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To describe the genomic analysis and epidemiologic response related to a slow and prolonged methicillin-resistant Staphylococcus aureus (MRSA) outbreak.
Prospective observational study.
Neonatal intensive care unit (NICU).
We conducted an epidemiologic investigation of a NICU MRSA outbreak involving serial baby and staff screening to identify opportunities for decolonization. Whole-genome sequencing was performed on MRSA isolates.
A NICU with excellent hand hygiene compliance and longstanding minimal healthcare-associated infections experienced an MRSA outbreak involving 15 babies and 6 healthcare personnel (HCP). In total, 12 cases occurred slowly over a 1-year period (mean, 30.7 days apart) followed by 3 additional cases 7 months later. Multiple progressive infection prevention interventions were implemented, including contact precautions and cohorting of MRSA-positive babies, hand hygiene observers, enhanced environmental cleaning, screening of babies and staff, and decolonization of carriers. Only decolonization of HCP found to be persistent carriers of MRSA was successful in stopping transmission and ending the outbreak. Genomic analyses identified bidirectional transmission between babies and HCP during the outbreak.
In comparison to fast outbreaks, outbreaks that are “slow and sustained” may be more common to units with strong existing infection prevention practices such that a series of breaches have to align to result in a case. We identified a slow outbreak that persisted among staff and babies and was only stopped by identifying and decolonizing persistent MRSA carriage among staff. A repeated decolonization regimen was successful in allowing previously persistent carriers to safely continue work duties.
Child and adolescent mental health is understood to be highly embedded in the family system, particularly the parent-child relationship. Indeed, models of risk pathways to psychopathology emphasize interactions and transactions between the family environment and individual differences at the child level, including gene-environment interplay. Therapist knowledge regarding the role of the family in these pathways is central to the clinical competencies involved in the evidence-based treatment of children and adolescents. This chapter provides an overview of current theory regarding family contributions to the major forms psychopathology seen among children and adolescents. Attention is given to key family and parenting variables as they are conceptualized in the current literature, the mechanisms by which these variables contribute to the emergence and maintenance of psychopathology and the origins and determinants of parenting.
The training of mental health practitioners has seen a growing focus on core competencies in recent years in response to the need for guidance in the implementation of evidence-based treatment of mental disorders. This chapter outlines the aims and advantages of a competency-based approach and describes existing models of competencies in the treatment of adults, children and adolescents. For the most part, existing models have focused on cognitive behavioural therapy (CBT) to the exclusion of other evidence-based approaches and on individual therapy at the expense of treatment in which family members are actively involved. We present a novel model of the therapist competencies needed for the effective delivery of evidence-based family interventions for common child and adolescent mental health disorders. The proposed framework provides a potential foundation for curricula planning and assessment in practitioner training and stands to inform evidence-based practice guidelines and future research into professional development.
ABSTRACT IMPACT: The Independent Investigator Incubator program provides 1:1 mentoring from ‘super-mentors’ to enhance junior faculty careers in research. OBJECTIVES/GOALS: In 2014, the Indiana University School of Medicine (IUSM) in collaboration with the Indiana CTSI established the Independent Investigator Incubator (I3) Program. The I3 Program is designed to provide 1:1 mentoring for new research faculty during the crucial early years of their careers. Our goal is to provide an overview of the I3 design and 5-year data. METHODS/STUDY POPULATION: The I3 Program employs a resource-sharing, centralized design that provides concentrated 1:1 mentorship from a senior faculty ‘super mentor’ as well as other resources, such as grant writing support. Unlike many mentorship programs, I3 mentors closely interact with the mentees within the School and are compensated for their efforts (5% full-time equivalency per mentee, max of 15%). The number of ‘super mentors’ has grown from 6 to 15 faculty over 5 years, and mentors typically serve 4 to 5 mentees. Mentee applications are accepted on a rolling enrollment basis. The I3 mentees represent a diverse group based on sex, ethnicity, terminal degree, academic track, and discipline. Mentors and mentees have annual reviews through the program. RESULTS/ANTICIPATED RESULTS: In five years, 110 mentees have enrolled in the I3 program. Upon entering, 53% had no external funding, 28% had internal funding, 12% had K-awards, 7% had R03/R21 awards. Over the first five years, 75% have received extramural funding. The median funding was $340,000 with nearly a third of mentees securing grants > 1 million in direct costs. For mentees who joined the program in its first three years (n=59), the average time to a notable extramural grant (defined as a NIH or foundation grant >$300K direct costs) was 2.2 years (median - 2.6 years). Nearly all mentees were satisfied with their mentor pairing based on the mentor’s ‘availability’ and ‘valuable feedback,’ and all mentees wanted the mentoring relationship to continue DISCUSSION/SIGNIFICANCE OF FINDINGS: Since 2014, the I3 Program has had a positive impact on the careers of junior faculty at IUSM as determined by faculty satisfaction and funding metrics. Future focus areas will include developing criteria/models for graduating from the program to balance fiscal sustainability with mentee needs during their transition to mid-career.
The most effective treatments for child and adolescent psychopathology are often family-based, emphasising the active involvement of family members beyond the referred individual. This book details the clinical skills, knowledge, and attitudes that form the core competencies for the delivery of evidence-based family interventions for a range of mental health problems. Offering practical case studies to illustrate treatment principles, and discussing barriers to treatment and problem-solving in relation to common difficulties. Covers topics such as anxiety, attention-deficit hyperactivity disorder, sleep, and eating disorders. Therapist competencies are thoroughly examined, from the role they play in severe/complex cases and in achieving successful outcomes to commonly misunderstood aspects of family-based interventions and how they can be enhanced. Clinical approaches to working with diverse families, and those of children affected by parental psychopathology, child maltreatment and family violence are also explored. Essential reading for psychologists, psychiatrists, paediatricians, mental health nurses, counsellors and social workers.
Although early life adversity (ELA) increases risk for psychopathology, mechanisms linking ELA with the onset of psychopathology remain poorly understood. Conceptual models have argued that ELA accelerates development. It is unknown whether all forms of ELA are associated with accelerated development or whether early maturation is a potential mechanism linking ELA with psychopathology. We examine whether two distinct dimensions of ELA – threat and deprivation – have differential associations with pubertal timing in girls, and evaluate whether accelerated pubertal timing is a mechanism linking ELA with the onset of adolescent psychopathology.
Data were drawn from a large, nationally representative sample of 4937 adolescent girls. Multiple forms of ELA characterized by threat and deprivation were assessed along with age at menarche (AAM) and the onset of DSM-IV fear, distress, externalizing, and eating disorders.
Greater exposure to threat was associated with earlier AAM (B = −0.1, p = 0.001). Each 1-year increase in AAM was associated with reduced odds of fear, distress, and externalizing disorders post-menarche (ORs = 0.74–0.85). Earlier AAM significantly mediated the association between exposure to threat and post-menarche onset of distress (proportion mediated = 6.2%), fear (proportion mediated = 16.3%), and externalizing disorders (proportion mediated = 2.9%).
Accelerated pubertal development in girls may be one transdiagnostic pathway through which threat-related experiences confer risk for the adolescent onset of mental disorders. Early pubertal maturation is a marker that could be used in both medical and mental health settings to identify trauma-exposed youth that are at risk for developing a mental disorder during adolescence in order to better target early interventions.
This article aims to temper the fetishization of the events of 1989–1990. It explores how the historical framing of the Federal Republic transforms when 1989–1990 becomes peripheral, and argues that the force of 1989–1990 as a mythic ending relies on two interpretive paradigms: on a temporal sensibility based on a belief in the progressive development of politics and society, and on a conception of identity and difference understood in terms of a Cold War global order. The article highlights how these twentieth-century paradigms guided the historiography that made 1989–1990 the climax of the history of the Federal Republic. The precondition of any new master narrative for the Federal Republic is the recognition that these paradigms have lost their purchase. Viewed instead through the new temporal sensibility of presentism and the lateral power politics of globalization, 1989–1990 assumes a new position amid longer arcs of historical change that do not hinge on the fate of the Berlin Wall.
Dieser Aufsatz zielt darauf ab die Fetischisierung der Ereignisse von 1989–1990 abzuschwächen. In diesem Sinne wird untersucht, wie sich der historische Rahmen der Bundesrepublik verändert, wenn 1989–1990 an die Peripherie gerückt wird; dabei wird argumentiert, dass die Kraft von 1989–1990 als ein mythisches Ende auf zwei interpretativen Paradigmen beruht, nämlich zum ersten auf einer temporalen Sensibilität, die auf einem Glauben an eine fortschrittliche Entwicklung von Politik und Gesellschaft beruht, und zum zweiten auf einem Konzept von Identität und Unterschiedlichkeit, das auf der globalen Ordnung des Kalten Krieges fußt. Der Aufsatz hebt hervor, wie diese Paradigmen des 20. Jahrhunderts die Historiographie bestimmten, die 1989–1990 zum Höhepunkt der Geschichte der Bundesrepublik gestaltete. Die Vorbedingung eines jeden neuen Masternarrativs für die Bundesrepublik ist somit die Erkenntnis, dass diese Paradigmen ihre Kraft verloren haben. Wenn man 1989–1990 dagegen vom Blickwinkel der neuen temporalen Sensibilität des Presentismus und der lateralen Machtpolitik der Globalisierung betrachtet, nimmt es eine neue Position ein: eine Position inmitten längerer historischer Veränderungsprozessen, die nicht vom Schicksal der Berliner Mauer abhängen.
The Zika virus was largely unknown to many health care systems before the outbreak of 2015. The unique public health threat posed by the Zika virus and the evolving understanding of its pathology required continuous communication between a health care delivery system and a local public health department. By leveraging an existing relationship, NYC Health+Hospitals worked closely with New York City Department of Health and Mental Hygiene to ensure that Zika-related processes and procedures within NYC Health+Hospitals facilities aligned with the most current Zika virus guidance. Support given by the public health department included prenatal clinical and laboratory support and the sharing of data on NYC Health+Hospitals Zika virus screening and testing rates, thus enabling this health care delivery system to make informed decisions and practices. The close coordination, collaboration, and communication between the health care delivery system and the local public health department examined in this article demonstrate the importance of working together to combat a complex public health emergency and how this relationship can serve as a guide for other jurisdictions to optimize collaboration between external partners during major outbreaks, emerging threats, and disasters that affect public health. (Disaster Med Public Health Preparedness. 2018;12:689-691)
The central question posed by Schiemann and Ulrich (2017) focuses on what human resources (HR) leaders need to know or do to deliver business results in the new work environment. Although understanding the knowledge and capabilities that successful HR professionals need is critical, the focal article places an overemphasis on the characteristics of individual HR leaders alone, without fully exploring the environmental inhibitors of their strategic effectiveness. In this commentary, we argue that competencies and the environment must be given equal attention to maximize impact on business and talent outcomes. We first describe the strategic competency gap among HR professionals and discuss four key organizational barriers that impede the strategic impact of HR on the business. We then offer recommendations for how industrial–organizational (I-O) psychologists and HR leaders can help remove these barriers to maximize strategic effectiveness.