Psychosocial and Academic Outcomes of De-shifting Three-Year High Schools in the Republic of Trinidad and Tobago

AbstractThe vision of the first postcolonial leader of Trinidad and Tobago was to build a nation of citizens who were educated. Education for All drove the new post-independence government in 1962 with a focus on free and equal education. This was achieved by using a three-year double shift schooling system to provide two school cycles in the morning and afternoon. This system was implemented in the early 1970s but was fraught with challenges. After achieving its Education for All mandate, the government de-shifted the three-year double shift schools and converted these to five-year full day schools by 2008. This study reviewed the impact of the de-shifting initiative on the academic achievement and psychosocial wellbeing of at-risk students in these schools through a theoretical lens of educational change and self-determination. An evaluative mixed methods case study approach was used to address the effectiveness of the rollout of the initiative, factors that could support academic achievement and wellbeing, and making change initiatives more effective. Five administrators from three schools were interviewed, and 13 teachers completed online surveys. Interview responses were coded and responses from surveys were analyzed manually. There were no significant changes in terms of academic achievement of these students, and while stigma persists, many of these students have experienced agency using the new five-year school system. Due to challenges faced during the COVID-19 pandemic, this study should be repeated with a larger sample to include perceptions and opinions of students expected to benefit from changes. Positive social change can occur by promoting community awareness and full stakeholder inclusion in decision-making

The Merits of Trust in Transformational Leadership

Trust in transformational leadership is related to motivation, self-enhancement, and positive job outcomes. Trust in the leader-follower relationship, from the perspective of subordinates, has yet to be examined. Trust is considered an important factor when seeking to improve the chances for organizational success and positive job outcomes. The merits of trust in transformational leadership were addressed in this qualitative case study for the purpose of understanding the value of trust in leader-follower relationships viewed from the experiences of subordinates. Interviews were conducted with 30 participants from 2 organizations within the Newton and Rockdale counties located in the state of Georgia; the chosen sample size was an exhaustive representation of those interviewed and conveyed the depth and breadth of participants\u27. Research questions addressed how subordinates perceived trust in their leaders and how leaders put into practice trust in their leader-follower relationships. Questions were analyzed using open and axial coding and the following themes emerged: perseverance, effective communication, feedback, commitment, confidence, unity, dependability, exemplary leadership, helpfulness, and satisfaction. Some connections were made between trust in transformational leadership and subordinates\u27 views of their trust in leaders. By implementing these practices and hiring managers with transformational behaviors, organizations can help succeed in engaging employees to promote trusting relationships and encourage future research in the leadership management field. This study may affect positive social change by demonstrating how trust can be created by both leaders and followers: these findings may also contribute to the expansion of new leadership development training programs

Staphylococcus aureus Bloodstream Infections in Older Adults: Clinical Outcomes and Risk Factors for In-Hospital Mortality

To assess clinical outcomes and identify risk factors for mortality in older adults with Staphylococcus aureus bloodstream infection (SAB).Retrospective review.University of Michigan Health System, Ann Arbor.All patients aged 80 and older with SAB between January 2004 and July 2008.Clinical data, including comorbid conditions, SAB source, echocardiography results, Charlson Comorbidity Index, mortality (in-hospital and 6-month), and need for rehospitalization or chronic care after discharge.Seventy-six patients aged 80 and older (mean 85.5 ± 4.2) with SAB were identified. Infection sources included 14 (18.4%) vascular catheter associated, 16 (21.1%) wound related, seven (9.2%) endocarditis, five (6.6%) intravascular, and 19 (25%) with unknown source; 46 (60.5%) patients had methicillin-resistant strains. Twenty-two (28.9%) patients underwent surgery or device placement within 30 days of developing SAB; 10 of these 22 had SAB associated with surgical site infection (SSI). Twenty two (28.9%) patients died in the hospital or were discharged to hospice care; at least 43 (56.6%) patients died within 6 months of presentation, and eight were lost to follow-up. Unknown source of bacteremia (odds ratio=5.2, P =.008) was independently associated with in-hospital death. Echocardiography was not pursued in 45% of patients. Of surviving patients, 40 (74.1%) required skilled care after discharge; eight (20%) required rehospitalization.SAB was associated with high mortality rates in patients aged 80 and older. The observed association between SAB and SSI may direct preventive strategies such as perioperative decolonization or antimicrobial prophylaxis. Interventions to optimize clinical care practices in elderly patients with SAB are essential given the associated morbidity and mortality.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/78653/1/j.1532-5415.2009.02666.x.pd

Hybrid Locomotive Waste Heat Recovery System (L-WHRS) Safety and Field Demonstration

693JJ618C000018ThermaDynamics Rail LLC (TDR) developed the Locomotive-Waste Heat Recovery Systems (L-WHRS) formed by high-pressure heat exchangers coupled to a closed-loop Organic Rankine Cycle (ORC). The L-WHRS can be configured to be non-invasively retrofitted onto different types of locomotive engines to recover and convert locomotive waste thermal energy into conditioned, pollutant-free, electrical power. Under the sponsorship of the Federal Railroad Administration (FRA), TDR successfully completed a series of demonstration phases that increased the technology readiness level to a full-scale operational system. Full-scale L-WHRS testing involved static tests using simulator and dynamic over-the-road locomotive tests under various operational conditions. This report describes the design and testing of the L-WHRS electrical system configured to supply electric power to selected locomotive electrical loads and to an advanced Energy Storage System (ESS). These tests demonstrated feasibility to utilize the L-WHRS as an electric generator that can simultaneously supply power to the ESS and locomotive electrical loads

Daptomycin versus vancomycin plus gentamicin for treatment of bacteraemia and endocarditis due to Staphylococcus aureus: subset analysis of patients infected with methicillin-resistant isolates

Objectives: In a prospective, randomized trial, daptomycin was non-inferior to standard therapy for Staphylococcus aureus bacteraemia and right-sided endocarditis. Since rates of infection due to methicillin-resistant S. aureus (MRSA) infection are increasing and treatment outcomes for bacteraemia caused by MRSA are generally worse than those observed with methicillin-susceptible S. aureus bacteraemia, clinical characteristics and treatment results in the trial’s pre-specified subset of patients with MRSA were analysed. Methods: Clinical characteristics and outcomes of patients receiving daptomycin were compared with those receiving vancomycin plus low-dose gentamicin. Success was defined as clinical improvement with clearance of bacteraemia among patients who completed adequate therapy, received no potentially effective non-study antibiotics and had negative blood cultures 6 weeks after end of therapy. Results: Twenty of the 45 (44.4%) daptomycin patients and 14 of the 43 (32.6%) vancomycin/gentamicin patients were successfully treated (difference 11.9%; confidence interval −8.3 to 32.1). Success rates for daptomycin versus vancomycin/gentamicin were 45% versus 27% in complicated bacteraemia, 60% versus 45% in uncomplicated bacteraemia and 50% versus 50% in right-sided MRSA endocarditis. Cure rates in patients with septic emboli and in patients who received pre-enrolment vancomycin were similar between treatment groups. However, in both treatment groups, success rates were lower in the elderly (≥75 years). Persisting or relapsing bacteraemia occurred in 27% of daptomycin and 21% of vancomycin/gentamicin patients; among these patients, MICs of ≥2 mg/L occurred in five daptomycin and four vancomycin/gentamicin patients. The clinical course of several patients may have been influenced by lack of surgical intervention. Conclusions: Daptomycin was an effective alternative to vancomycin/gentamicin for MRSA bacteraemia or right-sided endocarditis

Skin and Soft Tissue Infections Caused by Methicillin-Resistant Staphylococcus aureus USA300 Clone

An increase in SSTIs suggests that USA300 is becoming more virulent with a greater propensity to cause SSTIs

Staphylococcus aureus bacteriuria as a prognosticator for outcome of Staphylococcus aureus bacteremia: a case-control study

<p>Abstract</p> <p>Background</p> <p>When <it>Staphylococcus aureus </it>is isolated in urine, it is thought to usually represent hematogenous spread. Because such spread might have special clinical significance, we evaluated predictors and outcomes of <it>S. aureus </it>bacteriuria among patients with <it>S. aureus </it>bacteremia.</p> <p>Methods</p> <p>A case-control study was performed at John H. Stroger Jr. Hospital of Cook County among adult inpatients during January 2002-December 2006. Cases and controls had positive and negative urine cultures, respectively, for <it>S. aureus</it>, within 72 hours of positive blood culture for <it>S. aureus</it>. Controls were sampled randomly in a 1:4 ratio. Univariate and multivariable logistic regression analyses were done.</p> <p>Results</p> <p>Overall, 59% of patients were African-American, 12% died, 56% of infections had community-onset infections, and 58% were infected with methicillin-susceptible <it>S. aureus </it>(MSSA). Among 61 cases and 247 controls, predictors of <it>S. aureus </it>bacteriuria on multivariate analysis were urological surgery (OR = 3.4, p = 0.06) and genitourinary infection (OR = 9.2, p = 0.002). Among patients who died, there were significantly more patients with bacteriuria than among patients who survived (39% vs. 17%; p = 0.002). In multiple Cox regression analysis, death risks in bacteremic patients were bacteriuria (hazard ratio 2.9, CI 1.4-5.9, p = 0.004), bladder catheter use (2.0, 1.0-4.0, p = 0.06), and Charlson score (1.1, 1.1-1.3, p = 0.02). Neither length of stay nor methicillin-resistant <it>Staphylococcus aureus </it>(MRSA) infection was a predictor of <it>S. aureus </it>bacteriuria or death.</p> <p>Conclusions</p> <p>Among patients with <it>S. aureus </it>bacteremia, those with <it>S. aureus </it>bacteriuria had 3-fold higher mortality than those without bacteriuria, even after adjustment for comorbidities. Bacteriuria may identify patients with more severe bacteremia, who are at risk of worse outcomes.</p

Quantifying Cost-Effectiveness of Controlling Nosocomial Spread of Antibiotic-Resistant Bacteria: The Case of MRSA

BACKGROUND: The costs and benefits of controlling nosocomial spread of antibiotic-resistant bacteria are unknown. METHODS: We developed a mathematical algorithm to determine cost-effectiveness of infection control programs and explored the dynamical interactions between different epidemiological variables and cost-effectiveness. The algorithm includes occurrence of nosocomial infections, attributable mortality, costs and efficacy of infection control and how antibiotic-resistant bacteria affect total number of infections: do infections with antibiotic-resistant bacteria replace infections caused by susceptible bacteria (replacement scenario) or occur in addition to them (addition scenario). Methicillin-resistant Staphylococcus aureus (MRSA) bacteremia was used for illustration using observational data on S. aureus bacteremia (SAB) in our hospital (n = 189 between 2001-2004, all being methicillin-susceptible S. aureus [MSSA]). RESULTS: In the replacement scenario, the costs per life year gained range from 45,912 euros to 6590 euros for attributable mortality rates ranging from 10% to 50%. Using 20,000 euros per life year gained as a threshold, completely preventing MRSA would be cost-effective in the replacement scenario if attributable mortality of MRSA is > or = 21%. In the addition scenario, infection control would be cost saving along the entire range of estimates for attributable mortality. CONCLUSIONS: Cost-effectiveness of controlling antibiotic-resistant bacteria is highly sensitive to the interaction between infections caused by resistant and susceptible bacteria (addition or replacement) and attributable mortality. In our setting, controlling MRSA would be cost saving for the addition scenario but would not be cost-effective in the replacement scenario if attributable mortality would be < 21%