Universal screening for meticillin-resistant Staphylococcus aureus : interim results from the NHS Scotland pathfinder project

Following recommendations from a Health Technology Assessment (HTA), a prospective cohort study of meticillin-resistant Staphylococcus aureus (MRSA) screening of all admissions (N = 29 690) to six acute hospitals in three regions in Scotland indicated that 7.5% of patientswere colonised on admission to hospital. Factors associated with colonisation included re-admission, specialty of admission (highest in nephrology, care of the elderly, dermatology and vascular surgery), increasing age, and the source of admission (care home or other hospital). Three percent of all those who were identified as colonised developed hospital-associated MRSA infection, compared with only 0.1% of those not colonised. Specialtieswith a high rate of colonisation on admission also had higher rates of MRSA infection. Very few patients refused screening (11 patients, 0.03%) or had treatment deferred (14 patients, 0.05%). Several organisational issues were identified, including difficulties in achieving complete uptake of screening (88%) or decolonisation (41%); the latter was largely due to short duration of stay and turnaround time for test results. Patient movement resulted in a decision to decontaminate all positive patients rather than just those in high risk specialties as proposed by the HTA. Issues also included a lack of isolation facilities to manage patients with MRSA. The study raises significant concerns about the contribution of decolonisation to reducing risks in hospital due to short duration of stay, and reinforces the central role of infection control precautions. Further study is required before the HTA model can be re-run and conclusions redrawn on the cost and clinical effectiveness of universal MRSA screening

Exploring views on satisfaction with life in young children with chronic illness: an innovative approach to the collection of self-report data from children under 11

The objective of this study was to explore young children’s views on the impact of chronic illness on their life in order to inform future development of a patient-based self-report health outcome measure. We describe an approach to facilitating self-report views from young children with chronic illness. A board game was designed in order to obtain qualitative data from 39 children with a range of chronic illness conditions and 38 healthy controls ranging in age from 3 to 11 years. The format was effective in engaging young children in a self-report process of determining satisfaction with life and identified nine domains. The board game enabled children aged 5–11 years with chronic illness to describe the effects of living with illness on home, family, friends, school and life in general. It generated direct, non-interpreted material from children who, because of their age, may have been considered unable or limited their ability to discuss and describe how they feel. Obtaining this information for children aged 4 and under continues to be a challenge

Investigating bacteriophages targeting the opportunistic pathogen Acinetobacter baumannii

The multi-drug resistance of the opportunistic pathogen Acinetobacter baumannii is of growing concern, with many clinical isolates proving to be resistant to last resort as well as front line antibiotic treatments. The use of bacteriophages is an attractive alternative to controlling and treating this emerging nosocomial pathogen. In this study, we have investigated bacteriophages collected from hospital wastewater in Thailand and we have explored their activity against clinical isolates of A. baumannii. Bacteriophage vB_AbaM_PhT2 showed 28% host range against 150 multidrug resistant (MDR) isolates and whole genome sequencing did not detect any known virulence factors or antibiotic resistance genes. Purified vB_AbaM_PhT2 samples had endotoxin levels below those recommended for preclinical trials and were not shown to be directly cytotoxic to human cell lines in vitro. The treatment of human brain and bladder cell lines grown in the presence of A. baumannii with this bacteriophage released significantly less lactate dehydrogenase compared to samples with no bacteriophage treatment, indicating that vB_AbaM_PhT2 can protect from A. baumannii induced cellular damage. Our results have also indicated that there is synergy between this bacteriophage and the end line antibiotic colistin. We therefore propose bacteriophage vB_AbaM_PhT2 as a good candidate for future research and for its potential development into a surface antimicrobial for use in hospitals. View Full-Tex

Shakespearean allusion and the detective fiction of Georgette Heyer

This essay argues that Shakespearean allusion is a recurrent and important factor in the detective novels of Georgette Heyer. Though the master text for Heyer is Hamlet, a variety of Shakespeare plays are referred to, and mention of them functions in multiple ways. Quotations from Shakespeare reveal truths about the characters and comment on their situations and personalities. They also afford points of entry for people previously unacquainted to talk to each other, and finally they have effects in terms of genre, since their presence can, with equal facility, tend towards comic relief (in line with a tradition in Golden Age crime fiction of using Macbeth in particular to comic effect) or work to add gravitas and resonance. The use of Shakespearean allusion is thus central to Heyer’s technique. This article is published as part of a collection to commemorate the 400th anniversary of William Shakespeare’s death

Soil Microbial Community: Understanding the Belowground Network for Sustainable Grassland Management

Key points 1. In addition to the use of conventional methodologies in soil microbial research, molecular techniques are now being applied to gain insights into the soil microbial community; 2. Plant diversity can exert impacts on soil microbial diversity (through root activities and plant litter etc.), but may in itself be significantly altered by soil properties; 3. Soil microbial diversity largely determines the stability of soil ecosystems under biotic and abiotic perturbations. 4. Management of soil microbial diversity can only be achieved through better understanding their structures and functions

Soil Microbial Community: Understanding the Belowground Network for Sustainable Grassland Management

In addition to the use of conventional methodologies in soil microbial research, molecular techniques are now being applied to gain insights into the soil microbial community; Plant diversity can exert impacts on soil microbial diversity (through root activities and plant litter etc.), but may in itself be significantly altered by soil properties; Soil microbial diversity largely determines the stability of soil ecosystems under biotic and abiotic perturbations. Management of soil microbial diversity can only be achieved through better understanding their structures and functions

First Space-Based Microlens Parallax Measurement: Spitzer Observations of OGLE-2005-SMC-001

We combine Spitzer and ground-based observations to measure the microlens parallax of OGLE-2005-SMC-001, the first such space-based determination since S. Refsdal proposed the idea in 1966. The parallax measurement yields a projected velocity \tilde v ~ 230 km/s, the typical value expected for halo lenses, but an order of magnitude smaller than would be expected for lenses lying in the Small Magellanic Cloud (SMC) itself. The lens is a weak (i.e., non-caustic-crossing) binary, which complicates the analysis considerably but ultimately contributes additional constraints. Using a test proposed by Assef et al. (2006), which makes use only of kinematic information about different populations but does not make any assumptions about their respective mass functions, we find that the likelihood ratio is L_halo/L_SMC = 20. Hence, halo lenses are strongly favored but SMC lenses are not definitively ruled out. Similar Spitzer observations of additional lenses toward the Magellanic Clouds would clarify the nature of the lens population. The Space Interferometry Mission could make even more constraining measurements.Comment: ApJ, in press. Text and figures are updated to match the journal versio