Preterm infants harbour a rapidly changing mycobiota that includes Candida pathobionts

Fungi and the mycobiome are a fundamental part of the human microbiome that contributes to human health and development. Despite this, relatively little is known about the mycobiome of the preterm infant gut. Here, we have characterised faecal fungal communities present in 11 premature infants born with differing degrees of prematurity and mapped how the mycobiome develops during early infancy. Using an ITS1 sequencing-based approach, the preterm infant gut mycobiome was found to be often dominated by a single species, typically a yeast. Candida was the most abundant genus, with the pathobionts C.albicans and C.parapsilosis highly prevalent and persistent in these infants. Gestational maturity at birth affected the distribution and abundance of these Candida, with hospital-associated C.parapsilosis more prevalent and abundant in infants born at less than 31 weeks. Fungal diversity was lowest at 6 months, but increased with age and change of diet, with food-associated Saccharomycescerevisiae most abundant in infants post weaning. This study provides a first insight into the fungal communities present within the preterm infant gut, identifying distinctive features including the prominence of pathobiont species, and the influence age and environmental factors play in shaping the development of the mycobiome

Improving Neonatal Intensive Care Unit Providers' Perceptions of Palliative Care through a Weekly Case-Based Discussion

Objective: The primary objective was to evaluate the efficacy of a weekly palliative care-guided, case-based discussion of high-risk infants on Neonatal Intensive Care Unit (NICU) physician (MD) and Advanced Practice Provider (APP) perceptions of pediatric palliative care (PPC). Study Design: The study setting was a level IV academic NICU in a United States midwestern children's hospital. A pre/post design was used to evaluate the effects of a weekly palliative care-guided, case-based discussion of high-risk infants on neonatology providers' (MD and APP) perspectives of palliative and end-of-life care in the NICU using a previously published survey instrument. Surveys were completed at baseline and after 12 months of implementation. Data was analyzed with a Wilcoxon Signed Rank test with significance set at p < 0.05. Results: Thirty-one providers (13 APPs and 18 MDs) completed both pre- and post-intervention surveys. Post-intervention, providers were more likely to endorse that they "are comfortable with PPC", "feel comfortable teaching PPC to trainees", "feel confident handling end-of-life care", "have time to discuss PPC", and "were satisfied with the transition to end-of-life care for their most recent patient". They also were more likely to report, "families' perception of burden is relevant when making ethical decisions", that "parents are involved in decisions regarding palliative care", and that their "institution is supportive of palliative care." (p-values < 0.05 for all). Conclusion: NICU provider perceptions of palliative care can be improved through the implementation of a case-based interdisciplinary conference that emphasizes palliative care domains in the context of Neonatal ICU care

Translating Evidence-Based Policy to Practice: A Multilevel Partnership Using the Interactive Systems Framework

This is the published version, made available with the permission of the publisher.Despite increases in federal allocations, little is known about how to ensure successful implementation of evidence-based programs. This descriptive case study using the Interactive Systems Framework for Dissemination and Implementation illustrates the Prevention Support System (PSS) implemented for one federal evidence-based policy initiative. Exploring perspectives of intermediary organizations, the article describes the impetus for promoting evidence-based programming, multilevel systemic change, and the collaborations to develop strategic partnerships between national and state entities. Two early adopters, Kansas and Nebraska, illustrate the general capacity-building technical assistance activities conducted to build a multilevel PSS. The article concludes with outcomes, lessons learned, and recommendations for building stronger implementation capacity

Riparian Plant Isotopes Reflect Anthropogenic Nitrogen Perturbations: Robust Patterns Across Land Use Gradients

Riparian plants incorporate nitrogen (N) from aquatic, terrestrial, and atmospheric sources, and their stable isotope compositions (δ15 N) may reflect land use impacts on N sources and transformations over scales of sites to watersheds. We surveyed leaf δ15 N values of 11 common riparian tree, shrub, and herbaceous species from 20 streams and rivers spanning three fifth-order watersheds in northern Utah, USA (n - 255 sites and 819 leaf samples). Streams spanned undeveloped montane forests to suburban, urban, and agricultural lands. Mean species-specific differences in leaf δ15N values were relatively small within sites (1.2 ± 2.2‰), although emergent aquatic macrophytes had higher within-site δ15 N values than other growth forms. Leaf δ15 N values varied significantly across land-use categories, and were lowest in undeveloped montane reaches (0.5 ± 1.9‰; mean and standard deviation), intermediate in suburban and urban reaches (2.3 ± 2.6 and 3.2 ± 3.4‰), and greatest in agricultural reaches (4.1 ± 3.1‰). The substantial variation in leaf δ15N values within a land use category often corresponded with local management differences. In an undeveloped montane canyon permitting off-leash dogs, leaf δ15N values (1.5 ± 1.3‰) exceeded similar canyons that strictly prohibited dogs (δ15 N = - 0.7 ± 1.1‰). Canyons with cattle grazing had leaf δ15 N values enriched by 1.4 and 2.8‰ relative to similar, but un-grazed canyons. Variation in traffic between 0 and 5000 vehicles per day did not significantly affect leaf δ15N values, although a canyon with 50,000 vehicles per day showed a 5.7‰ increase relative to low-trafficked canyons. Urban leaf δ15N values were consistently enriched by 2.5 ± 0.6‰ relative to leaves in un-grazed montane reaches, and leaves in a septic-impacted suburban reach were enriched by 4.6‰ relative to upstream samples. Samples from a sewage-impacted urban river averaged 8.0 ± 4.1‰ and reached 22‰ adjacent to publicly owned treatment works (POTW). Another urban river displayed similar values in the absence of POTWs, implicating leaky sewers. Our results demonstrate the capacity of N isotopes from a diverse riparian plant community to inform our spatial understanding of watershed N-cycling perturbations, and illustrate the impact of human activities on N cycling even within protected watersheds. © 2015 Hall et al

Bacterial shedding and serologic responses following an outbreak of Salmonella Typhi in an endemic cohort.

BackgroundSalmonella enterica serovar Typhi (Salmonella Typhi) is the cause of typhoid fever. Salmonella Typhi may be transmitted through shedding in the stool, which can continue after recovery from acute illness. Shedding is detected by culturing stool, which is challenging to co-ordinate at scale. We hypothesised that sero-surveillance would direct us to those shedding Salmonella Typhi in stool following a typhoid outbreak.MethodsIn 2016 a typhoid outbreak affected one in four residents of a Nursing School in Malosa, Malawi. The Department of Health asked for assistance to identify nursing students that might spread the outbreak to other health facilities. We measured IgG antibody titres against Vi capsular polysaccharide (anti-Vi IgG) and IgM / IgG antibodies against H:d flagellin (anti-H:d) three and six months after the outbreak. We selected participants in the highest and lowest deciles for anti-Vi IgG titre (measured at visit one) and obtained stool for Salmonella culture and PCR. All participants reported whether they had experienced fever persisting for three days or more during the outbreak (in keeping with the WHO definitions of 'suspected typhoid'). We tested for salmonellae in the Nursing School environment.ResultsWe obtained 320 paired serum samples from 407 residents. We cultured stool from 25 residents with high anti-Vi IgG titres and 24 residents with low titres. We did not recover Salmonella Typhi from stool; four stool samples yielded non-typhoidal salmonellae; one sample produced a positive PCR amplification for a Salmonella Typhi target. Median anti-Vi and anti-H:d IgG titres fell among participants who reported persistent fever. There was a smaller fall in anti-H:d IgG titres among participants who did not report persistent fever. Non-typhoidal salmonellae were identified in water sampled at source and from a kitchen tap.ConclusionHigh titres of anti-Vi IgG did not identify culture-confirmed shedding of Salmonella Typhi. There was a clear serologic signal of recent typhoid exposure in the cohort, represented by waning IgG antibody titres over time. The presence of non-typhoidal salmonellae in drinking water indicates sub-optimal sanitation. Developing methods to detect and treat shedding remains an important priority to complement typhoid conjugate vaccination in efforts to achieve typhoid elimination

Early Childhood Lower Respiratory Illness and Air Pollution

BackgroundFew studies of air pollutants address morbidity in preschool children. In this study we evaluated bronchitis in children from two Czech districts: Teplice, with high ambient air pollution, and Prachatice, characterized by lower exposures.ObjectivesOur goal was to examine rates of lower respiratory illnesses in preschool children in relation to ambient particles and hydrocarbons.MethodsAir monitoring for particulate matter 2 years of age, for PAHs compared with fine particles. Preschool-age children may be particularly vulnerable to air pollution–induced illnesses