Adjunctive rifampicin for Staphylococcus aureus bacteraemia (ARREST): a multicentre, randomised, double-blind, placebo-controlled trial.

BACKGROUND: Staphylococcus aureus bacteraemia is a common cause of severe community-acquired and hospital-acquired infection worldwide. We tested the hypothesis that adjunctive rifampicin would reduce bacteriologically confirmed treatment failure or disease recurrence, or death, by enhancing early S aureus killing, sterilising infected foci and blood faster, and reducing risks of dissemination and metastatic infection. METHODS: In this multicentre, randomised, double-blind, placebo-controlled trial, adults (≥18 years) with S aureus bacteraemia who had received ≤96 h of active antibiotic therapy were recruited from 29 UK hospitals. Patients were randomly assigned (1:1) via a computer-generated sequential randomisation list to receive 2 weeks of adjunctive rifampicin (600 mg or 900 mg per day according to weight, oral or intravenous) versus identical placebo, together with standard antibiotic therapy. Randomisation was stratified by centre. Patients, investigators, and those caring for the patients were masked to group allocation. The primary outcome was time to bacteriologically confirmed treatment failure or disease recurrence, or death (all-cause), from randomisation to 12 weeks, adjudicated by an independent review committee masked to the treatment. Analysis was intention to treat. This trial was registered, number ISRCTN37666216, and is closed to new participants. FINDINGS: Between Dec 10, 2012, and Oct 25, 2016, 758 eligible participants were randomly assigned: 370 to rifampicin and 388 to placebo. 485 (64%) participants had community-acquired S aureus infections, and 132 (17%) had nosocomial S aureus infections. 47 (6%) had meticillin-resistant infections. 301 (40%) participants had an initial deep infection focus. Standard antibiotics were given for 29 (IQR 18-45) days; 619 (82%) participants received flucloxacillin. By week 12, 62 (17%) of participants who received rifampicin versus 71 (18%) who received placebo experienced treatment failure or disease recurrence, or died (absolute risk difference -1·4%, 95% CI -7·0 to 4·3; hazard ratio 0·96, 0·68-1·35, p=0·81). From randomisation to 12 weeks, no evidence of differences in serious (p=0·17) or grade 3-4 (p=0·36) adverse events were observed; however, 63 (17%) participants in the rifampicin group versus 39 (10%) in the placebo group had antibiotic or trial drug-modifying adverse events (p=0·004), and 24 (6%) versus six (2%) had drug interactions (p=0·0005). INTERPRETATION: Adjunctive rifampicin provided no overall benefit over standard antibiotic therapy in adults with S aureus bacteraemia. FUNDING: UK National Institute for Health Research Health Technology Assessment

Inverting the model of genomics data sharing with the NHGRI Genomic Data Science Analysis, Visualization, and Informatics Lab-space

The NHGRI Genomic Data Science Analysis, Visualization, and Informatics Lab-space (AnVIL; https://anvilproject.org) was developed to address a widespread community need for a unified computing environment for genomics data storage, management, and analysis. In this perspective, we present AnVIL, describe its ecosystem and interoperability with other platforms, and highlight how this platform and associated initiatives contribute to improved genomic data sharing efforts. The AnVIL is a federated cloud platform designed to manage and store genomics and related data, enable population-scale analysis, and facilitate collaboration through the sharing of data, code, and analysis results. By inverting the traditional model of data sharing, the AnVIL eliminates the need for data movement while also adding security measures for active threat detection and monitoring and provides scalable, shared computing resources for any researcher. We describe the core data management and analysis components of the AnVIL, which currently consists of Terra, Gen3, Galaxy, RStudio/Bioconductor, Dockstore, and Jupyter, and describe several flagship genomics datasets available within the AnVIL. We continue to extend and innovate the AnVIL ecosystem by implementing new capabilities, including mechanisms for interoperability and responsible data sharing, while streamlining access management. The AnVIL opens many new opportunities for analysis, collaboration, and data sharing that are needed to drive research and to make discoveries through the joint analysis of hundreds of thousands to millions of genomes along with associated clinical and molecular data types

The implications of role expectations for birth assistance among Bariba women

Throughout the Third World, a notable trend has been the proliferation of parallel health care systems in which cosmopolitan medical services co-exist with a variety of indigenous health care services, and client populations must make decisions regarding the preferred choice among the existing alternatives. Correspondingly, Bariba women in People's Republic of Benin, West Africa, who seek obstetrical care have an increasing number of available options from which to select, including government hospitals, maternity clinics, private clinics, and a variety of indigenous practitioners. An examination of the factors influencing choices of birth assistance among Bariba women suggests that attributes of indigenous midwives such as status characteristics and type of training serve as significant considerations for clientele selecting obstetrical care. Characteristics discussed as salient features of the midwife include religion, age, marital status, education, apprenticeship, and certain personal qualities such as courage and lack of modesty. In addition, features of the midwifery role are delineated; for instance, the role of indigenous midwife involves a great deal of variability in contrast to that of the government nurse-midwife, which appears as a more narrow specialization. In order to fulfill role expectations, the indigenous midwife must demonstrate attributes which fall within an acceptable range to the client population, thus rendering her reasonably homophilous. Homophily is defined as 'the degree to which pairs of individuals who interact are similar in certain attributes such as beliefs, values, education, social status'. The data suggest that a healer, in this instance an indigenous midwife, is selected in order to accomplish a particular task. A client assumes certain characteristics of the role occupant are requisite for the healer to be effective and competent. Clients and midwives are found to be homophilous in that they share concepts of causation, beliefs, values and role expectations. Where the healer is not homophilous with the client, the absence of homophily operates to deter prospective clients from utilizing obstetrical services. Thus in the case of the rural client/government midwife relationship, the respective role occupants are shown not to be homophilous. In contrast to the indigenous midwife, the government midwife does not share significant attributes, values and expectations with her client and this lack of homophily deters prospective clients from selecting the government midwife as an option for birth assistance.

Talking with Young Children about Social Ideas

During the early childhood years, children’s understanding of many social and moral issues undergoes immense changes. We became interested in learning more about these changes and supporting them through our laboratory preschool curriculum. One major change, for example, is that children come to classify themselves and others into sex, age, and kinship categories and to learn social role expectations. Children also show greatly deepened understanding of such moral issues as fair sharing, obedience, authority, and friendship. These areas of development are part of what can be called social cognition, or “children’s understanding of social behavior—what children think about their own behavior and the behavior of others” (Moore 1979, p. 54). Recent research on social cognition has generated a great deal of new information very useful to educators. This research describes the typical developmental stages in children’s social thinking, and is based on Piagetian theory. Stated briefly, “Understanding others is not merely a matter of ‘learning more’ about people in some quantitative sense; it is organizing what one knows into systems of meaning or belief” (Shantz 1975, p. 266). Most published social cognition activities have focused on children’s role-taking skills. Forman and Hill (1980), for example, offer many ingenious examples of how teachers can help children to understand what specific information is like from another person’s perspective. Out of this grows the ability to better understand the other person’s behavior. Educators have also developed curriculum ideas for stimulating children’s interpersonal problem-solving. Teachers can help a group of children to learn to notice and name a problem, generate alternative solutions, and evaluate the consequences of the alternatives (Spivack and Shure 1974; Copple, Sigel and Saunders 1979). While we used these activities as a foundation for our social cognition curriculum, we also wanted to venture into new program areas. We began to develop learning encounters concerning equally important issues such as social roles, justice in sharing, and the distinction between moral and conventional rules. Our goal was not to transmit either our values or factual information to the children concerning these issues. Rather, we had two major aims: 1. To present intellectually challenging problems that children could discuss either individually or as a group. This we believed would stimulate them to think about social and moral issues. 2. To learn about the varied aspects of the children’s social and moral thinking, and then to use this information as a basis for less authoritarian guidance and management. In implementing our goals, we focused on three different kinds of learning encounters: the dramatic skit, presented to a large group or the entire class; the thinking game, aimed at an individual child or a very small group; and the spontaneous discussion, relevant for a teacher interacting with any number of children

Austerity and its implications for immigrant health in France

The ongoing economic crisis in France increasingly has affected immigrant rights, including access to health care. Consistent with a 2014 League Against Cancer survey, we identify the ways in which sickness produces a “double penalty” for immigrants with serious illness. Immigrants with chronic illnesses such as cancer, diabetes, and other debilitating conditions divert vital funds from daily needs to deal with sickness and loss of work while at the same time national austerity measures shred the state's traditional safety net of social services and support. We examine how immigrants strategize to manage financial exigencies, therapeutic itineraries and social relations in the face of these converging pressures. We base our findings on two studies related by this theme: an investigation of health inequalities in the Médoc region, in which 88 women, 44 of North African and Eastern European origin, were interviewed over a three-year period (2010–2013); and a three-year study (2014–2017) of West African immigrant women with breast cancer seeking treatment in the greater Paris region, 70 members of immigrant associations, and clinical personnel in three hospitals

Polygamy, disrupted reproduction, and the state: Malian migrants in Paris, France

For Malian women, migration from West Africa to France has disrupted widely shared understandings of marriage and reproduction. In response to restrictive immigration policies, men and women routinely confront the challenges of polygamy, public disapproval of high fertility, and biomedical messages promoting contraception. Although many Malians continue to be strongly pronatalist, within a family, spouses may experience contradictory pressures and objectives regarding reproduction, particularly in polygamous marriages. Because women are more likely than men to interact with nurses and doctors in the context of maternity and child health care visits, they are systematically confronted by encouragement to contracept. French population policy is contradictory in this regard, as it has been strongly pronatalist throughout the 20th century, yet is equally strongly anti-natalist with regard to immigrant populations. Recent anti-immigrant policies such as the Pasqua law prohibiting polygamy have emerged as influences shaping men's and women's contested reproductive goals. Men tend to oppose contraception, citing Islamic doctrine while women increasingly justify contraceptive use in response to government policies and biomedical encouragement. In contrast, polygamy also may generate pregnancy rivalries as wives strategize to enhance their reproductive careers and thus to retain immigrant status.Reproduction Contraception Population policy Polygyny France Malian immigrants

Anxiétés culturelles et régulation institutionnelle (santé mentale "spécialisée" et "souffrance immigrée" à Paris)

Cette thèse a pour objet l'expertise en santé mentale spécialisée telle qu'elle se pratique en France et analyse la prise en charge institutionnelle et les représentations de la différence culturelle dans ce pays aujourd'hui. Par santé mentale "spécialisée", je fais référence aux structures qui s'adressent aux immigrés en leur offrant des soins de santé mentale qui prennent en compte les représentations culturelles de la souffrance. J'identifie et étudie en particulier trois modes d'expertise et de traitement des troubles: la psychiatrie transculturelle, l'anthropologie médicale clinique, et la médiation ethnoclinique. En proposant une généalogie des institutions de santé mentale spécialisée, et en appréhendant ces dernières comme "nœuds méta-discursifs" - autrement dit, comme points de rencontre entre idéologies étatiques, institutionnelles, et individuelles - je propose une analyse des anxiétés culturelles, des contradictions, et des doubles contraintes qui relèvent de l'opposition entre une idéologie républicaine universaliste et régulatrice, et un champ d'expertise qui s'efforce de promouvoir des soins de santé mentale sensibles aux particularismes culturels dans l'expression des troubles. Je soutiens que, tant qu'elle se situe à l'intersection de "la question immigrée" et de "la question sociale", la "souffrance immigrée" (Sayad, 2004) est devenue le moyen d'exprimer les "difficultés" des immigrés - qu'elles soient liées à la santé mentale ou aux problèmes d'ordre structurel - en termes de différence culturelle. Par conséquent, les représentations culturelles qui stigmatisent les immigrés sont intériorisées, rendant difficile l'identification et la prise en charge des inégalités structurelles qui engendrent effectivement la souffrance.This dissertation looks at "specialized" mental healthcare expertise in France as a lens through which to address the institutional management and representations of cultural difference in France today. By "specialized" mental healthcare centers, I refer structures that provide culturally-sensitive mental health services to immigrants specifically. I identify and explore three contemporary expert approaches: namely, transcultural psychiatry, clinical medical anthropology, and ethnoclinical mediation. By providing a genealogy of specialized mental healthcare institutions, and by construing them as "meta-discursive nodes" - that is, as points of encounter between state, institutional, and individual ideologies - I provide an analysis of the cultural anxieties, contradictions and double-binds that arise from the opposition between a regulative, universalist republican ideology, and a field of expertise which strives to promote culturally-sensitive mental healthcare for immigrants. I argue that, as a product of the conflation of the "immigrant issue" (la question immigrée) and the "social issue" (la question sociale), "immigrant suffering" (Sayad, 2004) has become a medium that problematically couches immigrants' "difficulties" - whether they relate to mental health pathology or structural problems - in terms of cultural difference. As a result, generic cultural representations of immigrants are uncritically reproduced, making it difficult to identify and address the structural inequalities that do engender suffering.PARIS-Médiathèque MQB (751132304) / SudocSudocFranceF