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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.
Paediatric residents are often taught cardiac anatomy with two-dimensional images of heart specimens, or via imaging such as echocardiography or computed tomography. This study aimed to determine if the use of a structured, interactive, teaching session using heart specimens with CHD would be effective in teaching the concepts of cardiac anatomy.
The interest amongst paediatric residents of a cardiac anatomy session using heart specimens was assessed initially by circulating a survey. Next, four major cardiac lesions were identified to be of interest: atrial septal defect, ventricular septal defect, tetralogy of Fallot, and transposition. A list of key structures and anatomic concepts for these lesions was developed, and appropriate specimens demonstrating these features were identified by a cardiac morphologist. A structured, interactive, teaching session was then held with the paediatric residents using the cardiac specimens. The same 10-question assessment was administered at the beginning and end of the session.
The initial survey demonstrated that all the paediatric residents had an interest in a cardiac anatomy teaching session. A total of 24 participated in the 2-hour session. The median pre-test score was 45%, compared to a median post-test score of 90% (p < 0.01). All paediatric residents who completed a post-session survey indicated that the session was a good use of educational time and contributed to increasing their knowledge base. They expressed great interest in future sessions.
A 2-hour hands-on cardiac anatomy teaching session using cardiac specimens can successfully highlight key anatomic concepts for paediatric residents.
Julia Lee identifies temporal, spatial, and affective innovation in 21st century transpacific fiction. Locating formally innovative contemporary Asian American writing in the post-1965 contexts of migration, global economies of labor, environmental anxiety, language difference, and racialized violence, Lee shows how writers have represented new technologies of immediate communication across oceanic flows of migrants, commodities, information, and waste in disjointed, parallel, and non-sequential narrative structures. Childhood trauma lingers across time and geography in a story about a Filipino nurse by Mia Alvar, while novels by Min Jin Lee, Ruth Ozeki, and Thi Bui layer Asian and American modernities, postmodernities, and contemporary present-tenses.
The late nineteenth and early twentieth century represent a unique challenge to Asian North American literary scholars. Given the various obstacles that immigrants from Asia had to overcome in order to enter the United States, the political oppression, economic hardships, and social ostracism they endured when they arrived, and the xenophobic expectations of a publishing industry and reading public eager to proliferate stories of the “yellow peril,” it is easy to understand why fewer Asian-authored literary texts were published in the United States and Canada during this time and, perhaps, easy to dismiss these years as relatively unimportant to Asian American literary history.
This chapter argues that form, materiality, and environment are fundamental in considering the significance of the Angel Island poems, which were carved into the walls of the Immigration Station by Chinese laborers attempting to enter the United States. The poems, their production, and dissemination call into question some of the foundational assumptions about what constitutes Asian American literature and offers an alternative for thinking about the field.
The years between 1850 and 1930 witnessed the first large-scale migration of peoples from East Asia and South Asia to North America and the emergence of the US as an imperial power in the Pacific. This period also produced the first instances of Asian North American writing, theater, and film. This exciting collection examines how the many literary and cultural works from this period approached questions of migration, exclusion, and identity. Covering an extensive ranges of topics including anticolonialist writing, the erotics of queer modernist poetry, interracial desire, and the racial gaze in silent film, the book shows the diverse and multi-ethnic nature of literary and cultural production at a crucial period in modern formations of race as well as literary and cultural aesthetics.
Two studies tested whether subjects with obsessive-compulsive disorder could successfully use BT STEPS, a computer-aided system, to perform self-assessment for self-treatment of obsessive-compulsive disorder by exposure and ritual prevention.
Subjects were given a self-guiding manual and could use a touch-tone telephone to access computer-controlled Interactive Voice Response interviews at their convenience from home. Using the BT STEPS system, patients rated themselves and worked out a plan for individually tailored self-exposure therapy.
Outcomes were similar in the two studies. Of the 63 subjects who used BT STEPS, 84% completed the self-assessment module. Most calls were made outside usual office hours. As expected, subjects did not improve merely by completing self-assessment. However, completion of self-assessment predicted later improvement with self-exposure therapy.
Most subjects successfully completed self-assessment using BT STEPS from their homes.
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