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The rocky shores of the north-east Atlantic have been long studied. Our focus is from Gibraltar to Norway plus the Azores and Iceland. Phylogeographic processes shape biogeographic patterns of biodiversity. Long-term and broadscale studies have shown the responses of biota to past climate fluctuations and more recent anthropogenic climate change. Inter- and intra-specific species interactions along sharp local environmental gradients shape distributions and community structure and hence ecosystem functioning. Shifts in domination by fucoids in shelter to barnacles/mussels in exposure are mediated by grazing by patellid limpets. Further south fucoids become increasingly rare, with species disappearing or restricted to estuarine refuges, caused by greater desiccation and grazing pressure. Mesoscale processes influence bottom-up nutrient forcing and larval supply, hence affecting species abundance and distribution, and can be proximate factors setting range edges (e.g., the English Channel, the Iberian Peninsula). Impacts of invasive non-native species are reviewed. Knowledge gaps such as the work on rockpools and host–parasite dynamics are also outlined.
Infants and young children are frequently colonized with C. difficile but rarely have symptomatic disease. However, C. difficile testing remains prevalent in this age group.
To design a computerized provider order entry (CPOE) alert to decrease testing for C. difficile in young children and infants.
An interventional age-targeted before-after trial with comparison group
Monroe Carell Jr. Children’s Hospital at Vanderbilt University, Nashville, Tennessee.
All children seen in the inpatient or emergency room settings from July 2012 through July 2013 (pre-CPOE alert) and September 2013 through September 2014 (post-CPOE alert)
In August of 2013, we implemented a CPOE alert advising against testing in infants and young children based on the American Academy of Pediatrics recommendations with an optional override. We further offered healthcare providers educational seminars regarding recommended C. difficile testing.
The average monthly testing rate significantly decreased after the CPOE alert for children 0–11 months old (11.5 pre-alert vs 0 post-alert per 10,000 patient days; P<.001) and 12–35 months old (61.6 pre-alert vs 30.1 post-alert per 10,000 patients days; P<.001), but not for those children ≥36 months old (50.9 pre-alert vs 46.4 post-alert per 10,000 patient days; P=.3) who were not targeted with a CPOE alert. There were no complications in those children who testing positive for C. difficile.
The average monthly testing rate for C. difficile for children <35 months old decreased without complication after the use of a CPOE alert in those who tested positive for C. difficile.
Healthcare-associated transmission of respiratory viruses is a concerning patient safety issue.
Surveillance for influenza virus among a cohort of healthcare workers (HCWs) was conducted in a tertiary care children's hospital from November 2009 through April 2010 using biweekly nasal swab specimen collection. If a subject reported respiratory symptoms, an additional specimen was collected. Specimens from ill HCWs and a randomly selected sample from asymptomatic subjects were tested for additional respiratory viruses by multiplex polymerase chain reaction (PCR).
A total of 1,404 nasal swab specimens were collected from 170 enrolled subjects. Influenza circulated at very low levels during the surveillance period, and 74.2% of subjects received influenza vaccination. Influenza virus was not detected in any specimen. Multiplex respiratory virus PCR analysis of all 119 specimens from symptomatic subjects and 200 specimens from asymptomatic subjects yielded a total of 42 positive specimens, including 7 (16.7%) in asymptomatic subjects. Viral shedding was associated with report of any symptom (odds ratio [OR], 13.06 [95% confidence interval, 5.45–31.28]; P< .0001) and younger age (OR, 0.96 [95% confidence interval, 0.92–0.99]; P = .023) when controlled for sex and occupation of physician or nurse. After the surveillance period, 46% of subjects reported working while ill with an influenza-like illness during the previous influenza season.
In this cohort, HCWs working while ill was common, as was viral shedding among those with symptoms. Asymptomatic viral shedding was infrequent but did occur. HCWs should refrain from patient care duties while ill, and staffing contingencies should accommodate them.
To define the utility of using routine diagnostic methods to detect influenza in older, hospitalized adults.
One academic hospital and 1 community hospital during the 2006–2007 and 2007–2008 influenza seasons.
Hospitalized adults 50 years of age or older.
Adults who were 50 years of age or older and hospitalized with symptoms of respiratory illness were enrolled and tested for influenza by use of reverse-transcriptase polymerase chain reaction (RT-PCR). Using RT-PCR as the gold standard, we assessed the performances of rapid antigen tests and conventional influenza culture and the diagnostic use of the clinical definition of influenza-like illness.
Influenza was detected by use of RT-PCR in 26 (11%) of 228 patients enrolled in our study. The sensitivity of the rapid antigen test performed at bedside by research staff members was 19.2% (95% confidence interval, 8.51%–37.9%); the sensitivity of conventional influenza culture was 34.6% (95% confidence interval, 19.4%–53.8%). The ability to detect influenza with both the rapid antigen test and culture was associated with patients with a higher viral load (P = .002 and P = .001, respectively). The ability to diagnose influenza by use of the clinical definition of influenza-like illness had a higher sensitivity (80.8%) but lacked specificity (40.6%).
Because rapid antigen testing and viral culture have poor sensitivity (19.2% and 34.6%, respectively), neither testing method is sufficient to use to determine what type of isolation procedures to implement in a hospital setting.
We examined interventions to optimize piperacillin-tazobactam use at 4 hospitals. Interventions for rotating house staff did not affect use. We could target empiric therapy in only 35% of cases. Because prescribing practices seemed to be institution specific, interventions should address attitudes of local prescribers. Interventions should target empiric therapy and ordering of appropriate cultures.
To determine knowledge and attitudes about pertussis and pertussis vaccination among healthcare workers (HCWs).
Self-administered, Web-based survey.
Tertiary-care academic medical center.
Medical center employees who participated in direct patient care were recruited to complete the survey through institutional e-mail.
Of 14,893 potentially eligible employees, 1,819 (12%) completed the survey. Most respondents (87%) did not plan to receive the pertussis vaccine. Intent to receive vaccination (which included recent history of vaccination) was associated with the following 4 factors: receipt of a physician recommendation for vaccination (odds ratio [OR], 9.01), awareness of Centers for Disease Control and Prevention recommendations for pertussis vaccination for HCWs (OR, 6.89), receipt of encouragement to be vaccinated from a coworker (OR, 4.72), the belief that HCWs may spread pertussis to patients and family (OR, 1.80). Two factors were negatively associated with intent to receive vaccination: the presence of children in the HCW's home (OR, 0.69) and employment as a nurse (OR, 0.59). Reasons cited by those who did not intend to receive vaccination included lack of a personal recommendation for vaccination (78%), receipt of vaccination as a child (51%), and perception that there was no significant risk for contracting pertussis (38%).
Of the HCWs surveyed, only 13% intended to receive the pertussis vaccine. A perceived lack of recommendation for vaccination and inaccurate conceptions about pertussis and pertussis vaccination were cited as reasons HCWs did not intend to be vaccinated. Institutional pertussis vaccination campaigns should focus on the risks of healthcare-associated pertussis and new recommendations for pertussis vaccination.