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Large tertiary care hospitals (TCHs) are thought to have higher antimicrobial resistance (AMR) rates when compared to small community hospitals (SCHs) as they provide care to patients with higher disease severity. However, we found no systematic differences in AMR rates between TCHs and SCHs in the United States. [ABSTRACT FROM AUTHOR]

Discusses the use of meiofauna in the assessment of contaminated terrestrial sites. Sampling of communities present in a former explosives burning ground; Dominance of nematoda in the sites; Structures of the nematode communities.

Background Acinetobacter baumannii is a common cause of healthcare-associated infections. Carbapenem-resistant (CR) A baumannii is a significant threat globally. We used a large reference laboratory database to study the epidemiology of A baumannii in children in the United States. Methods Antimicrobial susceptibility data from The Surveillance Network were used to phenotypically identify antibiotic resistance in A baumannii isolates in children 1–17 years of age between January 1999 and July 2012. Logistic regression analysis was used to calculate trends in the prevalence of antibiotic resistance in A baumannii. Isolates from infants (<1 year old) were excluded. Results The crude proportion of cephalosporin-resistant (CephR) A baumannii increased from 13.2% in 1999 to 23.4% in 2012 with a peak of 32.5% in 2008, and the proportion of CR A baumannii increased from 0.6% in 1999 to 6.1% in 2012 with a peak of 12.7% in 2008. From 1999 to 2012, the proportion of CephR and CR A baumannii increased each year by 3% and 8%, respectively (CephR odds ratio [OR] = 1.03, 95% confidence interval [CI], 1.01–1.04; CR OR = 1.08, 95% CI, 1.05–1.12); however, after 2008, a significant decrease in trend was observed (CephR OR = 0.78, 95% CI, 0.71–0.87; CR OR = 0.73, 95% CI, 0.62–0.86), but resistance remained higher than baseline (1999). Conclusions Overall, between 1999 and 2012, CephR and CR A baumannii isolates increased in children; however, a decreasing trend was observed after 2008.There is a need for ongoing surveillance of A baumannii infections and continued assessment of effective prevention strategies in vulnerable populations. [ABSTRACT FROM AUTHOR]

Background: In 2005, Bangladesh, India and Nepal agreed to eliminate visceral leishmaniasis (VL) as a public health problem. The approach to this was through improved case detection and treatment, and controlling transmission by the sand fly vector Phlebotomus argentipes, with indoor residual spraying (IRS) of insecticide. Initially, India applied DDT with stirrup pumps for IRS, however, this did not reduce transmission. After 2015 onwards, the pyrethroid alpha-cypermethrin was applied with compression pumps, and entomological surveillance was initiated in 2016. Methods: Eight sentinel sites were established in the Indian states of Bihar, Jharkhand and West Bengal. IRS coverage was monitored by household survey, quality of insecticide application was measured by HPLC, presence and abundance of the VL vector was monitored by CDC light traps, insecticide resistance was measured with WHO diagnostic assays and case incidence was determined from the VL case register KAMIS. Results: Complete treatment of houses with IRS increased across all sites from 57% in 2016 to 70% of houses in 2019, rising to >80% if partial house IRS coverage is included (except West Bengal). The quality of insecticide application has improved compared to previous studies, average doses of insecticide on filters papers ranged from 1.52 times the target dose of 25mg/m2 alpha-cypermethrin in 2019 to 1.67 times in 2018. Resistance to DDT has continued to increase, but the vector was not resistant to carbamates, organophosphates or pyrethroids. The annual and seasonal abundance of P. argentipes declined between 2016 to 2019 with an overall infection rate of 0.03%. This was associated with a decline in VL incidence for the blocks represented by the sentinel sites from 1.16 per 10,000 population in 2016 to 0.51 per 10,000 in 2019. Conclusion: Through effective case detection and management reducing the infection reservoirs for P. argentipes in the human population combined with IRS keeping P. argentipes abundance and infectivity low has reduced VL transmission. This combination of effective case management and vector control has now brought India within reach of the VL elimination targets. Author summary: Visceral Leishmaniasis (VL), also known as kala-azar, is a major parasitic disease in South Asia (Indian subcontinent), with 85% of the disease incidence in India. Historically VL had been controlled and almost eliminated with Indoor Residual Spraying (IRS) using dichlorodiphenyltrichloroethane (DDT). However, reinitiating this approach in 2015 failed due to high insecticide resistance in the sand fly vector and poor IRS quality, meaning that VL elimination targets were not met. To improve this the National Vector Borne Disease Control Programme changed to an effective insecticide, alpha-cypermethrin and altered the mode of application to compression pumps. Sentinel sites were established to monitor the entomological indicators, these showed the positive impact of these changes from 2016 to 2019. During this period the overall incidence of disease has decreased, and India is now on track to reach it's target incidence for VL of less than 1/1000 people at the sub-district (block) level. [ABSTRACT FROM AUTHOR]

Rescue excavation at Caldicot, C went (ST 4787) revealed at least six kilns of late third to early fourth century A. D. date, along with evidence for earlier (third century) production jars form the most important class of vessel produced and forms reminiscent of BB1 were particularly significant. The kiln products fit within the chronologically much broader reduced ware tradition of south-east Wales. [ABSTRACT FROM AUTHOR]

Background: Indoor residual spraying (IRS) is a key tool for controlling and eliminating malaria by targeting vectors. To support the development of effective intervention strategies it is important to understand the impact of vector control tools on malaria incidence and on the spread of insecticide resistance. In 2006, the World Health Organization (WHO) stated that countries should report on coverage and impact of IRS, yet IRS coverage data are still sparse and unspecific. Here, the subnational coverage of IRS across sub-Saharan Africa for the four main insecticide classes from 1997 to 2017 were estimated. Methods: Data on IRS deployment were collated from a variety of sources, including the President's Malaria Initiative spray reports and National Malaria Control Programme reports, for all 46 malaria-endemic countries in sub-Saharan Africa from 1997 to 2017. The data were mapped to the applicable administrative divisions and the proportion of households sprayed for each of the four main insecticide classes; carbamates, organochlorines, organophosphates and pyrethroids was calculated. Results: The number of countries implementing IRS increased considerably over time, although the focal nature of deployment means the number of people protected remains low. From 1997 to 2010, DDT and pyrethroids were commonly used, then partly replaced by carbamates from 2011 and by organophosphates from 2013. IRS deployment since the publication of resistance management guidelines has typically avoided overlap between pyrethroid IRS and ITN use. However, annual rotations of insecticide classes with differing modes of action are not routinely used. Conclusion: This study highlights the gaps between policy and practice, emphasizing the continuing potential of IRS to drive resistance. The data presented here can improve studies on the impact of IRS on malaria incidence and help to guide future malaria control efforts. [ABSTRACT FROM AUTHOR]

Abstract Objectives With increasing global interest in hospital antimicrobial stewardship (AMS) programmes, there is a strong demand for core elements of AMS to be clearly defined on the basis of principles of effectiveness and affordability. To date, efforts to identify such core elements have been limited to Europe, Australia, and North America. The aim of this study was to develop a set of core elements and their related checklist items for AMS programmes that should be present in all hospitals worldwide, regardless of resource availability. Methods A literature review was performed by searching Medline and relevant websites to retrieve a list of core elements and items that could have global relevance. These core elements and items were evaluated by an international group of AMS experts using a structured modified Delphi consensus procedure, using two-phased online in-depth questionnaires. Results The literature review identified seven core elements and their related 29 checklist items from 48 references. Fifteen experts from 13 countries in six continents participated in the consensus procedure. Ultimately, all seven core elements were retained, as well as 28 of the initial checklist items plus one that was newly suggested, all with ≥80% agreement; 20 elements and items were rephrased. Conclusions This consensus on core elements for hospital AMS programmes is relevant to both high- and low-to-middle-income countries and could facilitate the development of national AMS stewardship guidelines and adoption by healthcare settings worldwide. [ABSTRACT FROM AUTHOR]

The development of insecticide resistance in African malaria vectors threatens the continued efficacy of important vector control methods that rely on a limited set of insecticides. To understand the operational significance of resistance we require quantitative information about levels of resistance in field populations to the suite of vector control insecticides. Estimation of resistance is complicated by the sparsity of observations in field populations, variation in resistance over time and space at local and regional scales, and crossresistance between different insecticide types. Using observations of the prevalence of resistance in mosquito species from the Anopheles gambiae complex sampled from 1,183 locations throughout Africa, we applied Bayesian geostatistical models to quantify patterns of covariation in resistance phenotypes across different insecticides. For resistance to the three pyrethroids tested, deltamethrin, permethrin, and λ-cyhalothrin, we found consistent forms of covariation across sub-Saharan Africa and covariation between resistance to these pyrethroids and resistance to DDT. We found no evidence of resistance interactions between carbamate and organophosphate insecticides or between these insecticides and those from other classes. For pyrethroids and DDT we found significant associations between predicted mean resistance and the observed frequency of kdr mutations in the Vgsc gene in field mosquito samples, with DDT showing the strongest association. These results improve our capacity to understand and predict resistance patterns throughout Africa and can guide the development of monitoring strategies. [ABSTRACT FROM AUTHOR]

Objectives: Borderline personality disorder (BPD) is associated with frequent self-harm and suicidal behaviours. This study compared physician-assessed self-harm risk and intervention choice according to a (i) standard risk assessment and (ii) BPD-specific risk assessment methods.Methods: Forty-five junior and senior mental health physicians were assigned to standard or BPD-specific risk training groups. The assessment utilized a BPD case vignette containing four scenarios describing high/low lethality self-harm and chronic/new patterns of self-harm behaviour. Participants chose from among four interventions, each corresponding to a risk category.Results: Standard and BPD-specific groups were alike in their assessment of self-harm risk. Divergence occurred on intervention choice for assessments of low lethality, chronic risk ( p<.01) and high lethality, chronic risk ( p<.005). Overall, psychiatrists were more likely than their junior colleagues to correctly assess risk and management options.Conclusions: Although standard and BPD-specific methods are well aligned for assessing self harm-associated risk, BPD-specific training raised awareness of BPD-appropriate interventions, particularly in the context of chronic patterns of self-harm behaviour. Wider dissemination of BPD-specific risk training may enhance the confidence of mental health clinicians in identifying the nature of self-harm risk as well as the most clinically appropriate interventions for clients with BPD. [ABSTRACT FROM AUTHOR]

Motivation: The arbor morphologies of brain microglia are important indicators of cell activation. This article fills the need for accurate, robust, adaptive and scalable methods for reconstructing 3-D microglial arbors and quantitatively mapping microglia activation states over extended brain tissue regions. Results: Thick rat brain sections (100-300 μm) were multiplex immunolabeled for IBA1 and Hoechst, and imaged by step-and-image confocal microscopy with automated 3-D image mosaicing, producing seamless images of extended brain regions (e.g. 5903×9874×229 voxels). An over-complete dictionary-based model was learned for the image-specific local structure of microglial processes. The microglial arbors were reconstructed seamlessly using an automated and scalable algorithm that exploits microglia-specific constraints. This method detected 80.1 and 92.8% more centered arbor points, and 53.5 and 55.5% fewer spurious points than existing vesselness and LoG-based methods, respectively, and the traces were 13.1 and 15.5% more accurate based on the DIADEM metric. The arbor morphologies were quantified using Scorcioni's L-measure. Coifman's harmonic co-clustering revealed four morphologically distinct classes that concord with known microglia activation patterns. This enabled us to map spatial distributions of microglial activation and cell abundances. [ABSTRACT FROM AUTHOR]

The article discusses a study aimed to determine the clinical benefit of a mentalization-based intervention (MBI) added to a recovery-based model of care for borderline personality disorder (BPD) consumers with a history of recurrent, deliberate self-harm. Topics covered include an assessment of the implementation of the MBI, its compatibility with a recovery-based case psychiatric management approach, and

Background There is a need for effective computational methods for quantifying the three-dimensional (3-D) spatial distribution, cellular arbor morphologies, and the morphological diversity of brain astrocytes to support quantitative studies of astrocytes in health, injury, and disease. New method Confocal fluorescence microscopy of multiplex-labeled (GFAP, DAPI) brain tissue is used to perform imaging of astrocytes in their tissue context. The proposed computational method identifies the astrocyte cell nuclei, and reconstructs their arbors using a local priority based parallel (LPP) tracing algorithm. Quantitative arbor measurements are extracted using Scorcioni's L-measure, and profiled by unsupervised harmonic co-clustering to reveal the morphological diversity. Results The proposed method identifies astrocyte nuclei, generates 3-D reconstructions of their arbors, and extracts quantitative arbor measurements, enabling a morphological grouping of the cell population. Comparison with existing methods Our method enables comprehensive spatial and morphological profiling of astrocyte populations in brain tissue for the first time, and overcomes limitations of prior methods. Visual proofreading of the results indicate a >95% accuracy in identifying astrocyte nuclei. The arbor reconstructions exhibited 3.2% fewer erroneous jumps in tracing, and 17.7% fewer false segments compared to the widely used fast-marching method that resulted in 9% jumps and 20.8% false segments. Conclusions The proposed method can be used for large-scale quantitative studies of brain astrocyte distribution and morphology. [ABSTRACT FROM AUTHOR]

In recent years, there has been an increase in resistance of malaria vectors to insecticides, particularly to pyrethroids which are widely used in insecticide-treated nets. The Global Plan for Insecticide Resistance Management in malaria vectors (GPIRM), released in May 2012, is a collective strategy for the malaria community to tackle this challenge. This review outlines progress made to date and the challenges experienced in the implementation of GPIRM, and outlines focus areas requiring urgent attention. Whilst there has been some advancement, uptake of GPIRM at the national level has generally been poor for various reasons, including limited availability of vector control tools with new mechanisms of action as well as critical financial, human and infrastructural resource deficiencies. There is an urgent need for a global response plan to address these deficits and ensure the correct and efficient use of available tools in order to maintain the effectiveness of current vector control efforts whilst novel vector control tools are under development. Emphasis must be placed on enhancing national capacities (such as human and infrastructural resources) to enable efficient monitoring and management of insecticide resistance, and to support availability and accessibility of appropriate new vector control products. Lack of action by the global community to address the threat of insecticide resistance is unacceptable and deprives affected communities of their basic right of universal access to effective malaria prevention. Aligning efforts and assigning the needed resources will ensure the optimal implementation of GPIRM with the ultimate goal of maintaining effective malaria vector control. [ABSTRACT FROM AUTHOR]

The effect of long-term heavy-metal contamination on soil microbial and meiofaunal communities was assessed with a view to determining whether analysis of these communities could be used for ecological assessment of contaminated sites. Thirty soil cores were taken from an industrial site formerly used for the burning of waste from an explosives factory. The predominant contaminants in the soil were a range of heavy metals, including lead, copper and zinc. The numbers of culturable bacteria (especially those grown on Pseudomonas selective media) and the microbial community response to a suite of 95 carbon sources were suppressed in samples with high heavy-metal contamination. This corresponded to a reduction in the density and evenness of the nematode communities in the samples with high metal concentrations. Conversely the bacterial counts and responses to the 95 carbon sources were greater at sites with higher and more diverse populations of nematodes. However, epifluorescence counts of bacteria and the profiles of extracted fatty acids were not consistently altered by the heavy-metal contamination. These results suggest that culturable bacteria are effective indicators of pollution in soil, and reflect the perturbations seen in other components of the soil biota. Furthermore, this is the first study to show that both meiofaunal communities and microbial communities give similar indications of the ecological impact of heavy-metal contamination in soil. [Copyright &y& Elsevier]

Introduction Mettre en place des programmes de bon usage des antibiotiques dans tous les hôpitaux est essentiel pour lutter contre l’antibiorésistance. Une liste des mesures devant impérativement faire partie de ces programmes n’a été établie qu’en Europe, aux États-Unis et en Australie. L’objectif de ce travail était d’identifier et valider avec une méthode Delphi les mesures essentielles aux programmes de bon usage des antibiotiques qui peuvent être applicables dans tous les hôpitaux au niveau mondial. Matériels et méthodes Une revue de la littérature a été effectuée à partir d’une recherche Medline et sur les sites internet des principales organisations nationales et internationales afin d’identifier toutes les mesures décrites ( core elements et checklist items ). Un groupe d’experts a évalué chaque mesure identifiée en répondant à deux reprises à un questionnaire en ligne. Les mesures sélectionnées par ≥ 80 % des experts étaient retenues dès le premier questionnaire, celles sélectionnées par 70–79 % des experts étaient réévaluées lors du deuxième questionnaire et les mesures sélectionnées par < 70 % des experts étaient rejetées. Résultats La revue de la littérature a identifié 48 références, à partir desquelles 7 core elements (type de stratégie, e.g. Formation) et 29 checklist items (mesure précise au sein de la stratégie, e.g. Formation des prescripteurs) ont été recueillis. Quinze experts (Amérique du Nord = 2, Amérique latine et du Sud = 2, Europe = 5, Afrique = 2, Asie = 3, Australie = 1) ont participé à la procédure de consensus formalisé. Au final, tous les 7 core elements ont été retenus et 29 checklist items ont été sélectionnés (28 des 29 identifiés initialement, + un item suggéré par les experts). Conclusion Nous avons validé des standards minimaux qui peuvent être applicables au niveau international pour les programmes de bon usage des antibiotiques hospitaliers. Ce travail peut aider chaque pays, y compris les pays aux ressources limitées, à développer des recommandations nationales. [ABSTRACT FROM AUTHOR]