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We investigated intestinal trichomonads in western lowland gorillas, central chimpanzees and humans cohabiting the forest ecosystem of Dzanga-Sangha Protected Area in Central African Republic, using the internal transcribed spacer (ITS) region and SSU rRNA gene sequences. Trichomonads belonging to the genus Tetratrichomonas were detected in 23% of the faecal samples and in all host species. Different hosts were infected with different genotypes of Tetratrichomonas. In chimpanzees, we detected tetratrichomonads from ‘novel lineage 2’, which was previously reported mostly in captive and wild chimpanzees. In gorillas, we found two different genotypes of Tetratrichomonas. The ITS region sequences of the more frequent genotype were identical to the sequence found in a faecal sample of a wild western lowland gorilla from Cameroon. Sequences of the second genotype from gorillas were almost identical to sequences previously obtained from an anorexic French woman. We provide the first report of the presence of intestinal tetratrichomonads in asymptomatic, apparently healthy humans. Human tetratrichomonads belonged to the lineage 7, which was previously reported in domestic and wild pigs and a domestic horse. Our findings suggest that the ecology and spatial overlap among hominids in the tropical forest ecosystem has not resulted in exchange of intestinal trichomonads among these hosts.
Identifying routes of transmission among hospitalized patients during a healthcare-associated outbreak can be tedious, particularly among patients with complex hospital stays and multiple exposures. Data mining of the electronic health record (EHR) has the potential to rapidly identify common exposures among patients suspected of being part of an outbreak.
We retrospectively analyzed 9 hospital outbreaks that occurred during 2011–2016 and that had previously been characterized both according to transmission route and by molecular characterization of the bacterial isolates. We determined (1) the ability of data mining of the EHR to identify the correct route of transmission, (2) how early the correct route was identified during the timeline of the outbreak, and (3) how many cases in the outbreaks could have been prevented had the system been running in real time.
Correct routes were identified for all outbreaks at the second patient, except for one outbreak involving >1 transmission route that was detected at the eighth patient. Up to 40 or 34 infections (78% or 66% of possible preventable infections, respectively) could have been prevented if data mining had been implemented in real time, assuming the initiation of an effective intervention within 7 or 14 days of identification of the transmission route, respectively.
Data mining of the EHR was accurate for identifying routes of transmission among patients who were part of the outbreak. Prospective validation of this approach using routine whole-genome sequencing and data mining of the EHR for both outbreak detection and route attribution is ongoing.
This article reviews the history of defamation cases involving Africans in Southern Rhodesia. Two precedent-setting cases, one in 1938 and the other in 1946, provided a legal rationale for finding defamation that rested on the ability of litigants to prove they had been shamed. The testimony and evidence of these cases, both of which involved government employees, tracks how colonial rule was altering hierarchy and changing definitions of honor, often to the bewilderment of the litigants themselves. Importantly, both cases concluded that African employees of the state deserved special protection from defamation. The article then traces how the rules and ambiguities resulting from the legal logic of the 1938 and 1946 cases gave a wider group of litigants such as clerks, police, clergy, and teachers room to maneuver in the courtroom where they also claimed their professional honor. Such litigants perfectly understood the expectations of the court and performed accordingly by recounting embarrassing, even painful, experiences, all to validate their personal and professional honor in court. Such performances raise the question of how we might use court records to write a history of the emotional costs to people who used astute strategies that rested on dishonorable revelations to win their cases.
To determine risk factors for the development of surgical site infections (SSIs) in neurosurgery patients undergoing spinal fusion.
Retrospective case-control study.
Large, academic, quaternary care center.
The study population included all neurosurgery patients who underwent spinal fusion between August 1, 2009, and August 31, 2013. Cases were defined as patients in the study cohort who developed an SSI. Controls were patients in the study cohort who did not develop an SSI.
To achieve 80% power with an ability to detect an odds ratio (OR) of 2, we performed an unmatched case-control study with equal numbers of cases and controls.
During the study period, 5,473 spinal fusion procedures were performed by neurosurgeons in our hospital. With 161 SSIs recorded during the study period, the incidence of SSIs associated with these procedures was 2.94%. While anterior surgical approach was found to be a protective factor (OR, 0.20; 95% confidence interval [CI], 0.08–0.52), duration of procedure (OR, 1.58; 95% CI, 1.29–1.93), American Society of Anesthesiologists score of 3 or 4 (OR, 1.79; 95% CI, 1.00–3.18), and hospitalization within the prior 30 days (OR, 5.8; 95% CI, 1.37–24.57) were found in multivariate analysis to be independent predictors of SSI following spinal fusion. Prior methicillin-resistant Staphylococcus aureus (MRSA) nares colonization was highly associated with odds 20 times higher of SSI following spinal fusion (OR, 20.30; 95% CI, 4.64–8.78).
In additional to nonmodifiable risk factors, prior colonization with MRSA is a modifiable risk factor very strongly associated with development of SSI following spinal fusion.
Nasal swab culture is the standard method for identifying methicillin-resistant Staphylococcus aureus (MRSA) carriers. However, this method is known to miss a substantial portion of those carrying MRSA elsewhere. We hypothesized that the additional use of a sponge to collect skin culture samples would significantly improve the sensitivity of MRSA detection.
Hospitalized patients with recent MRSA infection were enrolled and underwent MRSA screening of the forehead, nostrils, pharynx, axilla, and groin with separate swabs and the forehead, axilla, and groin with separate sponges. Staphylococcal cassette chromosome mec (SCCmec) typing was conducted by polymerase chain reaction (PCR).
A total of 105 MRSA patients were included in the study.
At least 1 specimen from 56.2% of the patients grew MRSA. Among patients with at least 1 positive specimen, the detection sensitivities were 79.7% for the swabs and 64.4% for the sponges. Notably, 86.4% were detected by a combination of sponges and nasal swab, and 72.9% were detected by a combination of pharyngeal and nasal swabs, whereas only 50.9% were detected by nasal swab alone (P<0.0001 and P=0.0003, respectively). Most isolates had SCCmec type II (59.9%) and IV (35.7%). No correlation was observed between the SCCmec types and collection sites.
Screening using a sponge significantly improves MRSA detection when used in addition to screening with the standard nasal swab.
Bone is a complex tissue-organ system integrating multiple components in hierarchical layers of molecular cues, cellular communities, and networking highways. Bone moves through space and time in a dynamic manner modulated by homeostatic mechanisms nuanced through a coordinated intercalation of biological and biomechanical rhythms. The price we vertebrate species pay for maintaining this magnificently orchestrated tissue-organ is daunting.
Bone is the most metabolically expensive tissue in the human body. For every ounce of bone, a pound of soft tissue is required for maintenance . Moreover, the human skeletal system must be rugged in order to handle years of cyclic loading at high forces on the order of kilonewtons, and highly sensitive to the calibrated kinetics of calcium and phosphate release in order to maintain meticulously modulated ion levels . Consequently, the intrinsic design of bone and the dynamics that sustain it are an instructional core for regenerative bone therapeutics.
In this chapter we will introduce the profoundly compelling biodynamic structural marvel that gives shape to the amorphous mass in which it is wrapped and provides the fulcrums and pulleys that propel our anatomy along the avenues and boulevards of our towns. We will probe the blueprint of bone as a defining mold that guides and mentors attempts in the laboratory to design and develop compositions to repair and regenerate this structural tour de force.
Note from the Re: Sources Editor: This is my first contribution as editor of Re:Sources, and I'm proud to join the team of editors and authors who work diligently to put together each issue of this fine journal. I vow to try and maintain the standard of quality set by my immediate predecessor, Nena Couch—a daunting task, to be sure. I hope that you will find something of use within the pages of this column and that you will consider yourself an active participant in the shaping of its future. In the November 2006 issue (47.2) of Theatre Survey, which marked the fiftieth anniversary of the American Society for Theatre Research, editor Jody Enders invited readers to “ponder anew” what constitutes a resource and to submit “untraditional proposals” for the Re:Sources column. As she explained:
Perhaps it is a document or a series of documents available for the first time when an entire collection is declassified. It could be that odd scribble somewhere that proves that, once upon a time, there really was a performance of a play that everyone else had taken to be closet drama. Maybe it is a transcription or an English translation of a document hitherto unseen, difficult to access, almost impossible to read. (165)
Determining risk factors for acquisition of methicillin-resistant Staphylococcus aureus (MRSA) in hospitals is important for defining infection-control measures that may lead to fewer hospital-acquired infections.
To determine patient-associated risk factors for acquisition of MRSA in a tertiary care hospital with the goal of identifying modifiable risk factors.
A retrospective matched case-control study was performed. Case patients who acquired MRSA during hospitalization and 2 matched control patients were selected among inpatients admitted to target units during the period from 2001 through 2008. The odds of exposure to potential risk factors were compared between case patients and control patients, using matched univariate conditional logistic regression. A single multivariate conditional logistic regression model identifying independent patient-specific risk factors was generated.
A total of 451 case patients and 866 control patients were analyzed. Factors positively associated with MRSA acquisition were as follows: target unit stay before index culture; primary diagnosis of respiratory disease, digestive tract disease, injury or trauma, or other diagnosis compared with cardiocirculatory disease; peripheral vascular disease; mechanical ventilation with pneumonia; ventricular shunting or ventriculostomy; and ciprofloxacin use. Factors associated with decreased risk were receipt of a solid-organ transplant and use of penicillins, cephalosporins, rifamycins, daptomycin or linezolid, and proton pump inhibitors.
Among the factors associated with increased risk, few are modifiable. Patients with at-risk conditions could be targeted for intensive surveillance to detect acquisition sooner. The association of MRSA acquisition with target unit exposure argues for rigorous application of hand hygiene, appropriate barriers, environmental control, and strict aseptic technique for all procedures performed on such Patients. Our findings support focusing efforts to prevent MRSA transmission and restriction of ciprofloxacin use.
This article focuses on a single episode of racial interaction in 1931 in order to highlight competing notions of honor and respectability in a shared colonial society. This story elucidates how Africans and whites unraveled and rebuilt ‘racial etiquette’, the tacit code that guided individual encounters between blacks and whites and that were so vital to the expression of colonial power. In moments of transition, such as the early 1930s in Southern Rhodesia, the minutiae of racial etiquette were confusing, and this allowed for some dialogue between Africans and whites about what constituted proper behavior. As this story makes clear, Africans were as much a part of composing racial etiquette as whites, despite – indeed, because of – the latter's political power.
The rate of influenza vaccination among healthcare workers (HCWs) is approximately 40%. Differences in vaccination rates among HCW groups and reasons for accepting or rejecting vaccination are poorly understood.
To determine vaccination rates and motivators among different HCW groups during the 2004-2005 influenza season.
Cross-sectional survey conducted between July 10 and September 30, 2005.
Two tertiary care teaching hospitals in an urban center.
Physicians, nurses, nursing aides, and other staff. Surveys were collected from 1,042 HCWs (response rate, 42%).
Sixty-nine percent of physicians (n = 282) and 63% of medical students (n = 145) were vaccinated, compared with 46% of nurses (n = 336), 42% of nursing aides (n = 135), and 29% of administrative personnel (n = 144). Physicians and medical students were significantly more likely to be vaccinated than all other groups (P < .0001). Pediatricians (84%) were more likely than internists (69%) and surgeons (43%) to be vaccinated (P < .0001). Among the HCWs who were vaccinated, 33.4% received the live attenuated influenza vaccine (LAIV) and 66.6% received trivalent inactivated influenza vaccine (TIV). Vaccinated HCWs were less likely than unvaccinated HCWs to report an influenza-like illness (P = .03). Vaccination with LAIV resulted in fewer episodes of influenza-like illness than did receiving no vaccine (P = .03). The most common reason for rejecting vaccination was a concern about availability. Understanding that HCWs may transmit the virus to patients correlated with vaccine acceptance (P = .0004).
Significant differences in vaccination exist among physician specialties and employee groups, and there are inadequate vaccination rates among those with the greatest amount of patient contact, potentially providing a basis for group-specific interventions.
The syllabus for the Primary FRCA examination is broad, covering basic anaesthesia and associated skills together with an in depth knowledge of the principles of basic science which underlie clinical practice. Added to this, is the requirement to pass the examination at an early stage of the trainee's career. Often, it is an inadequate understanding or wariness of concepts which involve physics or simple mathematics that is the impediment to success in the examination.
The author has written a book which explains the principles of physics, mathematics and statistics and applies many of them to an understanding of anaesthetic apparatus, clinical measurement, cardiovascular and respiratory physiology, and general pharmacology. Each concept is supported by a graph or diagram which is explained in the text. A graphical display of data or a good diagram is often the key to interpretation and conveying a thorough understanding of subject matter to an examiner. This approach applies equally when responding to a question in an oral examination or when supplementing a written answer.
This book is undoubtedly aimed at the candidate sitting the Primary examination, however, the Final FRCA candidate should not forget that the theme of questioning in the second oral examination is basic science applied to anaesthesia, intensive care and pain management. This book should not be regarded as a substitute for the standard textbooks but will be invaluable as a supplement and also for revision.
Fluoroquinolones have not been frequently implicated as a cause of Clostridium difficile outbreaks. Nosocomial C. difficile infections increased from 2.7 to 6.8 cases per 1,000 discharges (P < .001). During the first 2 years of the outbreak, there were 253 nosocomial C. difficile infections; of these, 26 resulted in colectomy and 18 resulted in death. We conducted an investigation of a large C. difficile outbreak in our hospital to identify risk factors and characterize the outbreak.
A retrospective case-control study of case-patients with C. difficile infection from January 2000 through April 2001 and control-patients matched by date of hospital admission, type of medical service, and length of stay; an analysis of inpatient antibiotic use; and antibiotic susceptibility testing and molecular subtyping of isolates were performed.
On logistic regression analysis, clindamycin (odds ratio [OR], 4.8; 95% confidence interval [CI95], 1.9-12.0), ceftriaxone (OR, 5.4; CI95, 1.8-15.8), and levofloxacin (OR, 2.0; CI95, 1.2-3.3) were independently associated with infection. The etiologic fractions for these three agents were 10.0%, 6.7%, and 30.8%, respectively. Fluoroquinolone use increased before the onset of the outbreak (P < .001); 59% of case-patients and 41% of control-patients had received this antibiotic class. The outbreak was polyclonal, although 52% of isolates belonged to two highly related molecular subtypes.
Exposure to levofloxacin was an independent risk factor for C. difficile-associated diarrhea and appeared to contribute substantially to the outbreak. Restricted use of levofloxacin and the other implicated antibiotics may be required to control the outbreak.
Populations of Egyptian spiny mice (Acomys cahirinus dimidiatus) in a fragmented montane wadi system in the Sinai showed significant differences in the abundance of gut helminths. Differences in parasite load between populations were positively associated with measures of androgen activity but showed no significant relationship with glucocorticoid activity. Social discrimination tests with adult males from different wadis showed that those from sites with greater helminth abundance were less likely to investigate odours from other males and were less aggressive when subsequently interacting with the odour donors. Subjects showed markedly more investigation towards the odours of males from distant wadis compared with those from their own or immediately neighbouring wadi, but were less aggressive when confronted with odour donors from distant wadis. Despite this, there was a positive relationship between the amount of investigation towards distant male odour and subsequent aggression towards the male. While aggressiveness was positively associated with measures of androgen and glucocorticoid activity, no significant relationship emerged with individual helminth infection. Thus aggressiveness appeared to relate to overall local population levels of infection rather than individual challenge.
This article considers the different ways that Marirangwe purchase area farmers understood and used their farmland, resources and opportunities. In the pioneer period from 1931 to the 1940s, Marirangwe farmers favored extensive use of their land and its resources. However, as labor and capital opportunities changed, land became for some an expendable commodity. By the 1950s, the farmers' ability to generate capital through land sales paralleled the arrival of squatters in the area. With the help of these squatters and revenue from land sales, Marirangwe farmers prospered. This development, however, did not signal a change from the extensive farming habits of the pioneer period but rather a brief, and generally prosperous, period of specialization.
This paper examines the 1938 cattle culling and sales in Gutu and Victoria reserves, colonial Zimbabwe. What began as a routine culling very quickly became a crisis of authority for the Native Affairs Department since critics of the Department forced an inquiry into the sales. The criticism and defence of the culling facilitated a debate on state and personal justice, as well as a dialogue about the proper behaviour towards Africans, settlers and animals. The critics of the cullings as well as the colonial officers all believed themselves to be experts in African affairs. Thus what began as a criticism of cattle culling revealed tensions within white society, and in particular the need to refashion boundaries of expertise and authority within the Native Affairs Department. A close examination of the scope and development of the ensuing commission of inquiry reveals the importance of etiquette to the colonial enterprise in colonial Zimbabwe.