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Determining infectious cross-transmission events in healthcare settings involves manual surveillance of case clusters by infection control personnel, followed by strain typing of clinical/environmental isolates suspected in said clusters. Recent advances in genomic sequencing and cloud computing now allow for the rapid molecular typing of infecting isolates.
To facilitate rapid recognition of transmission clusters, we aimed to assess infection control surveillance using whole-genome sequencing (WGS) of microbial pathogens to identify cross-transmission events for epidemiologic review.
Clinical isolates of Staphylococcus aureus, Enterococcus faecium, Pseudomonas aeruginosa, and Klebsiella pneumoniae were obtained prospectively at an academic medical center, from September 1, 2016, to September 30, 2017. Isolate genomes were sequenced, followed by single-nucleotide variant analysis; a cloud-computing platform was used for whole-genome sequence analysis and cluster identification.
Most strains of the 4 studied pathogens were unrelated, and 34 potential transmission clusters were present. The characteristics of the potential clusters were complex and likely not identifiable by traditional surveillance alone. Notably, only 1 cluster had been suspected by routine manual surveillance.
Our work supports the assertion that integration of genomic and clinical epidemiologic data can augment infection control surveillance for both the identification of cross-transmission events and the inclusion of missed and exclusion of misidentified outbreaks (ie, false alarms). The integration of clinical data is essential to prioritize suspect clusters for investigation, and for existing infections, a timely review of both the clinical and WGS results can hold promise to reduce HAIs. A richer understanding of cross-transmission events within healthcare settings will require the expansion of current surveillance approaches.
Cognitive behavioural therapy (CBT) for major depression is an effective treatment, but outcomes for complex cases, with co-occurring biological, psychological and social factors, are variable. Complexity factors can cause treatment to become diffuse, disorganized and over-complicated. At Step 3, disorder-specific protocols should be provided with therapy kept as simple as possible and delivered responsively, e.g. barriers to treatment should be tackled, ensure the client is well-prepared and seek to form a strong therapeutic alliance. At Step 4, if disorder-specific protocols have been ineffective, the priority is to formulate how complexity factors are interacting with the client's depression. An individualized formulation is used to carefully target these interactions. The treatment is still evidence-based and simple at the point of delivery, but there is greater emphasis on case-level interactions that are unique to each individual. Case examples are used to illustrate both approaches.
As therapists we frequently use and hear the term ‘complexity’ in relation to clients, situations and settings. Although we may assume there is a shared understanding of what is meant by complexity, is this true? Do we really know what we mean by describing someone, or something, as complex? If we define complexity as ‘consisting of many different and connected parts, not easy to analyse or understand’ (Oxford English Dictionary, 2017), then we are probably describing intersections and interactions between different elements that can influence each other. Interestingly, the origin of the term derives from the Latin past participle plexus, meaning braided or entwined, which captures neatly the sense of the term ‘complex’ as meaning literally braided together. The breadth of this definition therefore may help to account for the diversity of the ways in which the term complexity is used in clinical settings. Continuing with the idea of the plait or braid, it also gives a sense of the number of threads or strands that could be incorporated within such a system. Complexity can derive from any source, and can interact with any part, so it can derive from the patient, the therapist, the therapeutic relationship or the healthcare setting; and each of these may interact with one or more parts. So from any source, complexity can affect processes and outcomes of care.
This essay is a social-scientific study of Paul's deployment of holiness language in 1 Corinthians. Specifically, an interpretation of holiness is offered to explain Paul's argument in 1 Cor 7.12–16 in favour of non-separation in the case of a believer married to a non-believer. For Paul, holiness involves participation in the oneness of God interpreted christologically. This participation is embodied in the holiness-as-oneness of the church. In relations between believers and unbelievers, purity rules to do with sex and marriage carry a significant symbolic burden. In some cases, clear lines of demarcation are drawn. Other cases constitute grey areas; and the suggestion here is that ‘mixed marriages’ are one such. For Paul, holiness is a matter of neither genealogical nor cultic purity. Rather, it has a boundary-transcending quality. In the case of a mixed marriage, the unbelieving partner, together with the children, is sanctified by remaining in oneness with the believing partner. Paul's concern for the oneness of the church spills over into a concern for the oneness of the household.
J. Stitt Wilson, mayor of Berkeley from 1911 to 1913, supported women's suffrage because he believed it would lead to a revaluation of the feminine and maternal values of cooperation and care and, along with the labor movement, provide the basis for creation of a socialist society that would embody the true values of Christianity. A rare example of a male activist and intellectual for whom women's equality was fundamental to his beliefs rather than auxiliary to them, Wilson drew his views from a mixture of Social Gospel; the labor movement; feminism; and socialism, particularly the maternalist socialism developed in parts of the Woman's Christian Temperance Union and the settlement house movement. Perhaps his most intellectually creative moment came when he applied Henry George's analysis of urban land values to a socialist and feminist vision of the city as a “social mother.” His election and work as mayor illustrate the overlap between the urban socialist and progressive social reform programs, while his failure to win any further elections reflects the divisions between them over the nature of capitalism.
The paper describes the initial results from renewed investigations at Niah Cave in Sarawak on the island of Borneo, famous for the discovery in 1958 of the c. 40,000–year old ‘Deep Skull’. The archaeological sequences from the West Mouth and the other entrances of the cave complex investigated by Tom and Barbara Harrisson and other researchers have potential implications for three major debates regarding the prehistory of south-east Asia: the timing of initial settlement by anatomically modern humans; the means by which they subsisted in the late Pleistocene and early Holocene; and the timing, nature, and causation of the transition from foraging to farming. The new project is informing on all three debates. The critical importance of the Niah stratigraphies was commonly identified – including by Tom Harrisson himself – as because the site provided a continuous sequence of occupation over the past 40,000 years. The present project indicates that Niah was first used at least 45,000 years ago, and probably earlier; that the subsequent Pleistocene and Holocene occupations were highly variable in intensity and character; and that in some periods, perhaps of significant duration, the caves may have been more or less abandoned. The cultural sequence that is emerging from the new investigations may be more typical of cave use in tropical rainforests in south-east Asia than the Harrisson model.
Physician trainees were surveyed to assess intention to perform hand hygiene (HH). Compared with preclinical medical students (MS), clinical MS and residents reported less confidence that HH prevents carrying home microorganisms (P = .006, P = .003) or protects oneself from antibiotic-resistant microorganisms (P = .01, P = .006). Clinical trainees may need targeted interventions focusing on intention to perform HH.
Anti-Wolbachia therapy delivers safe macrofilaricidal activity with superior therapeutic outcomes compared to all standard anti-filarial treatments, with the added benefit of substantial improvements in clinical pathology. These outcomes can be achieved, in principle, with existing registered drugs, e.g. doxycycline, that are affordable, available to endemic communities and have well known, albeit population-limiting, safety profiles. The key barriers to using doxycycline as an mass drug administration (MDA) strategy for widespread community-based control are the logistics of a relatively lengthy course of treatment (4–6 weeks) and contraindications in children under eight years and pregnancy. Therefore, the primary goal of the anti-Wolbachia (A·WOL) consortium is to find drugs and regimens that reduce the period of treatment from weeks to days (7 days or less), and to find drugs which would be safe in excluded target populations (pregnancy and children). A secondary goal is to refine regimens of existing antibiotics suitable for a more restricted use, prior to the availability of a regimen that is compatible with MDA usage. For example, for use in the event of the emergence of drug-resistance, in individuals with high loiasis co-infection and at risk of severe adverse events (SAE) to ivermectin, or in post-MDA ‘endgame scenarios’, where test and treat strategies become more cost effective and deliverable.
Significant new opportunities for astrophysics and cosmology have been identified at low radio frequencies. The Murchison Widefield Array is the first telescope in the southern hemisphere designed specifically to explore the low-frequency astronomical sky between 80 and 300 MHz with arcminute angular resolution and high survey efficiency. The telescope will enable new advances along four key science themes, including searching for redshifted 21-cm emission from the EoR in the early Universe; Galactic and extragalactic all-sky southern hemisphere surveys; time-domain astrophysics; and solar, heliospheric, and ionospheric science and space weather. The Murchison Widefield Array is located in Western Australia at the site of the planned Square Kilometre Array (SKA) low-band telescope and is the only low-frequency SKA precursor facility. In this paper, we review the performance properties of the Murchison Widefield Array and describe its primary scientific objectives.
The moral teaching of the New Testament epistles may be summed up as a radical reinterpretation of the scriptures and the story of Israel in the light of the life, death and resurrection of Jesus of Nazareth. This teaching took shape to serve the needs of groups of believers in the fi rst century seeking to live out their Christian discipleship in the towns and cities of the Roman empire, from Palestine and Syria in the east to Rome in the west. Taken together, it is a body of practical wisdom on how to live in holiness as the people of God in the time between the resurrection and parousia of Christ. This practical wisdom covers matters like Jew–Gentile relations, idolatry, eating and fasting, sex and marriage, household order, work, and obligations to those in authority. It is indebted to the moral traditions of Israel on the one hand and of Greece and Rome on the other, 1 all refracted through the lens of the story of Jesus and the experience of the Holy Spirit in daily life and in gatherings for worship.
Against this background, it is not possible to talk about ‘ethics’ in the normal sense of the word. The New Testament does not present abstract reflection of a philosophical kind on the nature and grounds of moral action. It is not a compendium of systematic reflection on the good. Rather, it represents a variety of attempts to articulate the implications of conversion and baptism.
This paper describes a cognitive model for first/second onset depression that has been precipitated by major life stress, entrenched for several months and is unresponsive to pharmacotherapy. These conditions create high risks for recurrent/chronic depression and early intervention is proposed to identify, treat and protect against relapse/recurrence. Severe life stress interacts with an individual's core self-representations and personal values, identity is disrupted and depression is maintained by dysfunctional goal engagement and disengagement. Treatment aims to restore functional self-regulation by increasing self-diversification and creating balanced goal investments. Outcome and follow-up data are reported in a case series of five consecutive patients. There was good therapist adherence to the prescribed targets and pre-post effect sizes were comparable or larger than published outcome studies. At the 12 month follow-up, three of the four treatment completers (75%) had made reliable and clinically significant changes and were in full remission. This provides encouraging preliminary evidence for the model's validity and the therapy's efficacy.
The four gospels are a central part of the Christian canon of scripture. In the faith of Christians, this canon constitutes a life-giving witness to who God is and what it means to be truly human. This volume treats the gospels not just as historical sources, but also as crucial testimony to the life of God made known in Jesus Christ. This approach helps to overcome the sometimes damaging split between critical gospel study and questions of theology, ethics and the life of faith. The essays are by acknowledged experts in a range of theological disciplines. The first section considers what are appropriate ways of reading the gospels given the kinds of texts they are. The second, central section covers the contents of the gospels. The third section looks at the impact of the gospels in church and society across history and up to the present day.
There can be no doubt that the four gospels of the Christian Bible are of fundamental significance for Christian life and thought. The gospel stories about Jesus' birth, life, death and resurrection, about his teaching, miracle working and care for the poor, are read and recounted in churches throughout the world every Sunday. They shape Christian worship and sacramental practice, inspire Christian art, architecture and aesthetics, and inform Christian morality at both the individual and social levels. It could even be said that Christian life in all its aspects is an ongoing 'performance' of the gospels. And, of course, to the extent that the Christian community is a part of the wider human community, the performance of the gospels contributes to the shaping of the moral, spiritual and aesthetic traditions of people worldwide whether Christian or not. It is fitting, therefore, that the Cambridge Companion series should include a Companion to the Gospels. Of course, there are many fine introductions to the gospels, the New Testament, and the Bible as a whole, already available. Most of these are written with a view to explaining the meaning and significance of the texts by means of the best tools of historical understanding currently available. They address, for example, questions about authorship and dating, about the historical context of the work, its author and audience, about the formation and transmission of the text in its various versions, and, more recently, questions about the history of the reception of the text.
Written later than the Gospel of Mark (on which it almost certainly draws), in all likelihood at some time towards the end of the period 70-100-ce, the Gospel of Matthew came to be given priority of place among the four canonical gospels and therefore, subsequently, priority of place as the first book of the New Testament. From a theological point of view, this way of ordering the canon is suggestive. It conveys the conviction, held from early on, that Matthew's presentation of Jesus as the fulfilment of scripture and the hope of humankind is true and authoritative. Beginning as it does with a genealogy which displays Jesus' messianic identity as 'the son of David, the son of Abraham' (1.1), Matthew's gospel picks up, as it were, where Malachi, the last book of the Old Testament in its Septuagintal form, leaves off. Malachi ends with the prophecy of the return of the prophet Elijah 'before the great and terrible day of the Lord comes' (Mal 4.5). In Matthew, the end-time Elijah duly appears in the person of John the Baptist, preparing the way for 'the Lord', one whose identity is revealed at his baptism as Jesus, God's 'beloved Son' (3.17). The Gospel of Matthew, in other words, is a fulcrum between the Testaments in a traditional Christian reading. It expresses the fulfilment of the Old Testament (or 'covenant') and the beginning of the New.