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To identify risk factors associated with methicillin-resistant Staphylococcus aureus (MRSA) acquisition in long-term care facility (LTCF) residents.
Multicenter, prospective cohort followed over 6 months.
Three Veterans Affairs (VA) LTCFs.
All current and new residents except those with short stay (<2 weeks).
MRSA carriage was assessed by serial nares cultures and classified into 3 groups: persistent (all cultures positive), intermittent (at least 1 but not all cultures positive), and noncarrier (no cultures positive). MRSA acquisition was defined by an initial negative culture followed by more than 2 positive cultures with no subsequent negative cultures. Epidemiologic data were collected to identify risk factors, and MRSA isolates were typed by pulsed-field gel electrophoresis (PFGE).
Among 412 residents at 3 LTCFs, overall MRSA prevalence was 58%, with similar distributions of carriage at all 3 facilities: 20% persistent, 39% intermittent, 41% noncarriers. Of 254 residents with an initial negative swab, 25 (10%) acquired MRSA over the 6 months; rates were similar at all 3 LTCFs, with no clusters evident. Multivariable analysis demonstrated that receipt of systemic antimicrobials during the study was the only significant risk factor for MRSA acquisition (odds ratio, 7.8 [95% confidence interval, 2.1–28.6]; P = .002). MRSA strains from acquisitions were related by PFGE to those from a roommate in 9/25 (36%) cases; 6 of these 9 roommate sources were persistent carriers.
MRSA colonization prevalence was high at 3 separate VA LTCFs. MRSA acquisition was strongly associated with antimicrobial exposure. Roommate sources were often persistent carriers, but transmission from roommates accounted for only approximately one-third of MRSA acquisitions.
Decolonisation in sub-Saharan Africa began in January 1956 when the Sudan joined long-independent Ethiopia and Liberia as a new, post-colonial state. Although the process is not yet complete because of the disputed status of Namibia and South Africa's continued rule by a white minority, over the past 30 years as many as 43 new states have achieved independence from colonial rule, the most recent being Zimbabwe in April 1980.
Comparative political analysts seek empirical generalizations which will hold water across systems and over a period of time. Yet, modeling important political phenomena over more than a handful of countries is still rather unusual. One focus for substantial comparative research has been the coup d'état—an irregular change of governmental leadership by force—in African countries. Scholars who have engaged in this research find they have various conceptual and methodological differences of opinion. In this Controversy, Robert Jackman and Rosemary O'Kane raise the issues in dispute. Their contentions are answered by Thomas Johnson, Pat McGowan, and Robert Slater. The exchange highlights important research issues without necessarily resolving them.
The August 1983 overthrow of Major Jean-Baptiste Ouedraogo by Captain Thomas Sankara in Upper Volta (now Burkina Faso), the New Year's Eve abrupt termination in Nigeria of Black Africa's largest multi-party democracy, and the decision by the Guinean army in April 1984 to remove their party leaders after the death of President Sékou Touré, illustrate two of the most salient realities of contemporary African politics: (1) military coups d'état are the principal form of régime change, and (2) they can happen under any type of political system–a functioning democracy, a personalistic civilian dictatorship, or an already existing military junta.1
The purpose of this article is to contribute to the theoretical understanding of African military coups d'etat. We begin by replicating a well-known model (Jackman, 1978) that purports to identify the structural determinants of coups d'etat within the states of Sub-Saharan Black Africa. When the research problem is changed slightly to focus exclusively on military coups, we find major weaknesses in the original Jackman model. We then extend and refine this model and thereby account in a theoretically meaningful fashion for 91% of the variation in military coups within 35 Black African states from 1960 through 1982. Our major substantive findings indicate that Black African states with relatively dynamic economies whose societies were not very socially mobilized before independence and which have maintained or restored some degree of political participation and political pluralism have experienced fewer military coups, attempted coups, and coup plots than have states with the opposite set of characteristics.