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

Chemosignals of stress influence social judgments.

Human body odors have important communicative functions regarding genetic identity, immune fitness and general health, but an expanding body of research suggests they can also communicate information about an individual's emotional state. In the current study, we tested whether axillary odors obtained from women experiencing psychosocial stress could negatively influence personality judgments of warmth and competence made about other women depicted in video scenarios. 44 female donors provided three types of sweat samples: untreated exercise sweat, untreated stress sweat and treated stress sweat. After a 'washout' period, a commercial unscented anti-perspirant product was applied to the left axilla only to evaluate whether 'blocking' the stress signal would improve the social evaluations. A separate group of male and female evaluators (n = 120) rated the women in the videos while smelling one of the three types of sweat samples. Women in the video scenes were rated as being more stressed by both men and women when smelling the untreated vs. treated stress sweat. For men only, the women in the videos were rated as less confident, trustworthy and competent when smelling both the untreated stress and exercise sweat in contrast to the treated stress sweat. Women's social judgments were unaffected by sniffing the pads. The results have implications for influencing multiple types of professional and personal social interactions and impression management and extend our understanding of the social communicative function of body odors

Web-Based System Navigation Database to Support Equitable Access to Assistive Technology: Usability Testing Study

BackgroundAssistive technology (AT) can contribute to how individuals participate and engage in everyday activities, such as communication and mobility, and facilitates access to the services they require. Navigating Canada’s AT system has been described as fragmented and complex, presenting barriers for individuals who require AT, caregivers, and health service providers. AccessATCanada was developed as a centralized web-based resource to help support access to AT by providing information about the existing jurisdictional funding programs and services. ObjectiveThis study aimed to evaluate the usability of AccessATCanada by gathering feedback about its features, functionality, and areas of strength and opportunity from potential end users. MethodsA usability testing study using a think-aloud approach and semistructured interviews was conducted to measure the effectiveness and efficiency of and user satisfaction with AccessATCanada and to identify issues with the interface during end-user interaction. A qualitative thematic analysis was used to generate insights into and core themes about user experiences. User feedback was used to inform subsequent updates of the database with the goal of enhancing website friendliness and functionality before its official launch. ResultsA total of 10 participants (6 consumers, 1 caregiver, and 3 providers) participated in the usability testing study. The usability performance and scores tended to improve between the 2 testing cycles. Most participants were able to successfully complete all the tasks independently. The efficiency scores tended to improve as the users continued to engage with the interface. The website received an overall System Usability Score of 62.22, which was ranked as “OK/fair to good.” The users provided an overall positive evaluation of the beta version of the web-based resource tested over 2 cycles and helped to identify areas for improvement. They commented on the functionality and added value of the website, discovery of new programs and resources, and design aesthetics. Most usability issues were reported as minor challenges related to presentation, functionality, and language, and feedback was adopted into later iterations of the website. ConclusionsThis study provides reflections on the value of usability testing and elements that are key to the creation of user-centered resources, such as the inclusion of participants with various abilities and considerations regarding website design and accessibility in an increasingly web-based world. AccessATCanada is now part of a growing global response to expand the reach of AT programs and services, improve the equity of access to AT, and reduce the complexity of navigating AT systems

Mean and standard errors of the confidence, trustworthiness and competence ratings of the women depicted in the videos as a function of the sweat odor pairing condition.

<p>Mean and standard errors of the confidence, trustworthiness and competence ratings of the women depicted in the videos as a function of the sweat odor pairing condition.</p

Timeline of events and measures for the donor session.

<p>Timeline of events and measures for the donor session.</p

Schematic of the study design for presenting stimuli and collecting data.

<p>Across subjects, blocks were counterbalanced so that each odor stimulus was paired with each video twice.</p