Driving forces of vancomycin-resistant E. faecium and E. faecalis blood-stream infections in children

BACKGROUND

Rates of invasive vancomycin-resistant Enterococcus (VRE) in the USA remains on the rise. Efforts to control vancomycin use and nosocomial transmission have had limited success in halting the spread of this pathogen. The role of antibiotic exposure remains a topic of controversy. We evaluated the association between emergence of VRE-blood-stream infections (BSI), aggregate and individual-patient vancomycin- exposure, and clonal transmission of VRE at an academic pediatric tertiary care hospital.

METHODS

E. faecium and E. faecalis isolates recovered from blood specimens from hospitalized children from 2003-2010 were retrieved from the microbiology database. Aggregate vancomycin use and individual-patient vancomycin exposure 6 months preceding each event of bacteremia were recorded. Pulse-field electrophoresis was performed on selected VRE isolates.

RESULTS

Of 151 episodes of E. faecium and E. faecalis BSI among hospitalized children <18 years of age, 9% (14) were due to VRE. Of these, 5 (36%) were due to nosocomial transmission. Aggregate (r .19, P = 0.3) and individual-patient vancomycin-exposure (X (2)  = .26; P = .87) were not associated with VRE-BSI. On bivariate analysis, OR for developing VRE-BSI among patients infected with clonal isolates was 36 (P < .0001). Infection control interventions, rather than antimicrobial stewardship interventions to decrease vancomycin use, proved to be effective in reducing the rates of VRE-BSI.

CONCLUSIONS

In our experience, VRE-BSI was associated with nosocomial transmission and was independent of aggregate and individual-patient vancomycin-exposure. Molecular epidemiology is a crucial tool to differentiate the role of nosocomial transmission and antibiotic exposure in the emergence of invasive VRE infections among hospitalized children.

A multi-sample changer coupled to an electron cyclotron resonance source for accelerator mass spectrometry experiments

A new multi-sample changer has been constructed allowing rapid changes between samples. The sample changer has 20 positions and is capable of moving between samples in 1 min. The sample changer is part of a project using Accelerator Mass Spectrometry (AMS) at the Argonne Tandem Linac Accelerator System (ATLAS) facility to measure neutron capture rates on a wide range of actinides in a reactor environment. This project will require the measurement of a large number of samples previously irradiated in the Advanced Test Reactor at Idaho National Laboratory. The AMS technique at ATLAS is based on production of highly charged positive ions in an electron cyclotron resonance ion source followed by acceleration in the ATLAS linac. The sample material is introduced into the plasma via laser ablation chosen to limit the dependency of material feed rates upon the source material composition as well as minimize cross-talk between samples.

Breastfeeding, skin-to-skin contact, and mother-infant interactions over infants' first three months

The effects of skin-to-skin contact (SSC) on the maintenance of mothers' decision to breastfeed, the effects of breastfeeding and SSC on mother-infant interactions, and whether maternal depressive symptoms mediate these effects were investigated over infants' first 3 months. When infants were 1 week, 1 month, 2 months, and 3 months of age, mothers in the SSC and control groups reported the type of infant feeding provided and completed the Edinburgh Postnatal Depression Scale (EPDS; J.L. Cox, J.M. Holden, & R. Sagovsky, 1987); mother-infant interactions were coded on the Nursing Child Assessment Feeding Scale (NCAFS; G. Summer & A. Spietz, 1994). Percentage of breastfeeding dyads in the SSC group was stable over the 3 months; yet, fewer dyads in the control group were breastfeeding at the 2- and 3-month visits than at the 1-week visit. Breastfeeding dyads had higher NCAFS Caregiver subscale scores, indicating more positive maternal interactions, at 1 week, 2 months, and 3 months. NCAFS scores did not differ for the SSC and control groups. EPDS scores did not mediate the effect of SSC on breastfeeding or breastfeeding on NCAFS Caregiver subscale scores.

Sexual and seasonal dimorphism in adult adfluvial bull trout (Salvelinus confluentus)

Sexual dimorphism in fishes may be obvious during the reproductive period and less clear during the nonreproductive periods. Despite being difficult to discern during the nonreproductive period, sex-related differences in body condition and shape can yield important insights into a species’ behaviour and ecology. The purpose of this study was to test hypotheses about body condition and shape variation related to sex and season (nonreproductive and reproductive periods) in a population of adult adfluvial bull trout (Salvelinus confluentus (Suckley, 1859)), which is a poorly understood and imperiled species across much of its range. Geometric morphometric samples were collected by angling in the spring and late summer in a reservoir in British Columbia. Principal components analysis identified two principal components (PC) that were related to body condition and that varied according to season and sex. Spring-caught females were in better body condition than spring-caught males. There was a significant sex × season interaction on body condition such that late-summer males were not different from late-summer females. Spawning bull trout exhibited a decline in body condition during the summer season. An additional PC that described head size was found to vary significantly between sexes; however, an assignment test showed that it failed to reliably distinguish between the sexes. We hypothesized that the ecology of these animals, including sex-specific behaviour, is responsible for sexual and seasonal differences in bull trout body condition and morphology. This study offers new insight into the ecology of bull trout and shows that shape data for fishes can be obtained nonlethally, which is particularly important for species that are imperiled.

Phase-sensitive frequency conversion of quadrature modulated signals

Two mechanisms that can make frequency conversion based on nonlinear mixing dependent on the phase of the input signal are identified. A novel phase-to-polarization converter that converts the orthogonal phase components of an input signal to two orthogonally polarized outputs is proposed. The operation of this scheme and a previously reported scheme at an increased symbol rate are simulated with semiconductor optical amplifiers (SOAs) as the nonlinear devices. Experimental results demonstrate the effectiveness of SOAs for nonlinear mixing over a wide range of wavelengths and difference frequencies and confirm the accuracy of the numerical model.

Comparative analysis of total mercury concentrations in anadromous and non-anadromous Arctic charr (Salvelinus alpinus) from eastern Canada

Previous research has documented that total mercury concentrations ([THg]) are lower in anadromous Arctic charr than in non-anadromous conspecifics, but the two life-history forms have rarely been studied together. Here, data from nine pairs of closely-located anadromous and non-anadromous Arctic charr populations were used to explore the impact of biological and life-history factors on individual [THg] across a range of latitudes (49-81° N) in eastern Canada. Unadjusted mean [THg] ranged from 20 to 114 ng/g wet weight (ww) in anadromous populations, and was significantly higher in non-anadromous populations, ranging from 111 to 227 ng/g ww. Within-population variations in [THg] were best explained by fish age, and were often positively related to fork-length and δN-inferred trophic level. Differences in [THg] were not related to differences in length-at-age (i.e., average somatic growth rate) among populations of either life-history type. Mercury concentrations were not related to site latitude in either the anadromous or non-anadromous fish. We conclude that the difference in Arctic charr [THg] with life-history type could not be explained by differences in fish age, fork-length, trophic position, or length-at-age, and discuss possible factors contributing to low mercury concentrations in anadromous, relative to freshwater, fish.

Ontogenetic shifts in morphology and resource use of cisco Coregonus artedi

Two previously described lacustrine cisco Coregonus spp. morphs [i.e. a small (<300 mm fork length, L(F)), low-gillraker (≤44) morph and a large (≥300 mm L(F) ), high-gillraker (≥45) morph] from Great Slave Lake, NT, Canada, were found to be synonymous with cisco Coregonus artedi. Geometric body shape did not differ between the two size classes nor could they be differentiated by 24 size-corrected linear measurements, indicating that the two groups had similar phenotypes. Strong, positive correlations between all linear characters and geometric centroid size (a composite variable of fish body length, mass and age) suggested that body morphology changed with age as fish grew. Total gillraker number (N(GR)) increased with L(F) according to: N(GR) = 36.3 + 0.034L(F). Differences in gillraker number and phenotype with age and size were explained by shifts in habitat and trophic resource use. Relative abundance within 0-30, 30-60, 60-90 and >90 m depth strata differed between size classes suggesting that morphology changed when fish shifted their habitat as they grew older. Large C. artedi had lower δ(13)C and slightly higher δ(15)N, indicating greater reliance on pelagic prey resources (i.e. more or larger zooplankton, such as Mysis spp.), compared to small C. artedi, which relied slightly more on benthic prey. Gillraker shape and number have always been used as key diagnostic characters in coregonine taxonomy; based on the findings presented here, ontogenetic shifts should be accounted for in resulting classifications.

Basal mercury concentrations and biomagnification rates in freshwater and marine food webs: effects on Arctic charr (Salvelinus alpinus) from eastern Canada

Patterns of total Hg (THg) and methyl Hg (MeHg) biomagnification were investigated in six pairs of co-located lacustrine and marine food webs supporting a common predator, Arctic charr. Mercury biomagnification rates (the slope of log Hg concentration versus δ(15)N-inferred trophic level) did not differ significantly between the two feeding habitats for either THg or MeHg, but THg and MeHg concentrations at the base of the food web were higher in the lacustrine environment than in the marine environment. The proportion of THg as MeHg was related to trophic level, and the relationship was statistically similar in the lacustrine and marine habitats. The biomagnification rate of MeHg exceeded that of THg in both habitats. We conclude that the known difference in Hg concentration between anadromous and non-anadromous Arctic charr is driven by differential Hg concentrations at the base of the lacustrine and marine foodwebs, and not by differential biomagnification rates.

The 2010 British Association of Stroke Physicians Survey of interventional treatments for stroke in the United Kingdom

INTRODUCTION

The UK National Stroke Strategy (Department of Health 2007) states that patients should have access to a stroke service with neurointerventional capacity. This survey was conducted by the Clinical Standards Committee of the British Association of Stroke Physicians to get a snapshot of the availability of interventional treatments for stroke in the United Kingdom.

METHODS

Questionnaires covering availability of endovascular treatments for stroke, e.g. intra-arterial thrombolysis and mechanical thrombectomy, were emailed to all British Association of Stroke Physicians members in October 2010. Where more than one response was received from the same hospital, the data were only entered once. If there was a discrepancy between different respondents for the same hospital, details were cross-checked with the respondents to ensure accuracy.

RESULTS

Responses were received from 58 hospitals in England, Scotland, Wales, and Northern Ireland. Intra-arterial thrombolysis and/or mechanical thrombectomy were available in 23 hospitals. Of these, three had not performed any procedures in 2010. Twenty centres had conducted a mean (range) of eight (2-20) procedures during the 10-month period. Thirty-five hospitals were not offering endovascular treatments. Sixteen of these were not referring patients to centres which could provide interventional treatments. Hospitals offering endovascular treatments had a mean (range) of 5.2 (2-12) stroke physicians, 2.3 (0-4) interventional neuroradiologists, and 3.6 (0-9) noninterventional neuroradiologists. Only two hospitals providing interventions had four or more interventional neuroradiologists.

CONCLUSIONS

Only a small number of hospitals in the United Kingdom provide interventional treatments for stroke. Almost 50% of hospitals not providing interventions had no processes in place for referral to providers.

Carbapenemase-producing Enterobacteriaceae in Irish critical care units: results of a pilot prevalence survey, June 2011

The epidemiology of carbapenemase-producing Enterobacteriaceae (CPE) in Ireland is changing, with an increase in the number of reported cases in late 2010 and early 2011. Reported cases were predominantly linked to critical care units. In June 2011, a four-week national pilot survey took place in 40 Irish critical care units (37 adult and three paediatric) to examine the prevalence of rectal carriage of CPE and inform national CPE screening guidelines. A total of 760 screening swabs were taken over the study period, and CPE were not detected in any of the participating critical care units.

Global major histocompatibility class II β (mh-IIβ)-polymorphism in Arctic charr Salvelinus alpinus

This study explored the use of the gene encoding the β subunit of the major histocompatibility (MH) receptor as a population marker in Arctic charr Salvelinus alpinus. The use of this polymorphic marker allowed differentiation of the S. alpinus lineages previously defined using mitochondrial DNA (mtDNA) but also allowed differentiation between the populations studied within those lineages. The majority of the variation observed here occurred prior to the last glaciation event. Nevertheless, all S. alpinus populations were differentiated using both MH Class II β (mh-IIβ) sequences and allelic frequencies. The fact that all the populations studied presented high rates of non-synonymous: synonymous substitutions and high levels of interpopulation variation, suggested mh-IIβ as an ideal marker to assess differentiation among S. alpinus populations in ways that may represent divergence both by genetic drift and natural adaptation to the local environment.

The effect of mother-infant skin-to-skin contact on infants' response to the Still Face Task from newborn to three months of age

The effect of mother-infant skin-to-skin contact on infants' developing social expectations for maternal behavior was investigated longitudinally over infants' first 3 months. Infants with and without skin-to-skin contact engaged with their mothers in the Still Face Task at ages 1 week, 1 month, 2 months, and 3 months. Infants with skin-to-skin contact began responding to changes in their mothers' behavior with their affect at 1 month; infants without skin-to-skin contact did so at 2 months. At 3 months, infants with skin-to-skin contact increased their non-distress vocalizations during the still face phase, suggesting social bidding to their mothers. Skin-to-skin contact accelerated infants' social expectations for their mothers' behavior and enhanced infants' awareness of themselves as active agents in social interactions.

The response scale for the intellectual disability module of the WHOQOL: 5-point or 3-point?

OBJECTIVE

To deal with the question of whether a 5-point response Likert scale should be changed to a 3-point scale when used in the field testing of people with intellectual disabilities (IDs), which was raised after the pilot study of World Health Organization Quality of Life (WHOQOL)-DIS, a module being developed with the World Health Organization measure of quality of life for disabilities.

METHODS

Three possible ways were used to generate hypothetical data by merging a 5-point scale into a 3-point scale. The analyses were based on both item response theory and classical measurement theory. The partial credit model for polytomous response was performed for item evaluation; the confirmatory factor analysis was used to check construct validity, the Cronbach's alpha for domain reliability, and correlation analyses for the relationship between the 5-point scale and the generated 3-point scale.

RESULTS

Most items with a 5-point response scale had disordered response options and/or unequal-length intervals between successive response options; these deficiencies were removed or improved without decline of validity and reliability in the hypothetical data of 3-point scales.

CONCLUSION

Instead of the 5-point scale, a 3-point scale could be used for IDs in the field test of developing the module WHOQOL-DIS.

Extra-corporeal membrane oxygenation in the management of 2009 influenza A (H1N1) refractory respiratory failure

Rapidly progressive acute respiratory failure attributed to 2009 H1N1 influenza A infection has been reported worldwide-3. Refractory hypoxaemia despite conventional mechanical ventilation and lung protective strategies has resulted in the use a combination of rescue therapies, such as conservative fluid management, prone positioning, inhaled nitric oxide, high frequency oscillatory ventilation and extracorporeal membrane oxygenation (ECMO)4. ECMO allows for pulmonary or cardiopulmonary support as an adjunct to respiratory and cardiac failure, minimising ventilator-associated lung injury (VALI). This permits treatment of the underlying disease process, while concurrently allowing for recovery of the acute lung injury. This case documents a previously healthy twenty-two year old Asian male patient with confirmed pandemic (H 1N1) 2009 influenza A who was successfully managed with ECMO in the setting of severe refractory hypoxaemia and progressive hypercapnia.

Automated anatomical demarcation using an active shape model for videofluoroscopic analysis in swallowing

The current gold standard method in the clinical assessment of swallowing is the visual inspection of videofluoroscopic frames. Specific clinical measurements are estimated based on various anatomical and bolus positional information with respect to time (or frame number). However, due to the subjective nature of visual inspection clinicians face intra- and inter-observer repeatability issues and bias when making these estimations. The correct demarcations of reference lines highlighting the positions of important anatomical landmarks would serve as a visual aid and could also be used in conjunction with bolus detection methods to objectively determine these desirable measurements. In this paper, we introduce and test the reliability of applying a 16-point Active Shape Model as a deformable template to demarcate the boundaries of salient anatomical boundaries with minimal user input. A robust end and corner point detection algorithm is also used to provide image information for the suggested movement of the template during the fitting stage. Results show the model deformation constraints calculated from a training set of images are clinically coherent. The Euclidean distances between the fitted model points against their corresponding target points were measured. Test images were taken from two different data sets from frames acquired using two different videofluoroscopy units. Overall, fitting was found to be more reliable on the vertebrae and inferior points of the larynx compared to the superior laryngeal points and hyoid bone, with the model always fitting the C7 vertebra with discrepancies no higher than a distance of 23 pixels (3.2% of the image width, approximately 7.6mm).

Factors associated with acute fatigue in primary care

BACKGROUND

To examine the role of psychological distress, negative life events, social support and lack of fitness (using breathlessness on exertion as a proxy) in the development of new onset fatigue in a primary care population.

METHOD

Adults between the ages of 18 and 45 years who were registered with five general practices in South East England were asked to complete a fatigue questionnaire and the 12-item General Health Questionnaire. Between 1 and 12 months later, subjects who visited the general practitioner (GP) with a suspected viral infection were recruited to the study and asked to complete measures of fatigue, psychological distress, life events, social support and allergies (stage 2). The next person to present to the GP with a complaint other than a viral illness was recruited as a control. Factors assessed at stage 2 that were associated with the development of fatigue were examined with stepwise logistic regression.

RESULTS

Acute fatigue was not associated with a viral illness. Negative life events and breathlessness on exertion (interpreted as lack of fitness) were associated with incident cases of fatigue. However, when controlling for concurrent psychological distress, the independent association of negative life events disappeared.

CONCLUSIONS

Psychological distress was strongly associated with new onset fatigue and hence emphasizes the significance of psychological distress as a concomitant complaint in fatigue. Further, the salient association between breathlessness and fatigue may indicate the need to recommend exercise as a therapeutic strategy to improve physical fitness in the primary care setting.

A comparison of Rasch item-fit and Cronbach's alpha item reduction analysis for the development of a Quality of Life scale for children and adolescents

OBJECTIVE

This study compares item reduction analysis based on classical test theory (maximizing Cronbach's alpha - approach A), with analysis based on the Rasch Partial Credit Model item-fit (approach B), as applied to children and adolescents' health-related quality of life (HRQoL) items. The reliability and structural, cross-cultural and known-group validity of the measures were examined.

METHODS

Within the European KIDSCREEN project, 3019 children and adolescents (8-18 years) from seven European countries answered 19 HRQoL items of the Physical Well-being dimension of a preliminary KIDSCREEN instrument. The Cronbach's alpha and corrected item total correlation (approach A) were compared with infit mean squares and the Q-index item-fit derived according to a partial credit model (approach B). Cross-cultural differential item functioning (DIF ordinal logistic regression approach), structural validity (confirmatory factor analysis and residual correlation) and relative validity (RV) for socio-demographic and health-related factors were calculated for approaches (A) and (B).

RESULTS

Approach (A) led to the retention of 13 items, compared with 11 items with approach (B). The item overlap was 69% for (A) and 78% for (B). The correlation coefficient of the summated ratings was 0.93. The Cronbach's alpha was similar for both versions [0.86 (A); 0.85 (B)]. Both approaches selected some items that are not strictly unidimensional and items displaying DIF. RV ratios favoured (A) with regard to socio-demographic aspects. Approach (B) was superior in RV with regard to health-related aspects.

CONCLUSION

Both types of item reduction analysis should be accompanied by additional analyses. Neither of the two approaches was universally superior with regard to cultural, structural and known-group validity. However, the results support the usability of the Rasch method for developing new HRQoL measures for children and adolescents.

Phylogeography and sympatric differentiation of the Arctic charr Salvelinus alpinus (L.) complex in Siberia as revealed by mtDNA sequence analysis

Sequence variation in the mtDNA control region of Arctic charr Salvelinus alpinus and Dolly Varden Salvelinus malma from 56 Siberian and North American populations was analysed to assess their phylogeographic relationships and the origins of sympatric forms. Phylogenetic trees confirm the integrity of phylogroups reported in previous mtDNA studies except that the Siberian group does not separate as a single cluster. Haplotype network analysis indicates the proximity of Siberian and Atlantic haplotypes. These are considered as one Eurasian group represented by the Atlantic, east Siberian (interior Siberia including Transbaikalia, Taimyr) and Eurosiberian (Finland, Spitsbergen, Taimyr) sub-groups. Salvelinus alpinus with presumably introgressed Bering group (malma) haplotypes were found along eastern Siberian coasts up to the Olenek Bay and the Lena Delta region, where they overlap with the Eurasian group and in the easternmost interior region. It is proposed that Siberia was colonized by S. alpinus in two stages: from the west by the Eurasian group and later from the east by the Bering group. The high diversity of Eurasian group haplotypes in Siberia indicates its earlier colonization by S. alpinus as compared with the European Alps. This colonization was rapid, proceeded from a diverse gene pool, and was followed by differential survival of ancestral mtDNA lineages in different basins and regions, and local mutational events in isolated populations. The results presented here support a northern origin of Transbaikalian S. alpinus, the dispersion of S. alpinus to the Lake Baikal Basin from the Lena Basin, segregation of S. alpinus between Lena tributaries and their restricted migration over the divides between sub-basins. These results also support sympatric origin of intralacustrine forms of S. alpinus.