Publications by authors named "Heather Cook"

41 Publications

Interprofessional Healthcare Students' Attitudes, Skills, and Knowledge After Comprehensive Pain Assessment Training in Verbal and Nonverbal Patients.

J Hosp Palliat Nurs 2021 May 12. Epub 2021 May 12.

Heather Cook, PharmD, is palliative care clinical pharmacist, Medstar Franklin Square Medical Center, Baltimore, MD. Karen Snow Kaiser, PhD, RN, is pain and palliative care coordinator, Quality and Safety Department, University of Maryland Capitol Region Health, Cheverly, MD. Kathryn A. Walker, PharmD, BCPS, CPE, is senior clinical director of palliative care, MedStar Health, Associate Professor, University of Maryland School of Pharmacy, Baltimore, MD Mary Lynn McPherson, PharmD, MA, MDE, BCPS, is professor and executive director, Advanced Post-Graduate Education in Palliative Care, Department of Pharmacy Practice and Science, University of Maryland School of Pharmacy.

A comprehensive pain assessment is the first step in safe, effective pain management. Few studies have explored variations of strategies and measures for multidimensional pain assessment education in both verbal and nonverbal patients. In this retrospective cohort study, interprofessional health care students enrolled in a palliative care curriculum completed a pain assessment training, which taught the PQRSTA ("palliating factors, precipitating factors, previous treatments, quality, region, radiation, severity, temporal factors and associated symptoms") mnemonic as a strategy for assessing pain in verbal patients and the Pain Assessment in Advance Dementia and Checklist of Nonverbal Pain Indicators measures for nonverbal patients. The purpose of this study was to compare the change in attitudes, self-perceived skills, and knowledge regarding pain assessment before and after the training. Attitudes and self-perceived skills were assessed in the pretraining and posttraining survey, which was analyzed using χ2 test or Fisher exact test. Students' knowledge responses were analyzed using Wilcoxon signed rank test to assess accuracy of responses compared with the expert defined score. One hundred eighty-two students were included. Results showed a statistically significant improvement in attitudes related to applicability of pain measures and self-perceived skills. Overall, data did not support an increase in knowledge using the PQRSTA mnemonic, or Pain Assessment in Advance Dementia and Checklist of Nonverbal Pain Indicators measures. Future pain trainings should consider training on only 1 nonverbal pain measure, incorporating bedside assessments, and integrating real-time feedback.
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http://dx.doi.org/10.1097/NJH.0000000000000771DOI Listing
May 2021

Global Landscape Review of Serotype-Specific Invasive Pneumococcal Disease Surveillance among Countries Using PCV10/13: The Pneumococcal Serotype Replacement and Distribution Estimation (PSERENADE) Project.

Microorganisms 2021 Apr 2;9(4). Epub 2021 Apr 2.

National Public Health Organisation, 15123 Athens, Greece.

Serotype-specific surveillance for invasive pneumococcal disease (IPD) is essential for assessing the impact of 10- and 13-valent pneumococcal conjugate vaccines (PCV10/13). The Pneumococcal Serotype Replacement and Distribution Estimation (PSERENADE) project aimed to evaluate the global evidence to estimate the impact of PCV10/13 by age, product, schedule, and syndrome. Here we systematically characterize and summarize the global landscape of routine serotype-specific IPD surveillance in PCV10/13-using countries and describe the subset that are included in PSERENADE. Of 138 countries using PCV10/13 as of 2018, we identified 109 with IPD surveillance systems, 76 of which met PSERENADE data collection eligibility criteria. PSERENADE received data from most (n = 63, 82.9%), yielding 240,639 post-PCV10/13 introduction IPD cases. Pediatric and adult surveillance was represented from all geographic regions but was limited from lower income and high-burden countries. In PSERENADE, 18 sites evaluated PCV10, 42 PCV13, and 17 both; 17 sites used a 3 + 0 schedule, 38 used 2 + 1, 13 used 3 + 1, and 9 used mixed schedules. With such a sizeable and generally representative dataset, PSERENADE will be able to conduct robust analyses to estimate PCV impact and inform policy at national and global levels regarding adult immunization, schedule, and product choice, including for higher valency PCVs on the horizon.
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http://dx.doi.org/10.3390/microorganisms9040742DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8066045PMC
April 2021

Changes in Invasive Pneumococcal Disease Caused by Serotype 1 Following Introduction of PCV10 and PCV13: Findings from the PSERENADE Project.

Microorganisms 2021 03 27;9(4). Epub 2021 Mar 27.

National Centre for Immunisation Research and Surveillance and Discipline of Child and Adolescent Health, Children's Hospital Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Westmead, NSW 2145, Australia.

serotype 1 (ST1) was an important cause of invasive pneumococcal disease (IPD) globally before the introduction of pneumococcal conjugate vaccines (PCVs) containing ST1 antigen. The Pneumococcal Serotype Replacement and Distribution Estimation (PSERENADE) project gathered ST1 IPD surveillance data from sites globally and aimed to estimate PCV10/13 impact on ST1 IPD incidence. We estimated ST1 IPD incidence rate ratios (IRRs) comparing the pre-PCV10/13 period to each post-PCV10/13 year by site using a Bayesian multi-level, mixed-effects Poisson regression and all-site IRRs using a linear mixed-effects regression (N = 45 sites). Following PCV10/13 introduction, the incidence rate (IR) of ST1 IPD declined among all ages. After six years of PCV10/13 use, the all-site IRR was 0.05 (95% credibility interval 0.04-0.06) for all ages, 0.05 (0.04-0.05) for <5 years of age, 0.08 (0.06-0.09) for 5-17 years, 0.06 (0.05-0.08) for 18-49 years, 0.06 (0.05-0.07) for 50-64 years, and 0.05 (0.04-0.06) for ≥65 years. PCV10/13 use in infant immunization programs was followed by a 95% reduction in ST1 IPD in all ages after approximately 6 years. Limited data availability from the highest ST1 disease burden countries using a 3+0 schedule constrains generalizability and data from these settings are needed.
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http://dx.doi.org/10.3390/microorganisms9040696DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8066231PMC
March 2021

Individuals lacking ridge detail: A case study in adermatoglyphia.

J Forensic Sci 2021 Jan 2;66(1):202-208. Epub 2020 Nov 2.

Thames Valley Police, Kidlington, Oxon, UK.

Adermatoglyphia is a very rare autosomal-dominant condition that is genetically inherited and causes an individual to be born without conventional ridge detail on either their palmar or plantar surfaces (the fingers and palms of the hands and the toes and the soles of the feet). While adermatoglyphia has been the focus of medical and genetic research, no previous research has been conducted with regard to the forensic recovery and identification of marks from an adermatoglyphic individual. By observation of ridge detail donated by an adermatoglyphic subject, the study uses different methods in order to capture fingermarks (methods include: inked capture, livescan (biometric) capture, cyanoacrylate fuming, ninhydrin enhancement, and physical developer). Unusually, the purpose of this paper ends up presenting a number of examples of an absence of evidence; unsuccessful attempts made to capture and enhance fingerprint ridge detail. This is determined over a range of standard means including "live" donations by the adermatoglyphic subject onto the Livescan system, and enhancements of latent donations. The subject shows to leave either insubstantial fingermarks with no detail, or no mark whatsoever.
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http://dx.doi.org/10.1111/1556-4029.14597DOI Listing
January 2021

An outbreak of serotype-1 sequence type 306 invasive pneumococcal disease in an Australian Indigenous population.

Commun Dis Intell (2018) 2020 Sep 15;44. Epub 2020 Sep 15.

Enhanced Invasive Pneumococcal Disease Surveillance Working Group; Centre for Disease Control, Top End Health Services, Northern Territory, Australia.

Between 2010 and 2013, an outbreak of serotype-1 sequence type 306 (ST306) invasive pneumococcal disease (IPD) occurred primarily in remote locations of Northern and Central Australia. This is a descriptive study of the epidemiology of the outbreak using nationwide IPD surveillance data, supplemented with more detailed data held by affected jurisdictions, and of the response to the outbreak, including vaccination strategies. In the year the outbreak peaked (2011), serotype-1 IPD incidence was over 30-fold higher in the affected regions than in the rest of Australia (incidence rate ratio: 30.7 [95% CI 20.1-48.9]). The study includes 245 cases of serotype-1 IPD from the outbreak regions, with 75.5% identified as Indigenous. No reported cases of serotype-1 IPD occurred in young children who had completed either a 10- or 13-valent pneumococcal conjugate vaccine schedule. However serotype-1 IPD did occur in older children who had previously received 23-valent pneumococcal polysaccharide vaccine. Development of public-health-focused national IPD management guidelines, including suitable vaccine strategies for consistent use nationwide, could potentially decrease the duration and intensity of similar outbreaks in the future.
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http://dx.doi.org/10.33321/cdi.2020.44.66DOI Listing
September 2020

Team-Based Integrated Knowledge Translation for Enhancing Quality of Life in Long-term Care Settings: A Multi-method, Multi-sectoral Research Design.

Int J Health Policy Manag 2020 04 1;9(4):138-142. Epub 2020 Apr 1.

Faculty of Nursing and School of Public Health, University of Alberta, Edmonton, AB, Canada.

Multi-sectoral, interdisciplinary health research is increasingly recognizing integrated knowledge translation (iKT) as essential. It is characterized by diverse research partnerships, and iterative knowledge engagement, translation processes and democratized knowledge production. This paper reviews the methodological complexity and decision-making of a large iKT project called Seniors - Adding Life to Years (SALTY), designed to generate evidence to improve late life in long-term care (LTC) settings across Canada. We discuss our approach to iKT by reviewing iterative processes of team development and knowledge engagement within the LTC sector. We conclude with a brief discussion of the important opportunities, challenges, and implications these processes have for LTC research, and the sector more broadly.
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http://dx.doi.org/10.15171/ijhpm.2019.123DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7182150PMC
April 2020

Team-Based Integrated Knowledge Translation for Enhancing Quality of Life in Long-term Care Settings: A Multi-method, Multi-sectoral Research Design.

Int J Health Policy Manag 2020 04 1;9(4):138-142. Epub 2020 Apr 1.

Faculty of Nursing and School of Public Health, University of Alberta, Edmonton, AB, Canada.

Multi-sectoral, interdisciplinary health research is increasingly recognizing integrated knowledge translation (iKT) as essential. It is characterized by diverse research partnerships, and iterative knowledge engagement, translation processes and democratized knowledge production. This paper reviews the methodological complexity and decision-making of a large iKT project called Seniors - Adding Life to Years (SALTY), designed to generate evidence to improve late life in long-term care (LTC) settings across Canada. We discuss our approach to iKT by reviewing iterative processes of team development and knowledge engagement within the LTC sector. We conclude with a brief discussion of the important opportunities, challenges, and implications these processes have for LTC research, and the sector more broadly.
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http://dx.doi.org/10.15171/ijhpm.2019.123DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7182150PMC
April 2020

Long-term Impact of Pneumococcal Conjugate Vaccines on Invasive Disease and Pneumonia Hospitalizations in Indigenous and Non-Indigenous Australians.

Clin Infect Dis 2020 06;70(12):2607-2615

National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases, Children's Hospital at Westmead, Sydney, Australia.

Background: Universal pneumococcal conjugate vaccine (PCV) programs began in Indigenous Australian children in 2001 and all children in 2005, changing to 13-valent PCV (PCV13) in 2011. We used laboratory data for invasive pneumococcal disease (IPD) and coded hospitalizations for noninvasive pneumococcal community-acquired pneumonia (PnCAP) to evaluate long-term impact.

Methods: Annual incidence (per 100 000 population) was calculated for age-specific total IPD, PCV13 non-7-valent PCV (PCV7) serotypes, and PnCAP by Indigenous status. Incidence in the pre-universal PCV7 (2002-2004), early PCV7 (2005-2007), pre-PCV13 (2008 to mid-2011), and post-PCV13 (mid-2011 to 2016) periods was used to calculate incidence rate ratios (IRRs).

Results: In the total population, all-age incidence of IPD declined from 11.8 pre-PCV7 to 7.1 post-PCV13 (IRR, 0.61 [95% confidence interval {CI}, .59-.63]) but for PnCAP declined among ages <1 year (IRR, 0.34 [95% CI, .25-.45]) and 1-4 years (IRR, 0.50 [95% CI, .43-.57]) but increased significantly among age ≥5 years (IRRs, 1.08-1.14). In Indigenous people, baseline PCV13 non-PCV7 IPD incidence was 3-fold higher, amplified by a serotype 1 epidemic in 2011. By 2015-2016, although incidence of IPD and PnCAP in children aged <5 years decreased by 38%, neither decreased in people aged ≥5 years.

Conclusions: Fifteen years post-PCV and 5 years post-PCV13, direct and indirect impact on IPD and PnCAP differed by age and between Indigenous and non-Indigenous people, with potential implications for long-term PCV impact in comparable settings.Fifteen years after pneumococcal conjugate vaccine (PCV) introduction and 5 years post-PCV13, direct and indirect impact on invasive pneumococcal disease and pneumococcal community-acquired pneumonia differed by age and between Indigenous and non-Indigenous people, with potential implications for long-term PCV impact in comparable settings.
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http://dx.doi.org/10.1093/cid/ciz731DOI Listing
June 2020

Identifying Potential Medication Discrepancies During Medication Reconciliation in the Post-Acute Long-Term Care Setting.

J Gerontol Nurs 2019 Jul;45(7):5-10

Medication reconciliation has been an area with increased focus among transitions of care due to associations with error rates and risk of patient harm. Chart reviews were performed to evaluate the discrepancies between the initial physician order sheet (POS), hospital discharge summary, electronic health record (EHR), health information exchange (HIE), and the patient interview/home medication list. The objectives were to determine which medication information source provided the least number of discrepancies and describe the different types of discrepancies among sources. Of all orders, 30% contained a discrepancy. The average number of discrepancies per medication source per patient included: 5.6 for the hospital discharge summary, 7.6 for the EHR, and 9.6 for the home medication list/interview. The most frequent types of discrepancies included: omission of medication orders between lists (42.7%), additional medications not included on the initial POS (24.6%), and discrepancies in frequency (11.8%). The hospital discharge summary proved to be the medication source that provided the least number of discrepancies, compared to the initial POS. [Journal of Gerontological Nursing, 45(7), 5-10.].
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http://dx.doi.org/10.3928/00989134-20190612-02DOI Listing
July 2019

Childhood growth and neurocognition are associated with distinct sets of metabolites.

EBioMedicine 2019 Jun 25;44:597-606. Epub 2019 May 25.

Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, VA, USA. Electronic address:

Background: Undernutrition is a serious global problem that contributes to increased child morbidity and mortality, impaired neurocognitive development, and decreased educational and economic attainment. Current interventions are only marginally effective, and identification of associated metabolic pathways can offer new strategies for intervention.

Methods: Plasma samples were collected at 9 and 36 months from a subset of the PROVIDE child cohort (n = 130). Targeted metabolomics was performed on bile acids, acylcarnitines, amino acids, phosphatidylcholines, and sphingomyelins. Metabolic associations with linear growth and neurocognitive outcomes at four years were evaluated using correlation and penalized-linear regression analysis as well as conditional random forest modeling.

Findings: Different metabolites were associated with growth and neurocognitive outcomes. Improved growth outcomes were associated with higher concentrations of hydroxy-sphingomyelin and essential amino acids and lower levels of acylcarnitines and bile acid conjugation. Neurocognitive scores were largely associated with phosphatidylcholine species and early metabolic indicators of inflammation. All metabolites identified explain ~45% of growth and neurocognitive variation.

Interpretation: Growth outcomes were predominantly associated with metabolites measured early in life (9 months), many of which were biomarkers of insufficient diet, environmental enteric dysfunction, and microbiome disruption. Hydroxy-sphingomyelin was a significant predictor of improved growth. Neurocognitive outcome was predominantly associated with 36 month phosphatidylcholines and inflammatory metabolites, which may serve as important biomarkers of optimal neurodevelopment. The distinct sets of metabolites associated with growth and neurocognition suggest that intervention may require targeted approaches towards distinct metabolic pathways. FUND: Bill & Melinda Gates Foundation (OP1173478); National Institutes of Health (AI043596, CA044579).
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http://dx.doi.org/10.1016/j.ebiom.2019.05.043DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6604877PMC
June 2019

Fecal Immunoglobulin A Against a Sporozoite Antigen at 12 Months Is Associated With Delayed Time to Subsequent Cryptosporidiosis in Urban Bangladesh: A Prospective Cohort Study.

Clin Infect Dis 2020 01;70(2):323-326

Division of Infectious Diseases and International Health, Department of Medicine, University of Virginia, Charlottesville.

In this prospective cohort study of Bangladeshi children, greater fecal immunoglobulin A, but not plasma immunoglobulin G, directed against the Cryptosporidium sporozoite-expressed antigen Cp23 at 12 months of age was associated with delayed time to subsequent cryptosporidiosis. This finding suggests a protective role for mucosal antibody-mediated immunity in naturally exposed children.
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http://dx.doi.org/10.1093/cid/ciz430DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6938969PMC
January 2020

2018 American Society of Consultant Pharmacists Annual Meeting & Exhibition.

Consult Pharm 2017 Oct;33(10):572-608

Poster abstracts are evaluated based on the following criteria: significance of the problem to healthy aging or medication management; innovativeness of ideas, methods, and/or approach; methodological rigor of methods and approach; presentation of finding; implications identified for future research, practice, and/or policy; and clarity of writing. Submissions are not evaluated through the peer-reviewed process used by . Industry support is indicated, where applicable. Presenting author is in italics. The poster abstract presentation is supported by the ASCP Foundation.
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October 2017

Development and Validation of a Prediction Model for Mortality and Adverse Outcomes Among Patients With Peripheral Eosinopenia on Admission for Clostridium difficile Infection.

JAMA Surg 2018 12;153(12):1127-1133

Department of Surgery, University of Arizona, Tucson.

Importance: Recent evidence from an animal model suggests that peripheral loss of eosinophils in Clostridium difficile infection (CDI) is associated with severe disease. The ability to identify high-risk patients with CDI as early as the time of admission could improve outcomes by guiding management decisions.

Objective: To construct a model using clinical indices readily available at the time of hospital admission, including peripheral eosinophil counts, to predict inpatient mortality in patients with CDI.

Design, Setting, And Participants: In a cohort study, a total of 2065 patients admitted for CDI through the emergency department of 2 tertiary referral centers from January 1, 2005, to December 31, 2015, formed a training and a validation cohort. The sample was stratified by admission eosinophil count (0.0 cells/μL or >0.0 cells/μL), and multivariable logistic regression was used to construct a predictive model for inpatient mortality as well as other disease-related outcomes.

Main Outcomes And Measures: Inpatient mortality was the primary outcome. Secondary outcomes included the need for a monitored care setting, need for vasopressors, and rates of inpatient colectomy.

Results: Of the 2065 patients in the study, 1092 (52.9%) were women and patients had a mean (SD) age of 63.4 (18.4) years. Those with an undetectable eosinophil count at admission had increased in-hospital mortality in both the training (odds ratio [OR], 2.01; 95% CI, 1.08-3.73; P = .03) and validation (OR, 2.26; 95% CI, 1.33-3.83; P = .002) cohorts in both univariable and multivariable analysis. Undetectable eosinophil counts were also associated with indicators of severe sepsis, such as admission to monitored care settings (OR, 1.40; 95% CI, 1.06-1.86), the need for vasopressors (OR, 2.08; 95% CI, 1.32-3.28), and emergency total colectomy (OR, 2.56; 95% CI, 1.12-5.87). Other significant predictors of mortality at admission included increasing comorbidity burden (for each 1-unit increase: OR, 1.13; 95% CI, 1.05-1.22) and lower systolic blood pressures (for each 1-mm Hg increase: OR, 0.99; 95% CI, 0.98-1.00). In a subgroup analysis of patients presenting without initial tachycardia or hypotension, only patients with undetectable admission eosinophil counts, but not those with an elevated white blood cell count, had significantly increased odds of inpatient mortality (OR, 5.76; 95% CI, 1.99-16.64).

Conclusions And Relevance: This study describes a simple, widely available, inexpensive model predicting CDI severity and mortality to identify at-risk patients at the time of admission.
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http://dx.doi.org/10.1001/jamasurg.2018.3174DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6414272PMC
December 2018

Chronic Obstructive Pulmonary Disease in Older Adults: Part I: Case Study.

J Gerontol Nurs 2018 Jul;44(7):10-14

Chronic obstructive pulmonary disease (COPD) is a distressing respiratory disease that may greatly impact a patient's quality of life. Although many treatment options exist, the Global Initiative for Chronic Obstructive Lung Disease Guidelines outline management strategies based on severity of daily symptoms and exacerbations. Although it is important to weigh the risks and benefits of medication use, involvement of patients in their overall care plan is imperative to optimal outcomes. According to recent studies, the prevalence of COPD in older adults is increasing, along with the complexity of care due to comorbidities, drug interactions, and side effects. A thorough evaluation of a patient case provides insight into the everyday challenges of COPD management. [Journal of Gerontological Nursing, 44(7), 10-14.].
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http://dx.doi.org/10.3928/00989134-20180614-04DOI Listing
July 2018

Species of Cryptosporidia Causing Subclinical Infection Associated With Growth Faltering in Rural and Urban Bangladesh: A Birth Cohort Study.

Clin Infect Dis 2018 10;67(9):1347-1355

International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh.

Background: Cryptosporidiosis is a major cause of childhood diarrhea in low- and middle-income countries and has been linked to impairment of child growth. This study investigated the burden of cryptosporidiosis and its impact on child growth in both a rural and an urban site in Bangladesh.

Methods: Pregnant women in the second trimester were identified at 2 sites in Bangladesh, 1 urban and 1 rural. Their offspring were enrolled at birth into the study (urban, n = 250; rural, n = 258). For 2 years, the children were actively monitored for diarrhea and anthropometric measurements were obtained every 3 months. Stool samples were collected monthly and during diarrheal episodes with Cryptosporidium infection and causative species determined by quantitative polymerase chain reaction assays.

Results: Cryptosporidium infections were common at both sites and mostly subclinical. In the urban site, 161 (64%) children were infected and 65 (26%) had ≥2 infections. In the rural site, 114 (44%) were infected and 24 (9%) had multiple infections. Adjusted for potential confounders, cryptosporidiosis was associated with a significantly greater drop in the length-for-age z score (LAZ) at 24 months from LAZ at enrollment (Δ-LAZ), an effect greatest in the children with multiple episodes of cryptosporidiosis. The most common species in Mirpur was Cryptosporidium hominis, whereas Cryptosporidium meleagridis predominated in Mirzapur.

Conclusions: Cryptosporidiosis is common in early childhood and associated with early growth faltering in Bangladeshi children. Predominant Cryptosporidium species differed between the 2 sites, suggesting different exposures or modes of transmission but similar consequences for child growth.

Clinical Trials Registration: NCT02764918.
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http://dx.doi.org/10.1093/cid/ciy310DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6186860PMC
October 2018

Role of maternal health and infant inflammation in nutritional and neurodevelopmental outcomes of two-year-old Bangladeshi children.

PLoS Negl Trop Dis 2018 05 29;12(5):e0006363. Epub 2018 May 29.

Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, Virginia, United States of America.

Background: Previous studies have shown maternal, inflammatory, and socioeconomic variables to be associated with growth and neurodevelopment in children from low-income countries. However, these outcomes are multifactorial and work describing which predictors most strongly influence them is lacking.

Methodology/principal Findings: We conducted a longitudinal study of Bangladeshi children from birth to two years to assess oral vaccine efficacy. Variables pertaining to maternal and perinatal health, socioeconomic status, early childhood enteric and systemic inflammation, and anthropometry were collected. Bayley-III neurodevelopmental assessment was conducted at two years. As a secondary analysis, we employed hierarchical cluster and random forests techniques to identify and rank which variables predicted growth and neurodevelopment. Cluster analysis demonstrated three distinct groups of predictors. Mother's weight and length-for-age Z score (LAZ) at enrollment were the strongest predictors of LAZ at two years. Cognitive score on Bayley-III was strongly predicted by weight-for-age (WAZ) at enrollment, income, and LAZ at enrollment. Top predictors of language included Rotavirus vaccination, plasma IL 5, sCD14, TNFα, mother's weight, and male gender. Motor function was best predicted by fecal calprotectin, WAZ at enrollment, fecal neopterin, and plasma CRP index. The strongest predictors for social-emotional score included plasma sCD14, income, WAZ at enrollment, and LAZ at enrollment. Based on the random forests' predictions, the estimated percentage of variation explained was 35.4% for LAZ at two years, 34.3% for ΔLAZ, 42.7% for cognitive score, 28.1% for language, 40.8% for motor, and 37.9% for social-emotional score.

Conclusions/significance: Birth anthropometry and maternal weight were strong predictors of growth while enteric and systemic inflammation had stronger associations with neurodevelopment. Birth anthropometry was a powerful predictor for all outcomes. These data suggest that further study of stunting in low-income settings should include variables relating to maternal and prenatal health, while investigations focusing on neurodevelopmental outcomes should additionally target causes of systemic and enteric inflammation.
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http://dx.doi.org/10.1371/journal.pntd.0006363DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5993301PMC
May 2018

Rapid Patient Discharge Contribution to Bed Surge Capacity During a Mass Casualty Incident: Findings From an Exercise With New York City Hospitals.

Qual Manag Health Care 2018 Jan/Mar;27(1):24-29

Division of State and Local Readiness, Office of Public Health Preparedness and Response, Centers for Disease Control and Prevention, Atlanta, Georgia (Ms Jacobs-Wingo); New York City Department of Health and Mental Hygiene, Bureau of Healthcare System Readiness, Office of Emergency Preparedness and Response, Long Island City, New York (Ms Jacobs-Wingo); HECO Public Health Consulting, LLC, Lafayette, Colorado (Ms Cook); and New York City Department of Health and Mental Hygiene, Hospital Readiness and Health Care Coalitions, Bureau of Healthcare System Readiness, Office of Emergency Preparedness and Response, Long Island City, New York (Mr Lang).

Background: Mass casualty incidents may increase patient volume suddenly and dramatically, requiring hospitals to expeditiously manage bed inventories to release acute care beds for disaster victims. Electronic patient tracking systems combined with unit walk-throughs can identify patients for rapid discharge. The New York City (NYC) Department of Health and Mental Hygiene's 2013 Rapid Patient Discharge Assessment (RPDA) aimed to determine the maximum number of beds NYC hospitals could make available through rapid patient discharge and to characterize discharge barriers.

Methods: Unit representatives identified discharge candidates within normal operations in round 1 and additional discharge candidates during a disaster scenario in round 2. Descriptive statistics were performed.

Results: Fifty-five NYC hospitals participated in the RPDA exercise; 45 provided discharge candidate counts in both rounds. Representatives identified 4225 patients through the RPDA: among these, 1138 (26.9%) were already confirmed for discharge; 1854 (43.9%) were round 1 discharge candidates; and 1233 (29.2%) were round 2 discharge candidates. These 4225 patients represented 21.4% of total bed capacity. Frequently reported barriers included missing prescriptions for aftercare or discharge orders.

Conclusion: The NYC hospitals could implement rapid patient discharge to clear one-fifth of occupied inpatient beds for disaster victims, given they address barriers affecting patients' safe and efficient discharge.
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http://dx.doi.org/10.1097/QMH.0000000000000161DOI Listing
July 2019

Targeted-release budesonide versus placebo in patients with IgA nephropathy (NEFIGAN): a double-blind, randomised, placebo-controlled phase 2b trial.

Lancet 2017 May 28;389(10084):2117-2127. Epub 2017 Mar 28.

Ospedale A Manzoni, Lecco, Italy.

Background: IgA nephropathy is thought to be associated with mucosal immune system dysfunction, which manifests as renal IgA deposition that leads to impairment and end-stage renal disease in 20-40% of patients within 10-20 years. In this trial (NEFIGAN) we aimed to assess safety and efficacy of a novel targeted-release formulation of budesonide (TRF-budesonide), designed to deliver the drug to the distal ileum in patients with IgA nephropathy.

Methods: We did a randomised, double-blind, placebo-controlled phase 2b trial, comprised of 6-month run-in, 9-month treatment, and 3-month follow-up phases at 62 nephrology clinics across ten European countries. We recruited patients aged at least 18 years with biopsy-confirmed primary IgA nephropathy and persistent proteinuria despite optimised renin-angiotensin system (RAS) blockade. We randomly allocated patients with a computer algorithm, with a fixed block size of three, in a 1:1:1 ratio to 16 mg/day TRF-budesonide, 8 mg/day TRF-budesonide, or placebo, stratified by baseline urine protein creatinine ratio (UPCR). Patients self-administered masked capsules, once daily, 1 h before breakfast during the treatment phase. All patients continued optimised RAS blockade treatment throughout the trial. Our primary outcome was mean change from baseline in UPCR for the 9-month treatment phase, which was assessed in the full analysis set, defined as all randomised patients who took at least one dose of trial medication and had at least one post-dose efficacy measurement. Safety was assessed in all patients who received the intervention. This trial is registered with ClinicalTrials.gov, number NCT01738035.

Findings: Between Dec 11, 2012, and June 25, 2015, 150 randomised patients were treated (safety set) and 149 patients were eligible for the full analysis set. Overall, at 9 months TRF-budesonide (16 mg/day plus 8 mg/day) was associated with a 24·4% (SEM 7·7%) decrease from baseline in mean UPCR (change in UPCR vs placebo 0·74; 95% CI 0·59-0·94; p=0·0066). At 9 months, mean UPCR had decreased by 27·3% in 48 patients who received 16 mg/day (0·71; 0·53-0·94; p=0·0092) and 21·5% in the 51 patients who received 8 mg/day (0·76; 0·58-1·01; p=0·0290); 50 patients who received placebo had an increase in mean UPCR of 2·7%. The effect was sustained throughout followup. Incidence of adverse events was similar in all groups (43 [88%] of 49 in the TRF-budesonide 16 mg/day group, 48 [94%] of 51 in the TRF-budesonide 8 mg/day, and 42 [84%] of 50 controls). Two of 13 serious adverse events were possibly associated with TRF-budesonide-deep vein thrombosis (16 mg/day) and unexplained deterioration in renal function in follow-up (patients were tapered from 16 mg/day to 8 mg/day over 2 weeks and follow-up was assessed 4 weeks later).

Interpretation: TRF-budesonide 16 mg/day, added to optimised RAS blockade, reduced proteinuria in patients with IgA nephropathy. This effect is indicative of a reduced risk of future progression to end-stage renal disease. TRF-budesonide could become the first specific treatment for IgA nephropathy targeting intestinal mucosal immunity upstream of disease manifestation.

Funding: Pharmalink AB.
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http://dx.doi.org/10.1016/S0140-6736(17)30550-0DOI Listing
May 2017

Pathways for best practice diffusion: the structure of informal relationships in Canada's long-term care sector.

Implement Sci 2017 02 3;12(1):11. Epub 2017 Feb 3.

Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada.

Background: Initiatives to accelerate the adoption and implementation of evidence-based practices benefit from an association with influential individuals and organizations. When opinion leaders advocate or adopt a best practice, others adopt too, resulting in diffusion. We sought to identify existing influence throughout Canada's long-term care sector and the extent to which informal advice-seeking relationships tie the sector together as a network.

Methods: We conducted a sociometric survey of senior leaders in 958 long-term care facilities operating in 11 of Canada's 13 provinces and territories. We used an integrated knowledge translation approach to involve knowledge users in planning and administering the survey and in analyzing and interpreting the results. Responses from 482 senior leaders generated the names of 794 individuals and 587 organizations as sources of advice for improving resident care in long-term care facilities.

Results: A single advice-seeking network appears to span the nation. Proximity exhibits a strong effect on network structure, with provincial inter-organizational networks having more connections and thus a denser structure than interpersonal networks. We found credible individuals and organizations within groups (opinion leaders and opinion-leading organizations) and individuals and organizations that function as weak ties across groups (boundary spanners and bridges) for all studied provinces and territories. A good deal of influence in the Canadian long-term care sector rests with professionals such as provincial health administrators not employed in long-term care facilities.

Conclusions: The Canadian long-term care sector is tied together through informal advice-seeking relationships that have given rise to an emergent network structure. Knowledge of this structure and engagement with its opinion leaders and boundary spanners may provide a route for stimulating the adoption and effective implementation of best practices, improving resident care and strengthening the long-term care advice network. We conclude that informal relational pathways hold promise for helping to transform the Canadian long-term care sector.
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http://dx.doi.org/10.1186/s13012-017-0542-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5291985PMC
February 2017

A Tale of Two Sites: Lessons on Leadership from the Implementation of a Long-term Care Delivery Model (CDM) in Western Canada.

Healthcare (Basel) 2016 Jan 4;4(1). Epub 2016 Jan 4.

First Nations Health Authority, Vancouver, BC V6C 1A1, Canada.

Residential, long-term care serves vulnerable older adults in a facility-based environment. A new care delivery model (CDM) designed to promote more equitable care for residents was implemented in a health region in Western Canada. Leaders and managers faced challenges in implementing this model alongside other concurrent changes. This paper explores the question: How did leadership style influence team functioning with the implementation of the CDM? Qualitative data from interviews with leadership personnel (directors and managers, residential care coordinators and clinical nurse educators), and direct care staff (registered nurses, licensed practical nurses, health care aides, and allied health therapists), working in two different facilities comprise the main sources of data for this study. The findings reveal that leaders with a servant leadership style were better able to create and sustain the conditions to support successful model implementation and higher team functioning, compared to a facility in which the leadership style was less inclusive and proactive, and more resistant to the change. Consequently, staff at the second facility experienced a greater sense of overload with the implementation of the CDM. This study concludes that strong leadership is key to facilitating team work and job satisfaction in a context of change.
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http://dx.doi.org/10.3390/healthcare4010003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4934537PMC
January 2016

Evaluation of impact of 23 valent pneumococcal polysaccharide vaccine following 7 valent pneumococcal conjugate vaccine in Australian Indigenous children.

Vaccine 2015 Nov 29;33(48):6666-74. Epub 2015 Oct 29.

National Centre for Immunisation Research and Surveillance for Vaccine Preventable Diseases, Westmead, Australia; Discipline of Paediatrics and Child Health, University of Sydney, Sydney, Australia; School of Public Health, University of Sydney, Sydney, Australia.

Background: High incidence and serotype diversity of invasive pneumococcal disease (IPD) in Indigenous children in remote Australia led to rapid introduction of 7-valent conjugate pneumococcal vaccine (7vPCV) at 2, 4 and 6 months in 2001, followed by 23-valent polysaccharide pneumococcal vaccine (23vPPV) in the second year of life. All other Australian children were offered 3 doses of 7vPCV without a booster from 2005. This study evaluated the impact of the unique pneumococcal vaccine schedule of 7vPCV followed by the 23vPPV booster among Indigenous Australian children.

Methods: Changes in IPD incidence derived from population-based passive laboratory surveillance in Indigenous children <5 years eligible for 23vPPV were compared to non-Indigenous eligible for 7vPCV only from the pre-vaccine introduction period (Indigenous 1994-2000; non-Indigenous 2002-2004) to the post-vaccine period (2008-2010 in both groups) using incidence rate ratios (IRRs) stratified by age into serotype groupings of vaccine (7v and 13vPCV and 23vPPV) and non-vaccine types. Vaccine coverage was assessed from the Australian Childhood Immunisation Register.

Results: At baseline, total IPD incidence per 100,000 was 216 (n=230) in Indigenous versus 55 (n=1993) in non-Indigenous children. In 2008-2010, IRRs for 7vPCV type IPD were 0.03 in both groups, but for 23v-non7v type IPD 1.2 (95% CI 0.8-1.8) in Indigenous versus 3.1 (95% CI 2.5-3.7) in non-Indigenous, difference driven primarily by serotype 19A IPD (IRR 0.6 in Indigenous versus 4.3 in non-Indigenous). For non-7vPCV type IPD overall, IRR was significantly higher in those age-eligible for 23vPPV booster compared to those younger, but in both age groups was lower than for non-Indigenous children.

Conclusion: These ecologic data suggest a possible "serotype replacement sparing" effect of 23vPPV following 7vPCV priming, especially for serotype 19A with supportive evidence from other immunogenicity and carriage studies. Applicability post 10vPCV or 13v PCV priming in similar settings would depend on local serotype distribution of IPD.
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http://dx.doi.org/10.1016/j.vaccine.2015.10.089DOI Listing
November 2015

Surveillance of pneumococcal serotype 1 carriage during an outbreak of serotype 1 invasive pneumococcal disease in central Australia 2010-2012.

BMC Infect Dis 2013 Sep 3;13:409. Epub 2013 Sep 3.

Background: An outbreak of serotype 1 invasive pneumococcal disease (IPD) occurred in Central Australia from October 2010 to the latter part of 2012. Surveillance of serotype 1 carriage was conducted to determine epidemiological features of asymptomatic carriage that could potentially be driving the outbreak.

Methods: 130 patients and accompanying persons presenting at Alice Springs Hospital Emergency Department consented to nasopharyngeal swab (NPS) collection. NPS were processed by standard methods, including culture, pneumococcal lytA quantitative real-time PCR, serotype 1-specific real-time PCR and multi-locus sequence typing (MLST).

Results: Pneumococcal carriage was detected in 16% of participants. Carriage was highest in the under 10 year olds from remote communities surrounding Alice Springs (75%). Four NPS were positive for serotype 1 DNA by PCR; 3 were also culture-positive for serotype 1 pneumococci. Serotype 1 isolates had atypical colony morphology on primary culture. All serotype 1 carriers were healthy children 5 to 8 years of age from remote communities. By MLST, serotype 1 isolates were ST306, as were IPD isolates associated with this outbreak.

Conclusions: During an outbreak of serotype 1 ST306 IPD, carriage of the outbreak strain was detected in 3% NPS collected. All carriers were healthy children 5 to 8 years of age.
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http://dx.doi.org/10.1186/1471-2334-13-409DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3766201PMC
September 2013

Low utilization of extra embryos in donor oocyte in vitro fertilization cycles: an ethical dilemma to donor management.

J Assist Reprod Genet 2013 Aug 30;30(8):1031-4. Epub 2013 Jun 30.

UCLA David Geffen School of Medicine, 10833 Le Conte Ave, Box 951740, Los Angeles, CA, 90095, USA,

Purpose: To explore outcomes of donor In Vitro Fertilization (IVF) cycles with regards to cryopreservation and utilization of extra embryos after fresh transfer.

Methods: A database search was performed to identify all consecutive fresh donor oocyte cycles from January 1, 2000 to December 31, 2010 at a private fertility laboratory. Parameters analyzed included: number of oocytes retrieved, number of patients choosing embryo cryopreservation, number of patients returning for frozen embryo transfer (FET), and pregnancy outcomes.

Results: A total of 1070 fresh oocyte donor cycles were identified. Average number of oocytes retrieved was 16.9 ± 7.9, and average number of embryos transferred was 2.3 ± 0.96. Sixty-six percent of patients cryopreserved excess embryos following fresh transfer, and only 40 % of these patients ultimately returned for FET. Patients who conceived in their fresh cycle were much less likely to return for FET than those who did not (25 % v 65 %, p < 0.001), however chance of conceiving with FET was no different between these two groups (38 % v 38 %, NS).

Conclusions: An unexpectedly low number of patients undergoing a donor oocyte IVF cycle will ultimately return to utilize extra embryos from their fresh cycle. This is concerning considering the high numbers of oocytes retrieved and the known complications from hyperstimulation, especially in light of the relatively high pregnancy rates associated with donor cycles. This raises concerns not only for donor management, but also raises ethical dilemmas when considering the large numbers of remaining embryos that will never be utilized.
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http://dx.doi.org/10.1007/s10815-013-0038-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3790114PMC
August 2013

Invasive pneumococcal disease in Australia 2007 and 2008.

Commun Dis Intell Q Rep 2012 Jun 30;36(2):E151-65. Epub 2012 Jun 30.

Vaccine Preventable Diseases Surveillance Section, Office of Health Protection, Department of Health and Ageing, Canberra, Australian Capital Territory 2601.

Enhanced surveillance for invasive pneumococcal disease (IPD) was conducted in all Australian states and territories in 2007 and 2008 with comprehensive comparative data available since 2002. There were 1,477 cases of IPD notified to the National Notifiable Diseases Surveillance System in Australia in 2007; a notification rate of 7.0 cases per 100,000 population. In 2008 there were 1,628 cases; a notification rate of 7.6 cases per 100,000 population. The overall rate of IPD in Indigenous Australians was almost 6 times the rate in non-Indigenous Australians in 2007 and almost 5 times in 2008. By 2008, the 4th year of a funded universal infant 7-valent pneumococcal conjugate vaccine (7vPCV) program in Australia with a 3+0 schedule, vaccine serotype IPD notification rates in those identified as non-Indigenous decreased in all age groups compared with 2002 levels, most significantly by 96% in children aged less than 5 years. However, rates of disease in non-vaccine serotypes increased by 168% in children aged less than 5 years, including a four-fold increase in the number of cases due to serotype 19A. For the Aboriginal and Torres Strait Islander population, national pre-vaccination data are not available, as the vaccine program was funded for this group from 2001. From 2002 to 2008, the proportion of disease due to 7vPCV serotypes in children aged less than 5 years decreased by 77%, while disease due to non-7vPCV serotypes increased by 76%. In Indigenous adults (≥50 years), rates of 23vPPV serotypes increased by 92%. There were 120 deaths attributed to IPD in 2007 and 113 in 2008, although it should be noted that deaths may be under-reported. The number of invasive pneumococcal isolates with reduced penicillin susceptibility remains low and reduced susceptibility to third-generation cephalosporins is rare.
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June 2012

Genital rhabdomyoma of the urethra in an infant girl.

Hum Pathol 2012 Apr 10;43(4):597-600. Epub 2011 Oct 10.

Department of Pathology and Laboratory Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA.

Extracardiac rhabdomyomas are rare benign entities that usually occur in the head and neck region. Although genital rhabdomyoma is known to occur in the lower genital tract of young and middle-aged women, involvement of the anatomically adjacent urethra by rhabdomyoma is exceedingly rare. We present a case of genital rhabdomyoma arising from the urethra of an infant girl. The tumor was characterized by the submucosal presence of mature-appearing rhabdomyoblastic cells containing conspicuous cross-striations, with the cells set in a collagenous stroma. Necrosis and mitoses were absent. Skeletal muscle differentiation of the tumor cells was supported by positive immunohistochemical staining for desmin and myogenin. To our knowledge, this is the first case of urethral genital-type rhabdomyoma in a child.
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http://dx.doi.org/10.1016/j.humpath.2011.06.012DOI Listing
April 2012

Reanalyzing the modified Ferriman-Gallwey score: is there a simpler method for assessing the extent of hirsutism?

Fertil Steril 2011 Nov 15;96(5):1266-70.e1. Epub 2011 Sep 15.

Department of Obstetrics and Gynecology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA.

Objective: To determine whether assessing the extent of terminal hair growth in a subset of the traditional nine areas included in the modified Ferriman-Gallwey (mFG) score can serve as a simpler predictor of total body hirsutism when compared with the full scoring system, and to determine if this new model can accurately distinguish hirsute from nonhirsute women.

Design: Cross-sectional analysis.

Setting: Two tertiary care academic referral centers.

Patient(s): 1,951 patients presenting for symptoms of androgen excess.

Intervention(s): History and physical examination, including mFG score.

Main Outcome Measure(s): Total body hirsutism.

Result(s): A regression model using all nine body areas indicated that the combination of upper abdomen, lower abdomen, and chin was the best predictor of the total full mFG score. Using this subset of three body areas is accurate in distinguishing true hirsute from nonhirsute women when defining true hirsutism as mFG >7.

Conclusion(s): Scoring terminal hair growth only on the chin and abdomen can serve as a simple yet reliable predictor of total body hirsutism when compared with full-body scoring using the traditional mFG system.
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http://dx.doi.org/10.1016/j.fertnstert.2011.08.022DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3205229PMC
November 2011

Fatalities associated with the 2009 H1N1 influenza A virus in New York city.

Clin Infect Dis 2010 Jun;50(11):1498-504

Bureau of Communicable Disease, Division of Disease Control, New York City Department of Health and Mental Hygiene, New York, USA.

BACKGROUND. When the 2009 H1N1 influenza A virus emerged in the United States, epidemiologic and clinical information about severe and fatal cases was limited. We report the first 47 fatal cases of 2009 H1N1 influenza in New York City. METHODS. The New York City Department of Health and Mental Hygiene conducted enhanced surveillance for hospitalizations and deaths associated with 2009 H1N1 influenza A virus. We collected basic demographic and clinical information for all patients who died and compared abstracted data from medical records for a sample of hospitalized patients who died and hospitalized patients who survived. RESULTS. From 24 April through 1 July 2009, 47 confirmed fatal cases of 2009 H1N1 influenza were reported to the New York City Department of Health and Mental Hygiene. Most decedents (60%) were ages 18-49 years, and only 4% were aged 65 years. Many (79%) had underlying risk conditions for severe seasonal influenza, and 58% were obese according to their body mass index. Thirteen (28%) had evidence of invasive bacterial coinfection. Approximately 50% of the decedents had developed acute respiratory distress syndrome. Among all hospitalized patients, decedents had presented for hospitalization later (median, 3 vs 2 days after illness onset; P < .05) and received oseltamivir later (median, 6.5 vs 3 days; P < .01) than surviving patients. Hospitalized patients who died were less likely to have received oseltamivir within 2 days of hospitalization than hospitalized patients who survived (61% vs 96%; P < .01). CONCLUSIONS. With community-wide transmission of 2009 H1N1 influenza A virus, timely medical care and antiviral therapy should be considered for patients with severe influenza-like illness or with underlying risk conditions for complications from influenza.
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http://dx.doi.org/10.1086/652446DOI Listing
June 2010

Staphylococcus aureus in the community: colonization versus infection.

PLoS One 2009 Aug 20;4(8):e6708. Epub 2009 Aug 20.

Department of Epidemiology and Biostatistics, School of Public Health, New York Medical College, Valhalla, New York, USA.

Background: Antibiotic-resistant Staphylococcus aureus infections have increased dramatically in the community, yet S. aureus nasal colonization has remained stable. The objectives of this study were to determine if S. aureus colonization is a useful proxy measure to study disease transmission and infection in community settings, and to identify potential community reservoirs.

Methodology/principal Findings: Randomly selected households in Northern Manhattan, completed a structured social network questionnaire and provided nasal swabs that were typed by pulsed field gel electrophoresis to identify S. aureus colonizing strains. The main outcome measures were: 1) colonization with S. aureus; and 2) recent serious skin infection. Risk factor analyses were conducted at both the individual and the household levels; logistic regression models identified independent risks for household colonization and infection.

Results: 321 surveyed households contained 914 members. The S. aureus prevalence was 25% and MRSA was 0.4%. More than 40% of households were colonized. Recent antibiotic use was the only significant correlate for household colonization (p = .002). Seventy-eight (24%) households reported serious skin infection. In contrast with colonization, five of the six risk factors that increased the risk of skin infection in the household at the univariate level remained independently significant in multivariable analysis: international travel, sports participation, surgery, antibiotic use and towel sharing. S. aureus colonization was not significantly associated with serious skin infection in any analysis. Among multiperson households with more than one person colonized, 50% carried the same strain.

Conclusions/significance: The lack of association between S. aureus nasal colonization and serious skin infection underscores the need to explore alternative venues or body sites that may be crucial to transmission. Moreover, the magnitude of colonization and infection within the household suggests that households are an underappreciated and substantial community reservoir.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0006708PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2724739PMC
August 2009

Invasive pneumococcal disease in Australia, 2006.

Commun Dis Intell Q Rep 2008 Mar;32(1):18-30

Surveillance Policy and Systems Section, Department of Health and Ageing, Canberra, Australian Capital Territory.

Enhanced surveillance for invasive pneumococcal disease (IPD) was carried out in all Australian states and territories in 2006 with comprehensive comparative data available since 2002. There were 1,445 cases of IPD notified to the National Notifiable Diseases Surveillance System in Australia in 2006; a notification rate of 7 cases per 100,000 population. The rates varied between states and territories and by geographical region with the highest rates in the Northern Territory, the jurisdiction with the largest proportion of Indigenous people. Invasive pneumococcal disease was reported most frequently in those aged 85 years or over (30.8 cases per 100,000 population) and in children aged one year (26.5 cases per 100,000 population). There were 130 deaths attributed to IPD resulting in an overall case fatality rate of 9%. The overall rate of IPD in Indigenous Australians was 4.3 times the rate in non-indigenous Australians. The rate of IPD in the under two years population continued to fall in 2006, but the rate in Indigenous children (73 cases per 100,000 population) was significantly greater than in non-Indigenous children (21 cases per 100,000 population). The rates of disease caused by serotypes in the 7-valent pneumococcal conjugate vaccine (7vPCV) decreased between 2002 and 2006 by 78% in children aged under two years as a result of the introduction of a universal childhood 7vPCV immunisation program. Significant decreases in IPD caused by 7vPCV serotypes also occurred in the 2-14 years and 65 years or over age groups. Rates of disease caused by non-7vPCV in the same periods were little changed. Serotypes were identified in 94% of all notified cases, with 43% of disease caused by serotypes in the 7vPCV and 85% caused by serotypes in the 23-valent polysaccharide pneumococcal vaccine (23vPPV). The number of invasive pneumococcal isolates with reduced penicillin susceptibility remains low and reduced susceptibility to third generation cephalosporins is rare.
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March 2008