Staphylococcus aureus Bacteremia in Adults

Staphylococcus aureus is an important cause of bacteremia, and S. aureus bacteremia constitutes a serious condition with high morbidity and mortality, secondary to multiple complications including infective endocarditis and embolization. The incidence of bacteremia with S. aureus is increasing with more frequent use of medications that lower immune system response, and with the utilization of more invasive medical procedures. In addition, the emergence of resistant S. aureus isolates is becoming more common and can negatively affect the outcome of an individual if not diagnosed and managed properly. Health care workers encounter S. aureus bloodstream infections on a routine basis, and in certain situations, it becomes a very challenging infection to control. Because of the impact this entity has on health care costs and the increased use of resources, it is necessary to highlight the causes, clinical presentation, associated complications, and treatment measures. In this chapter, we will cover each of these points, with somewhat more emphasis on methicillin‐resistant S. aureus that is prevalent in both community and hospital settings and is more commonly associated with worsening prognosis and higher mortality

Should rehabilitated hedgehogs be released in winter? A comparison of survival, nest use and weight change in wild and rescued animals

The rehabilitation of sick or injured wildlife and their subsequent release back into the wild is considered important, not only for the welfare of the individual animal but also for the conservation and management of endangered and threatened wildlife. The European hedgehog Erinaceus europaeus has declined by 25% in Britain over the last decade and is the most common mammal admitted to wildlife rehabilitation centres in Britain, with a large proportion of individuals admitted to gain body weight overwinter prior to release in the spring. Consequently, many thousands of hedgehogs are housed overwinter which incurs significant costs for rehabilitation centres, and has potentially animal welfare issues, such as, stress in captivity, reintroduction stress, increased mortality risk and impaired or altered behaviour. To determine if releasing rehabilitated hedgehogs during autumn and winter had an effect on their survival, body weight or nesting behaviour, we compared these factors between 34 rehabilitated hedgehogs with 23 wild hedgehogs across five sites in England over four different winters. Overwinter survival was high for both wild and rehabilitated hedgehogs, with a significant decrease in survival across both groups when hedgehogs became active post hibernation in spring. We found no differences in the survival rates up to 150 days post release, in weight change, or nest use between wild- and winter-released rehabilitated hedgehogs. Our results suggest that under the correct conditions, rehabilitated hedgehogs can be released successfully during winter, therefore avoiding or reducing time in captivity

An intervention using quality of life and symptom information as a clinical tool in patients with advanced cancer

The Schedule for Evaluation of Individual Quality of Life-Direct Weighting (SEIQoL-DW) recognizes the individuals’ values with no pre-judgement. The objective of this study was to determine if clinician awareness and understanding of individual patients’ subjective quality of life (SQoL), bothersome symptoms and symptom interference on SQoL, would lead to improvement over time in the SQoL of patients with advanced cancer. Methods: SEIQoL-DW and symptom bother/interference with SQoL was measured up to 4 time points on Sixty-five (n=65) patients receiving chemotherapy for advanced cancer. Measurements from the intervention group (n=33) was reported to the clinical team at each time point via an info-graph placed in the clinical notes. Measurements from the control group (n=32) was not reported to the clinical team. Results: SEIQoL-DW of all patients improved from baseline to time point 4 (p >0.05).A significant improvement in patient’s perception of health functioning was seen in the intervention group compared to the control group (51% v 19%, p=0.014). Symptom interference in SQoL reduced by 9% in the intervention group versus 37% increase in the control group. In totality, a 46% difference was observed between groups (p < 0.05). Interpretation: Translating SEIQoL-DW and symptom bother/interference into a format for use as a ‘Clinical Tool’ in routine practice improves patient reported health functioning and symptom interference on their SQoL. This patient centered approach could lead to a paradigm shift in our understanding of patient’s needs and in harmony with other clinical interventions, should be considered a valuable step towards personalized medicine

De drie gezichten van Pieter Bruegel de Oude (ca. 1525-1569)

Modern approaches to patient treatment and personalized medicine increasingly recognize the importance of the patient’s quality of life outcome. The art of assessing and using quality of life information in routine practice remains a challenge and poses a stumbling block for clinicians. This critical review of the literature identifies useful measures to minimize those challenges and guide nurses and researchers in selecting the correct tool for measuring quality of life in their clinical settingThis publication is supported by Mayo roscommon Hospice Foundation, Knock, Co. Mayo, Ireland and supported by an educational grant from the Irish Hospice Foundation, Dublin Ireland.peer-reviewe

The Structure of an Interdomain Complex That Regulates Talin Activity*S⃞♦

Talin is a large flexible rod-shaped protein that activates the integrin family of cell adhesion molecules and couples them to cytoskeletal actin. It exists in both globular and extended conformations, and an intramolecular interaction between the N-terminal F3 FERM subdomain and the C-terminal part of the talin rod contributes to an autoinhibited form of the molecule. Here, we report the solution structure of the primary F3 binding domain within the C-terminal region of the talin rod and use intermolecular nuclear Overhauser effects to determine the structure of the complex. The rod domain (residues 1655–1822) is an amphipathic five-helix bundle; Tyr-377 of F3 docks into a hydrophobic pocket at one end of the bundle, whereas a basic loop in F3 (residues 316–326) interacts with a cluster of acidic residues in the middle of helix 4. Mutation of Glu-1770 abolishes binding. The rod domain competes with β3-integrin tails for binding to F3, and the structure of the complex suggests that the rod is also likely to sterically inhibit binding of the FERM domain to the membrane