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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.
The Discrimination and Stigma Scale (DISC) is a patient-reported outcome measure which assesses experiences of discrimination among persons with a mental illness globally.
This study evaluated whether the psychometric properties of a short-form version, DISC-Ultra Short (DISCUS) (11-item), could be replicated in a sample of people with a wide range of mental disorders from 21 sites in 15 countries/territories, across six global regions. The frequency of experienced discrimination was reported. Scaling assumptions (confirmatory factor analysis, inter-item and item-total correlations), reliability (internal consistency) and validity (convergent validity, known groups method) were investigated in each region, and by diagnosis group.
1195 people participated. The most frequently reported experiences of discrimination were being shunned or avoided at work (48.7%) and discrimination in making or keeping friends (47.2%). Confirmatory factor analysis supported a unidimensional model across all six regions and five diagnosis groups. Convergent validity was confirmed in the total sample and within all regions [ Internalised Stigma of Mental Illness (ISMI-10): 0.28–0.67, stopping self: 0.54–0.72, stigma consciousness: −0.32–0.57], as was internal consistency reliability (α = 0.74–0.84). Known groups validity was established in the global sample with levels of experienced discrimination significantly higher for those experiencing higher depression [Patient Health Questionnaire (PHQ)-2: p < 0.001], lower mental wellbeing [Warwick-Edinburgh Well-being Scale (WEMWBS): p < 0.001], higher suicidal ideation [Beck Hopelessness Scale (BHS)-4: p < 0.001] and higher risk of suicidal behaviour [Suicidal Ideation Attributes Scale (SIDAS): p < 0.001].
The DISCUS is a reliable and valid unidimensional measure of experienced discrimination for use in global settings with similar properties to the longer DISC. It offers a brief assessment of experienced discrimination for use in clinical and research settings.
To determine the clinical diagnoses associated with the National Healthcare Safety Network (NHSN) pneumonia (PNEU) or lower respiratory infection (LRI) surveillance events
Retrospective chart review
A convenience sample of 8 acute-care hospitals in Pennsylvania
All patients hospitalized during 2011–2012
Medical records were reviewed from a random sample of patients reported to the NHSN to have PNEU or LRI, excluding adults with ventilator-associated PNEU. Documented clinical diagnoses corresponding temporally to the PNEU and LRI events were recorded.
We reviewed 250 (30%) of 838 eligible PNEU and LRI events reported to the NHSN; 29 reported events (12%) fulfilled neither PNEU nor LRI case criteria. Differences interpreting radiology reports accounted for most misclassifications. Of 81 PNEU events in adults not on mechanical ventilation, 84% had clinician-diagnosed pneumonia; of these, 25% were attributed to aspiration. Of 43 adult LRI, 88% were in mechanically ventilated patients and 35% had no corresponding clinical diagnosis (infectious or noninfectious) documented at the time of LRI. Of 36 pediatric PNEU events, 72% were ventilator associated, and 70% corresponded to a clinical pneumonia diagnosis. Of 61 pediatric LRI patients, 84% were mechanically ventilated and 21% had no corresponding clinical diagnosis documented.
In adults not on mechanical ventilation and in children, most NHSN-defined PNEU events corresponded with compatible clinical conditions documented in the medical record. In contrast, NHSN LRI events often did not. As a result, substantial modifications to the LRI definitions were implemented in 2015.
This study examined the relationship between lead exposure and attention regulation in children from low-income families. Children with lead exposure were expected to have lower attention regulation abilities than children who were not exposed. The 57 participants (39% male, 61% female) were children aged 4 and 5 years (mean age 4y 7mo [SD5mo]); 24 children were lead-exposed (10–29µg/dl) and 33 were non-exposed comparisons (1–6µg/dl). Both groups qualified to be enrolled in programs for low-income families. A puzzle-matching task was completed in parent–child and child-alone conditions. Attention allocation and puzzle-matching performance were assessed in the two conditions. Children who were lead-exposed demonstrated less self-regulated attention than comparisons and had poorer puzzle performance in the child-alone condition. Attention patterns did not differ in the parent–child condition. This study extends previous knowledge concerning effects of lead exposure on preschool children from disadvantaged environments and suggests that lead exposure affects specific attention regulation abilities.
Surface passivation is a key issue in compound semiconductor device technology. The high density of surface states on unpassivated surfaces can lead to excessive non-radiative recombination at the surface, affecting optical devices, or provide leakage and low-field breakdown in electronic devices. Our previous studies on low energy, low-dose hydrogen ion treatment carried out at room temperature showed long-term improvement in the optical properties of near surface quantum wells. We have accordingly applied this process to GaAs-based pseudomorphic HEMTs (PHEMT) in order to improve their power performance. Although our process is designed so that the hydrogen reactions are confined to the surface of the substrate, a critical factor in the success of this treatment is the extent of in-diffusion of the hydrogen, and the possibility of dopant passivation. PHEMT structures were hydrogenated at various conditions and both Hall mobility and carrier density were monitored. For a low hydrogen ion dose (3 × 1016 cm−2) at 80 eV energy, some degradation of Hall mobility and carrier density was noted after the treatment, but full recovery of both parameters was achieved after a 400°C thermal anneal. Much higher hydrogen doses resulted in severe degradation of mobility and carrier density, which were only partially recovered after thermal anneal. Measurements on actual PHEMT devices showed an approximately 15% decrease in the transconductance, and in addition, a 60% decrease in the gate-to-drain leakage current after irradiation with 80 eV hydrogen ions at a dose of 3 × 1016 cm−2. The decrease of the leakage current indicates that passivation is taking place. The decrease of the transconductance suggests that hydrogen may be diffusing into the regions of the dopants. Optimization of the hydrogenation parameters should allow leakage reduction without sacrifice of transconductance.
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