Multicenter observational study on factors and outcomes associated with various methicillin-resistant Staphylococcus aureus types in children with cystic fibrosis

Rationale: Methicillin-resistant Staphylococcus aureus (MRSA) prevalence continues to increase in patients with cystic fibrosis (CF) in the United States, reaching 26.5% in 2012. Approximately 30% of strains are SCCmec (staphylococcal cassette chromosome mec) IV type, frequently USA300, which in the general population have different genotypic and phenotypic features than SCCmec II type. Objectives: We hypothesized that risk factors for acquisition and outcomes in patients with CF differed for "health care-associated" (SCCmec II) versus "community-associated" (SCCmec IV)MRSAstrains. Methods: To determine the role of SCCmec type and Panton-Valentine leukocidin (PVL), MRSA isolates from patients not more than 18 years old at seven CF centers were typed and the association of potential risk factors and subsequent clinical course was assessed, using data provided by the CF Patient Registry. Measurements and Main Results: Participants with chronic MRSA (295) had typeable isolates and clinical data; 205 (69.5%) had SCCmec II PVL(-), 39 (13.2%) had SCCmec IV PVL(-), and 51 (17.3%) had SCCmec IVPVL(1) strains.SCCmec IV, comparedwith SCCmec II, increased during the study period, 1996-2010 (P = 0.03). SCCmec II was associated with Pseudomonas aeruginosa-positive cultures and three or more clinic visits in the 6 months preceding the first positive MRSA culture (adjusted odds ratio, 2.05; 95% confidence interval, 1.13-3.74; P = 0.019). Lung function and anthropometrics remained unchanged in the 6 months after initial MRSA detection compared with the 6 months prior. Although CF care increased for participants in both groups in the 6 months after MRSA detection, inhaled antibiotics were prescribed more frequently in those with SCCmec II strains and increased hospitalizations occurred in those with SCCmec IV PVL(-) strains compared with those with PVL(1) strains (adjusted difference, 34.10%; 95% confidence interval, 7.58-60.61; P = 0.012). Participants in both groups had an increase in CF care in the 2 years after MRSA detection compared with the 2 years prior. Conclusions: Increased exposure to CF clinics and P. aeruginosa may constitute risk factors for acquisition of SCCmec II MRSA strains. Clinical interventions increased 6 months and 2 years after initial MRSA detection regardless of SCCmec type

Outcomes and Treatment of Chronic Methicillin-Resistant Staphylococcus aureus Differs by Staphylococcal Cassette Chromosome mec (SCC mec ) Type in Children With Cystic Fibrosis

Methicillin-resistant Staphylococcus aureus (MRSA) infects ∼25% of patients with cystic fibrosis (CF) in the United States. We hypothesized that health-related outcomes differed between healthcare-associated (staphylococcal cassette chromosome mec [SCCmec] II) vs community-associated (SCCmec IV) MRSA strains in patients chronically infected with CF

Work and resilience: Care leavers' experiences of navigating towards employment and independence

Poor education and employment outcomes have long been associated with care experienced young people transitioning into independence, even after adjusting for prior disadvantage. In the United Kingdom, such young people are generally referred to as care leavers. Policies that aim to reduce the gap between care leavers and non-care experienced young people's success transitioning to employment and independence have had limited success. This paper draws on a qualitative methodology that utilized theories of resilience, to glean a range of perspectives from both care leavers and their employers. All the participants were engaged in a U.K. local authority's initiative to support care leavers into employment. Drawing on resilience theory, resilience was found to be located in a complex interaction between a resilience enabling environment and, crucially, emotionally supportive networks. Uniquely, we argue that emotional support, drawn from such networks, is the key factor that facilitates young people navigating towards such resources, leading to successful outcomes. Previous studies have underplayed this aspect in favour of more tangible resources. Attention to strengthening emotional support networks is thus identified as a significant factor that supports transition to employment and successful independence for care leavers

Grantham Institute Outlook 2021-2022

The Grantham Institute's annual Outlook magazine provides an overview of the climate and environmental research and activities underway at Imperial College London, encompassing both recent achievements and future plans

Splenic infarction in sickle cell trait: A comprehensive systematic review of case studies

Abstract Sickle cell trait (SCT), a commonly asymptomatic condition, has many associated clinical complications that upon presentation, can be very difficult to attribute to SCT. The effects of SCT on the spleen, for example, are not completely understood, though there have been a number of case reports detailing related complications in diverse populations. Our objective was to perform the first comprehensive case report review of splenic infarction in SCT patients to highlight the relevance of this seemingly rare condition. We conducted an extensive literature search reviewing case reports and case series of acute splenic infarctions from 1970 to 2020. This comprehensive search resulted in 54 articles with a total of 85 individuals. The ages ranged from 7 to 65, 12% were female. Individuals were of African‐American (26%), European (16%), South Asian (13%), Middle Eastern (7%), Latin American (7%), North or East African (4%), Mediterranean (4%), West African (1%), and unknown (22%) origins. Although splenic infarct in SCT patients has been associated with high altitudes, 39% of cases reporting altitude occurred below 3000 m. Among cases where HbS values were recorded, 88% occurred in individuals with HbS levels higher than 35%, suggesting that high HbS values may be a risk factor for splenic infarction. Our findings indicate that splenic infarct occurs across a wide range of demographic populations and environmental settings. While our understanding of SCT evolves, the findings here suggest that future advances in research and healthcare could benefit more from real‐time surveillance and registry initiation for various SCT outcomes such as splenic infarct

Grantham Institute Outlook 2022-2023

The Grantham Institute Outlook magazine provides an overview of the climate and environmental research underway at Imperial College London, encompassing both recent achievements and future plans

THE THUMPER / le JIMMY HEATH SEXTET

Titre uniforme : [For all we know]Comprend : FOR MINORS ONLY / Jimmy HEATH - WHO NEEDS IT ? / Wynton KELLY - DON'T YOU KNOW I CARE ? / RUSSELL et ELLINGTON - TWO TEES / Jimmy HEATH - THE THUMPER / Jimmy HEATH - NEWKEEP / Jimmy HEATH - FOR ALL WE KNOW / LEWIS et COOTS - I CAN MAKE YOU LOVE ME / RUSSELL et de ROSE - NICE PEOPLE / Jimmy HEATHBnF-Partenariats, Collection sonore - BelieveContient une table des matière