI=2.37, 4.72), moderate to severe liver disease (during hospitalization, OR=2.47, 95% CI=1.53, 3.99; within 1 year, OR=1.49, 95% CI=1.01, 2.20), and neutropenia (during hospitalization, OR=2.67, 95% CI=1.32, 5.42). Predictors not included in current recommendations included dementia (during hospitalization, OR=1.8, 95% CI=1.23, 2.61) and neurologic disorders (during hospitalization, OR=1.86, 95% CI=1.42, 2.45; within 1 year, OR=1.28, 95% CI=1.02, 1.59). Conclusions Several mortality predictors among unvaccinated Veterans with serious pneumococcal disease were consistent with pneumococcal vaccine recommendations, including organ or immune system dysfunction–related conditions. Other predictors, including neurologic disorders or dementia, may warrant expanded vaccination recommendations

Risk stacking of pneumococcal vaccination indications increases mortality in unvaccinated adults with Streptococcus pneumoniae infections

Background Several chronic disease states have been identified as pneumococcal vaccination indications due to their ability to increase pneumococcal disease development and subsequent mortality. However, the risk of mortality according to the number of these disease states present is unknown. We sought to determine the impact of concomitant, multiple risk factors (stacked risks) for pneumococcal disease on 30-day mortality in adults. Methods This was a national case-control study of unvaccinated older Veterans (≥50 years of age) admitted to Veterans Affairs medical centers from 2002 to 2011 with serious pneumococcal infections (pneumonia, bacteremia, meningitis) based on positive S. pneumoniae blood, cerebrospinal fluid, or respiratory cultures, respectively. Cases were those not alive 30 days following culture, while controls were alive. Using logistic regression, we quantified risk of 30-day mortality among patients with stacked risk factors, including age ≥65 years, alcohol abuse, chronic heart disease, chronic liver disease, chronic respiratory disease, diabetes mellitus, immunodeficiency, and smoking. Results We identified 9730 serious pneumococcal infections, with an overall 30-day mortality rate of 18.6% (1764 cases, 7966 controls). Infection types included pneumonia (62%), bacteremia (26%), and bacteremic pneumonia (11%). Along with eight individual risk factors, we assessed 247 combinations of risk factors. Most cases (85%) and controls (74%) had at least two risk factors. Mortality increased as risks were stacked, up to six risk factors (one: OR 1.5, CI 1.08–2.07; two: OR 2.01, CI 1.47–2.75; three: OR 2.71, CI 1.99–3.69; four: OR 3.27, CI 2.39–4.47; five: OR 3.63, CI 2.60–5.07; six: OR 4.23, CI 2.69–6.65), with each additional risk factor increasing mortality an average of 55% (±13%). Conclusions Among adults ≥50 years with serious pneumococcal disease, mortality risk increased approximately 55% as vaccination indications present increased. Mortality with six stacked indications was double that of two indications

A Review of Combination Antimicrobial Therapy for Enterococcus Faecalis Bloodstream Infections and Infective Endocarditis

Enterococci, one of the most common causes of hospital-associated infections, are responsible for substantial morbidity and mortality. Enterococcus faecalis, the more common and virulent species, cause serious high-inoculum infections, namely infective endocarditis, that are associated with cardiac surgery and mortality rates that remained unchanged for the last 30 years. The best cure for these infections are observed with combination antibiotic therapy; however, optimal treatment has not been fully elucidated. It is the purpose of this review to highlight treatment options, their limitations, and provide direction for future investigative efforts to aid in the treatment of these severe infections. While ampicillin plus ceftriaxone has emerged as a preferred treatment option, mortality rates continue to be high, and from a safety standpoint, ceftriaxone, unlike other cephalosporins, promotes colonization with vancomycin resistant-enterococci due to high biliary concentrations. More research is needed to improve patient outcomes from this high mortality disease

The Effect of Molecular Rapid Diagnostic Testing on Clinical Outcomes in Bloodstream Infections: A Systematic Review & Meta-analysis

Background. Previous reports on molecular rapid diagnostic testing (mRDT) do not consistently demonstrate improved clinical outcomes in bloodstream infections (BSIs). This meta-analysis seeks to evaluate the impact of mRDT in improving clinical outcomes in BSIs. Methods. We searched PubMed, CINAHL, Web of science, and EMBASE through May 2016 for BSI studies comparing clinical outcomes by mRDT and conventional microbiology methods. Results. Thirty-one studies were included with 5,920 patients. Risk of morality was significantly lower with mRDT as compared to conventional microbiology methods (OR 0.66, 95% CI 0.54-0.80) yielding a NNT of 20. The risk of mortality was slightly lower with mRDT in studies with antimicrobial stewardship programs (ASPs) (OR 0.64, 95% CI 0.51-0.79) and non-ASP studies failed to demonstrate a significant decrease in risk of mortality (OR 0.72, 95% CI 0.46-1.12). Significant decreases in mortality risk were observed with both Gram-positive (OR 0.73, 95% CI 0.55-0.97) and Gram-negative organisms (OR 0.51, 95% CI 0.33-0.78) but not yeast (OR 0.90, 95% CI 0.49-1.67). Time to effective therapy decreased by a weighted mean difference of -5.03 hours (95% CI -8.60 to -1.45) and length of stay decreased by -2.48 days (95% CI -3.90 to -1.06). Conclusions. For BSIs, mRDT was associated with significant decreases in risk of mortality in the presence of a ASP, but not in its absence. Additionally, mRDT decreased time to effective therapy and length of stay. mRDT should be considered as part of the standard of care in patients with BSIs

Virtual harm reduction efforts for Internet gambling: effects of deposit limits on actual Internet sports gambling behavior

Background: In an attempt to reduce harm related to gambling problems, an Internet sports betting service provider, bwin Interactive Entertainment, AG (bwin), imposes limits on the amount of money that users can deposit into their online gambling accounts. We examined the effects of these limits on gambling behavior. Methods: We compared (1) gambling behavior of those who exceeded deposit limits with those who did not, and (2) gambling behavior before and after exceeding deposit limits. We analyzed 2 years of the actual sports gambling behavior records of 47000 subscribers to bwin. Results: Only 160 (0.3%) exceeded deposit limits at least once. Gamblers who exceeded deposit limits evidenced higher average number of bets per active betting day and higher average size of bets than gamblers who did not exceed deposit limits. Comparing the gambling behavior before and after exceeding deposit limits revealed slightly more unfavorable gambling behavior after exceeding deposit limits. Conclusion: Our findings indicate that Internet gamblers who exceed deposit limits constitute a group of bettors willing to take high risks; yet, surprisingly, they appear to do this rather successfully because their percentage of losses is lower than others in the sample. However, some of these gamblers exhibit some poor outcomes. Deposit limits might be necessary harm reduction measures to prevent the loss of extremely large amounts of money and cases of bankruptcy. We discuss how these limits might be modified based on our findings

Associations Between Hearing Performance and Physiological Measures - An Overview and Outlook

The current paper summarises the research investigating associations between physiological data and hearing performance. An overview of state-of-the-art research and literature is given as well as promising directions for associations between physiological data and data regarding hearing loss and hearing performance. The physiological parameters included in this paper are: electrodermal activity, heart rate variability, blood pressure, blood oxygenation and respiratory rate. Furthermore, the environmental and behavioural measurements of physical activity and body mass index, alcohol consumption and smoking have been included. So far, only electrodermal activity and heart rate variability are physiological signals simultaneously associated with hearing loss or hearing performance. Initial findings suggest blood pressure and respiratory rate to be the most promising physiological measures that relate to hearing loss and hearing performance