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Background: Carbapenem-resistant Enterobacteriaceae (CRE) represent a significant antibiotic resistance threat, in part because carbapenemase genes can spread on mobile genetic elements. Here, we describe the molecular epidemiology and outcomes of patients with CRE bacteriuria from the same city in a nonoutbreak setting. Methods: The Georgia Emerging Infections Program performs active, population-based CRE surveillance in Atlanta. We studied a cohort of patients with CRE (resistant to all tested third-generation cephalosporins and ≥1 carbapenem, excluding ertapenem) first identified in urine, and not in a prior or simultaneous sterile site, between 2012 and 2015. Whole-genome sequencing (WGS) was performed on a convenience sample. We obtained epidemiologic and outcome data through chart review and Georgia Vital Statistics records (90-day mortality). Using WGS, we created a core-genome alignment-based phylogenetic tree of the Klebsiella pneumoniae isolates and calculated the SNP difference between each sample. Using SAS version 9.4 software, we performed the Fisher exact test and univariable odds ratios (OR) with 95% CI to compare patient isolates with and without a carbapenemase gene. Results: Among 81 patients included, the median age was 68 (IQR, 57–74) years, and most were female (58%), black (60%), and resided in a long-term care facility 4 days prior to culture isolation (53%). Organisms isolated were K. pneumoniae (84%), Escherichia coli (7%), Enterobacter cloacae (7%), and Klebsiella oxytoca (1%). WGS identified at least 1 β-lactamase gene in 91% of the isolates; 85% contained a carbapenemase gene, the most frequent of which was blaKPC-3 (94%). Patients with CRE containing a carbapenemase gene were more likely to be black (OR, 3.7; 95% CI, 1.0–13.8) and to have K. pneumoniae (OR, 8.9; 95% CI, 2.2–35.0). Using a core-genome alignment of 3,708 genes (~63% of the complete genome), we identified a median of 67 (IQR, 23–3,881) SNP differences between each K. pneumoniae isolate. A phylogenetic tree identified clustering around carbapenemase gene and multilocus sequence type (84% were ST 258) but not based on referring laboratory or county of residence (Fig. 1). Although 7% of patients developed an invasive CRE infection within 1 year and 21% died within 90 days, having a carbapenemase gene was not associated with these outcomes. Conclusions: Molecular sequencing of a convenience sample of CRE bacteriuria support K. pneumoniae ST258 harboring blaKPC-3 being distributed throughout the Atlanta area, across the healthcare continuum. Overall mortality was high in this population, but the presence of carbapenemase genes was not associated with worse outcomes.
The present research describes the preliminary evaluation of Mindfields, a self-regulatory intervention designed to enhance the development of life skills and self-set goals among school-aged adolescent offenders. Differences between intervention and control participants pre- and post-treatment were assessed using the Mindfields Assessment Battery (MAB). Twenty-four adolescents from a youth correctional facility, youth justice service centres, and alternative education schools (Mage = 14.79, SD = 1.47) were assigned to either an intervention group (n = 18) or a wait-list control group (n = 6). At pre-intervention, there were no significant differences between intervention and control participants. Post-intervention analysis between the two groups revealed that intervention participants reported significant reductions in self-reported delinquency and impulsivity compared to the control group. Moreover, while the pre- to post- intervention scores for the control participants remained relatively stable, the pre- to post-scores for intervention participants indicated significant reductions for pro-delinquency and improvements in self-satisfaction. Preliminary findings are promising and provide evidence for the effectiveness of this new self-regulatory intervention for school-aged adolescents.
Readiness for change (or treatment readiness) is a core concept of many rehabilitation programs for adult and juvenile offenders. The present study examined the experiences of six young people aged 13 to 17 years who participated in Mindfields®, a 6-week self-regulatory intervention aimed at enhancing life skills and goal setting among youths who present with challenging and/or risky behaviour. This article investigates the extent to which: readiness for change influences individual responses to the Mindfields® program; external factors influence the achievement and maintenance of program success; and goal achievement leads to perceptions of self-efficacy and personal control over one's behaviour. Prior to, and on completion of the intervention, participants completed the Mindfields® Assessment Battery that measures goal commitment, social competence, self-regulation, life satisfaction, delinquent involvement, and readiness for change. Findings show the importance of participants’ motivation to make life-changing decisions, but this motivation and promising goals can be compromised by factors external to the individual. Our findings prompt future research into ways in which young people can maintain their motivation and readiness for change, and draw encouragement from less successful outcomes than might have been expected.
This research investigated the reliability and validity of the Mindfields Assessment Battery (MAB), measuring three components of self-regulation (forethought, performance control, self-reflection) of young offenders. Participants were 57 12- to 18-year-olds from youth justice service centres, alternative education schools, and a youth correctional facility (Nmales = 46; NIndigenous = 7). Psychometric properties of the battery were sound with adequate alpha levels for the scales. The factor structure and internal reliability of three measures were replicated and validated. Positive significant correlations found between these subscales indicated consistent relationships with young people's responses to challenging situations. Prodelinquency scores were significantly positively correlated with minor misdemeanours and negatively correlated with social competency. Significant positive correlations were found between social competence and goal commitment, and self-regulation and life satisfaction. The battery provides a reliable, valid way of assessing forethought, performance control, self-reflection, and treatment amenability within the conceptual framework of self-regulation.
Forensic determination of sexual harassment entails a contextual understanding of the scope of sexual harassment and a determination of whether events have occurred that fall within a particular legal or institution’s definition of sexual harassment. Hence, a proper determination of whether or not sexual harassment took place is crucial. In all forensic determinations of culpability, the investigator hopes to achieve a result from the investigation that accurately portrays reality. However, all forensic determinations have an error rate associated with them. The error rate has two parts: false positives and false negatives. Reducing false positive and false negative errors in sexual harassment investigations centres on conducting a sound sexual harassment investigation. A sound sexual harassment investigation will collect all relevant evidence, synthesize all collected evidence, attempt to come to a conclusion based on the evidence, and make appropriate recommendations for repairing damage to individuals and the organization.
There is currently no generally accepted formula for the optimal timing of health technology assessments (HTAs). This paper presents some of the relevant issues and then reviews the existing literature on timing of HTAs. It finds that the literature that specifically addresses these issues is limited. There is a consensus that HTAs should be initiated at an early stage of the development of a new health technology, and repeated during the life cycle of the technology. However, the questions of reliably identifying new technologies at an early stage in their development and of deciding on a detectable critical point for starting evaluation are not resolved. It is proposed that a system of categorization and prioritization of health technologies should be developed to allow decisions to be made as to when a strongly precautionary approach is required and how the limited resources available for HTA could be optimally deployed.
During development of the central nervous system (CNS) both
deafferentation and axotomy induce
increased neuronal death and result in a smaller brain with diminished
function at maturity. Unilateral
cerebellar pedunculotomy has been used as a model to study the relative
importance of these 2 types of
lesion on the survival of developing CNS neurons. Within the cerebellum,
unilateral pedunculotomy causes
deafferentation of the hemicerebellum and axotomy in the efferent pathway
the ipsilateral deep
cerebellar nuclei. This results in a smaller hemicerebellum with normal
cortical laminae but no
extracerebellar outflow. In order to identify the sequence of events which
leads to this altered structure and
therefore to understand the relative importance of afferent versus target-derived
trophic support, unilateral
cerebellar pedunculotomy was performed on neonatal rat pups, aged between
and 3 days. The cerebella
were analysed for histological and vascular changes after survival times
0, 3, 6, 9, 12, 18, 21, 24 and 48 h.
The results show that the effects of axotomy on the deep cerebellar nuclear
neurons begin within 3 h of the
lesion and apoptotic neuronal degeneration occurs within 48 h. However,
cerebellar cortical neurons
continue to undergo normal histological development for at least 48 h
after deafferentation. In addition,
since ischaemia induces similar effects, a study of the vascular tree was
made. The results indicate that the
pedunculotomy does not alter the blood supply to the cerebellum, nor induce
ischaemia of the cerebellar
neurons. From this it may be hypothesised that target-derived trophic
support is more crucial for the
survival of immature neurons than is the trophic effect of afferent input.
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