Screening strategies in surveillance and control of methicillin-resistant Staphylococcus aureus (MRSA)

With reports of hospital-acquired methicillin-resistant Staphylococcus aureus (MRSA) continuing to increase and therapeutic options decrease, infection control methods are of increasing importance. Here we investigate the relationship between surveillance and infection control. Surveillance plays two roles with respect to control: it allows detection of infected/colonized individuals necessary for their removal from the general population, and it allows quantification of control success. We develop a stochastic model of MRSA transmission dynamics exploring the effects of two screening strategies in an epidemic setting: random and on admission. We consider both hospital and community populations and include control and surveillance in a single framework. Random screening was more efficient at hospital surveillance and allowed nosocomial control, which also prevented epidemic behaviour in the community. Therefore, random screening was the more effective control strategy for both the hospital and community populations in this setting. Surveillance strategies have significant impact on both ascertainment of infection prevalence and its control

Scrapworthy Lives: A Cognitive Sociological Analysis of a Modern Narrative Form

Over the past 20 years, scrapbooking has become immensely popular in America. This dissertation is the study of scrapworthy lives, that is, how lives become structured by scrapbooking and how people show others that their own life and the lives of their loves ones are value—or scrapworthy. I conducted in-depth interviews with 38 scrapbookers, 11 scrapbook industry workers, and 10 family and friends of scrapbookers. I also used photo-elicitation interviewing techniques with both the scrapbookers and the family members and friends of 10 scrapbookers to examine a selection of scrapbook pages the respondents had completed. I used grounded theory methods to analyze my data, providing a more thorough understanding of scrapbooking. Scrapbooks are a site where people socially construct a narrative of their life. Through scrapbooking, scrapbookers do gender, family, race, ethnicity, and religion. Stratification within the larger society can be seen within the scrapbooking thought community. Moreover, through scrapbooking, people can demonstrate their membership in other thought communities (e.g., motherhood). Though scrapbookers are able to demonstrate their gender, family status, race, ethnicity, and religion through scrapbooking, the hobby is done primarily for the scrapbookers and not for others. Scrapbooking is a leisure activity, though some may consider it as a form of work. Scrapbookers are a thought community in their own right and an excellent site to explore Zerubavel’s (1997) six cognitive acts (i.e., perceiving, classifying, reckoning time, attending, assigning meaning, and remembering). In particular, scrapbookers come to classify nearly everything (including people, things, time, and space) in the world around them as either scrapworthy or not. Scrapbooks are a modern narrative form, though versions of scrapbooks have been around for centuries. Scrapbooks are memorials about everyday life. The content of scrapbooks is what is left out of the typical history book but is considered just as memorable by scrapbookers. Scrapbookers are storytellers. These stories could just as easily be passed down orally or recorded on blogs and some scrapbooks combine elements of oral histories and blogs. Ultimately, scrapbooks are memorials about the scrapbooker

Seroepidemiology of group A rotavirus in suburban São Paulo, Brazil

Age-specifc patterns of rotavirus infection were investigated using a randomly selected and representative sample of sera from a suburban community of São Paulo, Brazil screened for class-specifc antibodies to group A rotavirus. Age-serology of anti-rotavirus IgG showed primary infection predominant in young infants with a median age of around 18 months consistent with IgM serology suggesting highest rates of recent infection between ages 4 and 48 months. Anti-rotavirus serum IgA prevalence increased gradually with age. Paired samples from infants, collected 1 month apart, indicated high exposure rates with seroconversion occurring in several infants during the reported low transmission season. Between 5 and 10% of adults had elevated IgM levels indicative of recent infection and, potentially, of an important contribution adults may play to rotavirus transmission. Further understanding of the dynamics of rotavirus transmission within populations, at group and serotype level, would benefit the design and monitoring of future immunization programmes

Early skin-to-skin contact for mothers and their healthy newborn infants.

BackgroundMother-infant separation post birth is common. In standard hospital care, newborn infants are held wrapped or dressed in their mother's arms, placed in open cribs or under radiant warmers. Skin-to-skin contact (SSC) begins ideally at birth and should last continually until the end of the first breastfeeding. SSC involves placing the dried, naked baby prone on the mother's bare chest, often covered with a warm blanket. According to mammalian neuroscience, the intimate contact inherent in this place (habitat) evokes neuro-behaviors ensuring fulfillment of basic biological needs. This time frame immediately post birth may represent a 'sensitive period' for programming future physiology and behavior.ObjectivesTo assess the effects of immediate or early SSC for healthy newborn infants compared to standard contact on establishment and maintenance of breastfeeding and infant physiology.Search methodsWe searched the Cochrane Pregnancy and Childbirth Group's Trials Register (17 December 2015), made personal contact with trialists, consulted the bibliography on kangaroo mother care (KMC) maintained by Dr Susan Ludington, and reviewed reference lists of retrieved studies.Selection criteriaRandomized controlled trials that compared immediate or early SSC with usual hospital care.Data collection and analysisTwo review authors independently assessed trials for inclusion and risk of bias, extracted data and checked them for accuracy. Quality of the evidence was assessed using the GRADE approach.Main resultsWe included 46 trials with 3850 women and their infants; 38 trials with 3472 women and infants contributed data to our analyses. Trials took place in 21 countries, and most recruited small samples (just 12 trials randomized more than 100 women). Eight trials included women who had SSC after cesarean birth. All infants recruited to trials were healthy, and the majority were full term. Six trials studied late preterm infants (greater than 35 weeks' gestation). No included trial met all criteria for good quality with respect to methodology and reporting; no trial was successfully blinded, and all analyses were imprecise due to small sample size. Many analyses had statistical heterogeneity due to considerable differences between SSC and standard care control groups. Results for womenSSC women were more likely than women with standard contact to be breastfeeding at one to four months post birth, though there was some uncertainty in this estimate due to risks of bias in included trials (average risk ratio (RR) 1.24, 95% confidence interval (CI) 1.07 to 1.43; participants = 887; studies = 14; I² = 41%; GRADE: moderate quality). SSC women also breast fed their infants longer, though data were limited (mean difference (MD) 64 days, 95% CI 37.96 to 89.50; participants = 264; studies = six; GRADE:low quality); this result was from a sensitivity analysis excluding one trial contributing all of the heterogeneity in the primary analysis. SSC women were probably more likely to exclusively breast feed from hospital discharge to one month post birth and from six weeks to six months post birth, though both analyses had substantial heterogeneity (from discharge average RR 1.30, 95% CI 1.12 to 1.49; participants = 711; studies = six; I² = 44%; GRADE: moderate quality; from six weeks average RR 1.50, 95% CI 1.18 to 1.90; participants = 640; studies = seven; I² = 62%; GRADE: moderate quality).Women in the SCC group had higher mean scores for breastfeeding effectiveness, with moderate heterogeneity (IBFAT (Infant Breastfeeding Assessment Tool) score MD 2.28, 95% CI 1.41 to 3.15; participants = 384; studies = four; I² = 41%). SSC infants were more likely to breast feed successfully during their first feed, with high heterogeneity (average RR 1.32, 95% CI 1.04 to 1.67; participants = 575; studies = five; I² = 85%). Results for infantsSSC infants had higher SCRIP (stability of the cardio-respiratory system) scores overall, suggesting better stabilization on three physiological parameters. However, there were few infants, and the clinical significance of the test was unclear because trialists reported averages of multiple time points (standardized mean difference (SMD) 1.24, 95% CI 0.76 to 1.72; participants = 81; studies = two; GRADE low quality). SSC infants had higher blood glucose levels (MD 10.49, 95% CI 8.39 to 12.59; participants = 144; studies = three; GRADE: low quality), but similar temperature to infants in standard care (MD 0.30 degree Celcius (°C) 95% CI 0.13 °C to 0.47 °C; participants = 558; studies = six; I² = 88%; GRADE: low quality). Women and infants after cesarean birthWomen practicing SSC after cesarean birth were probably more likely to breast feed one to four months post birth and to breast feed successfully (IBFAT score), but analyses were based on just two trials and few women. Evidence was insufficient to determine whether SSC could improve breastfeeding at other times after cesarean. Single trials contributed to infant respiratory rate, maternal pain and maternal state anxiety with no power to detect group differences. SubgroupsWe found no differences for any outcome when we compared times of initiation (immediate less than 10 minutes post birth versus early 10 minutes or more post birth) or lengths of contact time (60 minutes or less contact versus more than 60 minutes contact).Authors' conclusionsEvidence supports the use of SSC to promote breastfeeding. Studies with larger sample sizes are necessary to confirm physiological benefit for infants during transition to extra-uterine life and to establish possible dose-response effects and optimal initiation time. Methodological quality of trials remains problematic, and small trials reporting different outcomes with different scales and limited data limit our confidence in the benefits of SSC for infants. Our review included only healthy infants, which limits the range of physiological parameters observed and makes their interpretation difficult

Health-seeking behaviour, diagnostics and transmission dynamics in the control of visceral leishmaniasis in the Indian subcontinent

Countries in the Indian subcontinent have committed to reducing the incidence of kala-azar, a clinical manifestation of visceral leishmaniasis, to below 1 in 10,000 by 2020. We address the role of timing of use and accuracy of diagnostics in kala-azar control and elimination. We use empirical data on health-seeking behaviour and health-system performance from the Indian state of Bihar, Bangladesh and Nepal to parameterize a mathematical model. Diagnosis of cases is key to case management, control and surveillance. Treatment of cases prevents onward transmission, and we show that the differences in time to diagnosis in these three settings explain the observed differences in incidence. Shortening the time from health-care seeking to diagnosis is likely to lead to dramatic reductions in incidence in Bihar, bringing the incidence down to the levels seen in Bangladesh and Nepal. The results emphasize the importance of maintaining population and health-system awareness, particularly as transmission and disease incidence decline. We explore the possibility of diagnosing patients before the onset of clinical kala-azar (before 14 days fever), and show that this could have a marked impact on incidence, even for a moderately sensitive test. However, limited specificity (that results in false positives) is a major barrier to such a strategy. Diagnostic tests of high specificity used at an early stage of active infection, even if sensitivity is only moderate, could have a key role in the control of kala-azar, and prevent its resurgence when paired with the passive health-care system and tests of high sensitivity, such as the test for rK39 antibody response

A Fair Exchange: The Reciprocal Relationship Between Universities and Clinical Placement Supervisors

Clinical psychology training in the UK relies heavily upon supervised clinical practice placements. Placement supervisors have a significant responsibility for providing trainees with the learning experiences required for qualification. The role is demanding and whilst the university benefits greatly, it is less clear what supervisors receive in return. This is important when one considers how positive relationships and social action are influenced by reciprocity and a sense of belongingness. Despite its importance, no research has directly explored the relationship between supervisors and the university in a clinical psychology training context. This novel study sought to explore how supervisors perceive their role and their connectedness / belongingness to the university, and whether technology utilized by other areas of pedagogy led to improvements. Access to electronic resources was sent to clinical placement supervisors (n=100). A subset of these (n=7) signed up to complete a semi-structured interview. The interviews were analysed using template analysis. Common themes emerged, including perceived benefits of the supervisor role, such as feeling connected to the training course, despite significant challenges and demands. The provision of electronic resources was found to have the potential to enhance connectedness for all stakeholders. The implications of these findings are discussed

Antarctic firn compaction rates from repeat-track airborne radar data: I. Methods

While measurements of ice-sheet surface elevation change are increasingly used to assess mass change, the processes that control the elevation fluctuations not related to ice-flow dynamics (e.g. firn compaction and accumulation) remain difficult to measure. Here we use radar data from the Thwaites Glacier (West Antarctica) catchment to measure the rate of thickness change between horizons of constant age over different time intervals: 2009–10, 2010–11 and 2009–11. The average compaction rate to ∼25 m depth is 0.33 m a–1, with largest compaction rates near the surface. Our measurements indicate that the accumulation rate controls much of the spatio-temporal variations in the compaction rate while the role of temperature is unclear due to a lack of measurements. Based on a semi-empirical, steady-state densification model, we find that surveying older firn horizons minimizes the potential bias resulting from the variable depth of the constant age horizon. Our results suggest that the spatiotemporal variations in the firn compaction rate are an important consideration when converting surface elevation change to ice mass change. Compaction rates varied by up to 0.12 m a–1 over distances 20% larger during the 2010–11 interval than during 2009–10

The natural history of respiratory syncytial virus in a birth cohort: the influence of age and previous infection on reinfection and disease.

This study aimed to quantify the effect of age, time since last infection, and infection history on the rate of respiratory syncytial virus infection and the effect of age and infection history on the risk of respiratory syncytial virus disease. A birth cohort of 635 children in Kilifi, Kenya, was monitored for respiratory syncytial virus infections from January 31, 2002, to April 22, 2005. Predictors of infection were examined by Cox regression and disease risk by binomial regression. A total of 598 respiratory syncytial virus infections were identified (411 primary, 187 repeat), with 409 determined by antigen assay and 189 by antibody alone (using a "most pragmatic" serologic definition). The incidence decreased by 70% following a primary infection (adjusted hazard ratio = 0.30, 95% confidence interval: 0.21, 0.42; P < 0.001) and by 59% following a secondary infection (hazard ratio = 0.41, 95% confidence interval: 0.22, 0.73; P = 0.003), for a period lasting 6 months. Relative to the age group <6 months, all ages exhibited a higher incidence of infection. A lower risk of severe disease following infection was independently associated with increasing age (P < 0.001) but not reinfection. In conclusion, observed respiratory syncytial virus incidence was lowest in the first 6 months of life, immunity to reinfection was partial and short lived, and disease risk was age related

Simulation and Characterization of a Miniaturized Scanning Electron Microscope

A miniaturized Scanning Electron Microscope (mSEM) for in-situ lunar investigations is being developed at NASA Marshall Space Flight Center with colleagues from the University of Alabama in Huntsville (UAH), Advanced Research Systems (ARS), the University of Tennessee in Knoxville (UTK) and Case Western Reserve University (CWRU). This effort focuses on the characterization of individual components of the mSEM and simulation of the complete system. SEMs can provide information on the size, shape, morphology and chemical composition of lunar regolith. Understanding these basic properties will allow us to better estimate the challenges associated with In-Situ Resource Utilization and to improve our basic science knowledge of the lunar surface (either precluding the need for sample return or allowing differentiation of unique samples to be returned to Earth.) The main components of the mSEM prototype includes: a cold field emission electron gun (CFEG), focusing lens, deflection/scanning system and backscatter electron detector. Of these, the electron gun development is of particular importance as it dictates much of the design of the remaining components. A CFEG was chosen for use with the lunar mSEM as its emission does not depend on heating of the tungsten emitter (lower power), it offers a long operation lifetime, is orders of magnitude brighter than tungsten hairpin guns, has a small source size and exhibits low beam energy spread