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To assess influenza symptoms, adherence to mask use recommendations, absenteesm and presenteeism in acute care healthcare workers (HCWs) during influenza epidemics.
The TransFLUas influenza transmission study in acute healthcare prospectively followed HCWs prospectively over 2 consecutive influenza seasons. Symptom diaries asking for respiratory symptoms and adherence with mask use recommendations were recorded on a daily basis, and study participants provided midturbinate nasal swabs for influenza testing.
In total, 152 HCWs (65.8% nurses and 13.2% physicians) were included: 89.1% of study participants reported at least 1 influenza symptom during their study season and 77.8% suffered from respiratory symptoms. Also, 28.3% of HCW missed at least 1 working day during the study period: 82.6% of these days were missed because of symptoms of influenza illness. Of all participating HCWs, 67.9% worked with symptoms of influenza infection on 8.8% of study days. On 0.3% of study days, symptomatic HCWs were shedding influenza virus while at work. Among HCWs with respiratory symptoms, 74.1% adhered to the policy to wear a mask at work on 59.1% of days with respiratory symptoms.
Respiratory disease is frequent among HCWs and imposes a significant economic burden on hospitals due to the number of working days lost. Presenteesm with respiratory illness, including influenza, is also frequent and poses a risk for patients and staff.
Arteriovenous malformations may present with significant haemodynamic compromise in the neonatal period, typically with high output cardiac failure that may be accompanied by hypoxia and right ventricular dysfunction. Targeted neonatal echocardiography performed by trained neonatologists provides an enhanced physiology-based approach that can guide treatment and minimise complications. We present a case of a large hepatic vascular malformation whose therapy was guided by targeted neonatal echocardiography to prevent paradoxical embolisation of procedural glue to the systemic circulation.
Background: Antibiotic stewardship programs (ASPs) have traditionally focused on inpatient prescribing, but they are now mandated to involve ambulatory settings. We developed and tested an educational tool in resident physicians to empower outpatient providers to perform self-reflection stewardship (SRS) to improve their antibiotic use. Results of the first SRS workshop are reported. Methods: A 90-minute SRS workshop focusing on the evaluation and management of sinusitis in ambulatory care was developed for PGY 2-3 internal medicine residents. Participants received a 15-minute didactic on the evaluation and management of adults with sinusitis, including typical microbiology, differentiation of bacterial sinusitis, and guideline recommendations on antibiotic treatment. In a computer lab, participants were instructed how to review charts of patients they had treated with antibiotics for sinusitis during the past year using the SlicerDicer application in Epic. Over 1 hour, they worked in pairs to complete and discuss a self-reflection inventory for 5 patients from each of their respective reviews. They evaluated pertinent history, comorbidities, presenting symptoms and signs, diagnostic testing performed, and a self-assessment of the subsequent antibiotic prescribing, including appropriateness of using an antibiotic, antibiotic choice and duration. In addition, they reflected on potential patient and prescriber challenges. Residents then identified common themes and developed a personal improvement plan for antibiotic prescribing for sinusitis. The last 15 minutes were spent debriefing with ASP faculty on reasons for overprescription of antibiotics for URIs and individual improvement plans. Residents completed workshop evaluations using a Likert scale and open-ended comments. Results: In total, 26 residents participated. All (100%) agreed or strongly agreed that the SRS workshop improved their understanding of how to obtain data on their own practice habits. Moreover, 23 (88%) agreed or strongly agreed that the workshop improved their understanding of when to prescribe antibiotics and how to practice antibiotic stewardship in the outpatient setting. Also, 20 participants (77%) agreed or strongly agreed that the SRS workshop helped them gain insight into reasons why they might overprescribe antibiotics in the outpatient setting. Furthermore, 25 (96%) agreed or strongly agreed that the SRS workshop helped them identify at least 1 way they could improve their antibiotic prescribing in the outpatient setting. Conclusions: The SRS workshop was well received by residents and offers a tool to empower primary care resident physicians to access their own antibiotic prescribing data, perform a structured self-reflection, and enhance their understanding of antibiotic stewardship in the ambulatory setting. SRS is a potential tool to improve ambulatory antibiotic use.
Given a manifold
with a submanifold
, the deformation space
is a manifold with a submersion to
whose zero fiber is the normal bundle
, and all other fibers are equal to
. This article uses deformation spaces to study the local behavior of various geometric structures associated with singular foliations, with
a submanifold transverse to the foliation. New examples include
-algebroids, Courant algebroids, and Lie bialgebroids. In each case, we obtain a normal form theorem around
, in terms of a model structure over
In light of the infection risk associated with external ventricular drainage (EVD), we decided to establish the surveillance of EVD-associated meningitis/ventriculitis in German intensive care units (ICUs) in the framework of the German national nosocomial infection surveillance system (KISS). Here, we present the current reference data and subsequent risk-factor analysis for EVD-associated meningitis/ventriculitis rates.
The surveillance method corresponds with the surveillance methods for device-associated infections recommended by the National Healthcare Safety Network (NHSN). All ICUs participating for at least 1 month from 2008 to 2016 in the module ICU-KISS were included in the reference dataset and the multivariate analysis.
Current reference data (2008–2016) are based on input from 157 ICUs. The mean EVD-associated meningitis/ventriculitis rate per 1,000 EVD days was 3.96, with little variation between neurosurgical, surgical, interdisciplinary (hospitals with >400 beds), and neurological ICUs. In total, 893 EVD-associated meningitis/ventriculitis cases and 225,351 EVD days were included in the risk-factor analysis. After multivariate analysis, 2 factors remained significant: (1) stay in an ICU labeled other than neurosurgical, surgical, interdisciplinary (>400 beds), and neurological as a protective factor and (2) EVD utilization rate above the 75th quantile as a risk factor for acquisition of EVD-associated meningitis/ventriculitis.
EVD-associated meningitis and ventriculitis are frequent complications of care in intensive care patients at risk. A long hospital stay and/or the presence of the EVD puts the patient at high risk for pathogen acquisition with subsequent infection.
Dietary fibers (DF) are considered as beneficial nutrients for health. Current data suggest that their interaction with the gut microbiota largely contributes to their physiological effects. The FiberTAG project(1) innovates in searching for new biomarkers reflecting the health effect of dietary fibers, including chitin-glucan (CG, extracted from the fungal exoskeleton Aspergillus niger). CG improves metabolic disorders associated with obesity in mice, but its effect on gut microbiota composition and function has never been evaluated in vivo in humans.
Materials and Methods
CG (KitoZyme, Belgium) was given to healthy volunteers (n = 15), during three weeks (4.5g/day). Volatile Organic Compound (VOC) metabolites released in breath were analyzed using SYFT methodology. Fatty acid (FA) profiling was assessed in stool samples, by gas-liquid chromatography(2). The gut microbiome was analyzed by Illumina sequencing (V5-V6 region of 16S rRNA).
Three weeks of CG supplementation was well tolerated and lead to changes in the kinetics of breath VOC, especially the short-chain fatty acid, alcohols and alkanes. Fecal vaccenic acid, produced upon the bacterial metabolism of fatty acids, was significantly increased by CG. Several bacterial genera were correlated with breath VOC (i.e. 2 methylbutyric acid and RuminococcaceaeUCG005). Moreover, Roseburia, often presented as a butyrate producer, was positively correlated with the production of a rumenic acid isomer “cis-9,cis-11-18:2”.
We show that breath VOC analysis, a non-invasive methodology, reveals characteristics of microbiota-CG interactions. We also show that CG selectively changes the profile of FA metabolites, in favor of vaccenic acid, another bioactive metabolite produced by Roseburia, prone to act on host physiology. This study will help to establish a set of new biomarkers linking insoluble DF and gut microbiota, with focus on their interest in human health.
Background: A number of small intervention studies suggested that a Mediterranean diet (MedD) and physical activity can lower the risk for breast cancer. LIBRE is the first large multicenter RCT to test the effect of these lifestyle factors on the incidence of breast cancer in women at risk because of BRCA mutations(1). LIBRE also offers to unravel underlying mechanisms such as the role of short-chain fatty acids (SCFA) for beneficial effects of such lifestyle interventions.
Methods: We examined the effect of the lifestyle intervention on the production of SCFA measured in feces by gas chromatography. From the ongoing LIBRE trial we included all complete datasets (171 women; mean age 44 ± 11 years). Both women with and without previous breast cancer diagnosis were recruited (diseased; non-diseased). The participants were randomized into an intervention group (IG) trained for MedD and physical activity, and a usual care control group (CG). Adherence to the MedD was assessed at baseline and after 3 months (V1) using the validated Mediterranean Diet Adherence Screener (MEDAS) and the EPIC food frequency questionnaire (FFQ).
Results: At baseline there was no difference in SCFA levels between the groups. In the IG the MEDAS score increased substantially by 2.5 points (p < 0.001), in the CG only mildly by 0.4 points (p < 0.05). Correspondingly, the intake of fibers increased solely in the IG. In the course of the study the amount of caproic acid decreased in the control group (p < 0.001). At V1 non-diseased women showed higher amounts of acetic acid (p = 0.042), n-butyric acid (p = 0.023), n-valeric acid (p = 0.018) and iso-valeric acid (p = 0.031). There were several correlations between the intake of different fibers and fecal SCFA. For example, the sum of poly- and oligosaccharides correlated with acetic acid (p = 0.001; r = 0.316), propionic acid (p = 0.034; r = 0,251), n-butyric acid (p = 0.010; r = 0.316) and iso-valeric acid (p = 0.012; r = 0.306). There was no correlation between the MEDAS and SCFA.
Discussion: A lifestyle change towards a MedD and increased physical activity did not change the levels of SCFA in feces, although an increase of fiber intake was documented in the IG. To further analyze SCFA metabolism in this target population, gut microbiota composition and function (metabolites) are currently analyzed.
N95 respirator masks are recommended for protection against respiratory viruses. Despite passing fit-testing 10% of N95 respirator users encountered breakthroughs with exposure to influenza virus compared to full protection provided by a powered air purifying respirator. The current recommendation of N95 respirators should be evaluated for endemic and emerging scenarios.
Which of the new political parties that emerged in advanced democracies faded away and which ones managed to survive and why? Considering a party as dead once it ceases to nominate candidates in any elections, we develop two sets of hypotheses to account for party death derived from two conceptions of political parties. One conceptualizes parties as vehicles formed by career-oriented politicians eager to maximize individual rewards. Failure to deliver seats or government access is therefore expected to predict an earlier death. The other conceptualizes parties as societal organizations that serve representational functions valued in themselves by elites and members alike. This conception stresses the importance of roots in society or ideological novelty. Using survival analysis, we test our hypotheses in 17 advanced democracies based on a new data set covering 144 new parties from birth until their (potential) death. Arguments derived from both conceptions have significant support stressing the complexity of the drivers underpinning parties’ very existence.
Evidence suggests that both high and low birth weight children have increased the risk for obesity and the metabolic syndrome in adulthood. Previously we have found altered feeding behaviour and food preferences in pre-school children and adults born with low birth weight. In this study, we investigated if birth weight was associated with different intake of fat, carbohydrate and/or protein at 6–12 years of age. This is a cross-sectional study where 255 guardians answered online and telephone questions including anthropometrics and demographic data, parental family food rules (food control, encouragement and restriction) and a complete web-based FFQ for their children (130 boys and 125 girls). Baseline demographic and parental food rules characteristics did not differ accordingly to sex. Linear regression models were conducted separately for each sex, adjusted for income, age and maternal age. There were no differences in total energy intake, but energy density (ED, energy content/g) was negatively associated with birth weight in boys. Macronutrient analysis showed that ED intake was from a greater intake of fat. Birth weight was not a significant predictor of protein and carbohydrate intake in boys. In girls, we saw a positive correlation between fat intake and cholesterol intake v. birth weight, but no association with ED intake (results did not remain after adjustment). The study shows that low birth weight is associated with altered fat intake in childhood in a sex-specific manner. It is likely that biological factors such as fetal programming of homoeostatic and/or hedonic pathways influencing food preferences are involved in this process.
Labour Beyond Cosatu is the fourth volume in the series Taking Democracy Seriously – a ground-breaking, textured and nuanced study on workers and democracy – which was established in the 1990s. The series looks at members of trade unions affiliated to the Congress of South African Trade Unions (Cosatu) and provides a rich database of trade union members and research conducted over the past twenty years. It is one of the very few such resources available to researchers anywhere in the world. Labour Beyond Cosatu paints a complex picture. The 12 chapters of the volume explore various rebellions and conflicts in the trade union sector, starting with the National Union of Mineworkers (NUM) and rivalries between Cosatu affiliates. Unpacking the conflicts between state-sector and private-sector workers, contributors look at the impact of generational and educational shifts, seen by some commentators as proof that Cosatu is now ‘middle class’. The book also raises the issue of gender in the unions by usefully locating the controversy around charges levelled at Zwelinzima Vavi in 2013 in the larger context of serious problems in the gender politics within parts of Cosatu.Refuting the image of a union federation solidly committed to the ANC, Labour Beyond Cosatu presents evidence of a sharp decline in support for the ANC within Cosatu, and growing scepticism towards the Alliance. It shows that attempts to understand the labour movement in South Africa in the future will need to include research of smaller, independent unions and social movements. The volume’s contributors make a major contribution to key debates on labour and democracy, providing new material that can potentially shift the discussion in important ways. This book will be of great value to students and researchers in Industrial Sociology, Political Studies, Industrial Psychology and Economics and Management.
Members of Cosatu unions in our survey earned an average monthly income of R12 361.26, ranging from an individual who earned R45 000 a month to one who earned just R1 086. Of the entire sample, 25 per cent earned less than R6 800 per month and half earned less than R11 000 per month. There were also differences between Cosatu members who were members of public sector unions (average monthly income R14 108.58) and private sector unions (average monthly income R10 760.92). The households of more than 80 per cent of these union members were entirely dependent on wages for household incomes, with only 4.4 per cent reporting receiving child-care grants and fewer than 1 per cent receiving either old-age or disability grants. These wages supported on average 4.26 other household members, including children, as dependents (members of private sector unions supported more household members, an average of 4.39 dependents, whereas members of public sector unions supported an average of 4.05 dependents).
These figures illustrate the income diversity among members of trade unions historically affiliated to Cosatu. In an opinion piece in the Mail & Guardian, Loane Sharp (2014), an economist associated with the Free Market Foundation, argued that a ‘class war’ was behind the divisions in Cosatu that led to the expulsion of Numsa:
The middle class has fundamentally different values to the working class, including upward job mobility (as opposed to the working-class value of job security); home ownership; saving for retirement; independence from government financial assistance; and high-quality government services in policing, schooling and healthcare. The Numsa-Cosatu split, then, is much more complex than it at first appears. It is a battle for the heart of the ANC. It involves the long wave of South Africa's economic history. It sets the working class against the middle class in an epic battle of interests.
In this reading of the situation, Numsa members have a more radical working-class approach, whereas Cosatu, dominated by public sector unions, would have more conservative – or possibly liberal – values based on their interests rooted in the experience of class mobility.
There are clearly a number of limitations to this analysis which relates a complex set of issues to a distinction between a working class and a middle class. First, the alignment of the trade unions in the conflict contradicts the argument.
WORKERS, HOUSEHOLDS AND SOUTH AFRICA'S SOCIO-ECONOMIC ORDER
This chapter attempts to examine critically the view of Cosatu workers as a labour aristocracy or a ‘self-interested’ elite. It does so by examining wage data gathered from members of Cosatu affiliates in the fifth of a series of surveys of Cosatu membership which have been conducted since 1994, and it looks at the wage data through a number of other variables derived from questions in the 2014 survey of membership.
The notion of Cosatu members as a labour aristocracy can be related to the growing divisions in the labour market between permanent and temporary workers and high-income and low-income earners (see Forslund and Reddy 2015: 84–88). Our data suggests that Cosatu does not organise many temporary workers but it does organise workers who earn low wages. Importantly, those who support the labour aristocracy thesis often use labour market data as applied to individuals. In this chapter we take seriously the point that trade union members support dependents on their wages. Pnina Werbner's (2010) use of the notion of a ‘marginal labour elite’ provides a far more useful way of understanding Cosatu's membership. Werbner's ‘marginal labour elite’ locates trade union members outside of the workplace and in relation to their social reality by focusing specifically on their role in the household as a wage earner.
Twenty years into democracy, South African society is still marked by immense socio-economic problems such as chronic levels of unemployment and incessant levels of poverty and inequality. The number and intensity of strikes have increased in private and public sector workplaces. Globally, in the phase of informationtechnology- led capitalism, the number of workers employed as permanent workers is decreasing as the number employed as temporary, casual or part-time workers is increasing.
This trend is explained by Jan Theron's (2010) description of the interrelated processes of ‘informalisation from above’ and ‘informalisation from below’. Whereas ‘informalisation from below’ refers to those who engage in survivalist activities or self-employment, ‘informalisation from above’ is a response to employers’ efforts to restructure workplaces by externalising labour. This process fragments and differentiates the workforce by creating a layer of workers who, despite being located in the formal workplace, find themselves on the outside of labour legislation and collective bargaining because their employer, the service provider, determines their working conditions and is not legally bound to an employment relationship with the core business.