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Background Recent work has argued that genus Klebsiella is best divided into 3 clades: K. pneumoniae (Kp), K. quasipneumoniae (Kq), and K. variicola (Kv). Kv has drawn attention from reports of higher mortality and virulence. We evaluated a previously defined group of military trauma patients with Klebsiella infections for the presence of Kv, described clinical and isolate characteristics, and compared Kv and Kp groups. Methods All initial and serial (≥7 days from prior isolate) infecting Kp isolates (identified by clinical laboratories without the ability to speciate Kq and Kv) were collected from the Trauma Infectious Disease Outcomes Study (6/09–12/14). Additionally, a previously defined group of colonizing isolates linked to the infecting isolates and a selection of random colonizers were included from groin swabs. DNA extraction and PCR targeting Kv per published methods was performed. Antimicrobial susceptibilities were determined using the BD Phoenix Automated Microbiology System and CLSI criteria. Multidrug resistance was defined as either resistance to ≥3 classes of aminoglycosides, β-lactams, carbapenems and/or fluoroquinolones or production of ESBL or KPC. Results Of 237 archived Kp isolates (from 122 patients), 10 (4%) were identified as Kv by PCR (from 8 [7%] patients). The Kv sources were 4 from blood (40%), 1 intra-abdominal (10%) and 5 from groin (50%). Six (3%) isolates were identified as Kq (4 from groin and 2 from respiratory specimens). The Kv and Kp patients were all males, with a median age of 25 (IQR 21–46) and 23 (IQR 21–28), length of hospital stay of 24 days (IQR: 5–106) and 53 days (IQR 36–74), and Injury Severity Score of 21 (IQR: 10–50) and 38 (IQR: 30–45), respectively. There were no deaths in the Kv group compared with 4 with Kp. Infecting Kv isolates were more likely to be from blood compared with Kp (80% vs. 17%, P = 0.04). No infecting Kv isolates were multidrug-resistant compared with 70% of infecting Kp isolates (P < 0.01). Conclusion Kv represented 4% of the previously identified Kp isolates in this population. Patient characteristics were similar in both groups. While Kv was less resistant than Kp, it was more likely to be associated with invasive disease in this group. Disclosures All authors: No reported disclosures.

Cognitive impairment presents a serious and common obstacle to competitive employment for people with severe mental illness, including those who receive supported employment. This study evaluated a cognitive enhancement program to improve cognition and competitive employment in people with mental illness who had not responded to supported employment.In a randomized controlled trial, 107 people with severe mental illness (46% with schizophrenia or schizoaffective disorder) who had not obtained or kept competitive work despite receiving high-fidelity supported employment were assigned to receive either enhanced supported employment (with specialized cognitive training of employment specialists) or enhanced supported employment plus the Thinking Skills for Work program, a standardized cognitive enhancement program that includes practice of computer cognitive exercises, strategy coaching, and teaching of coping and compensatory strategies. Research assistants tracked competitive employment weekly for 2 years, and assessors blind to treatment assignment evaluated cognitive functioning at baseline, at the end of cognitive enhancement training, and 12 and 24 months after baseline.Participants in the Thinking Skills for Work group improved more than those in the enhanced supported employment only group on measures of cognitive functioning and had consistently better competitive employment outcomes during the follow-up period, including in jobs obtained (60% compared with 36%), weeks worked (23.9 compared with 9.2), and wages earned ($3,421 compared with $1,728).The findings suggest that cognitive enhancement interventions can reduce cognitive impairments that are obstacles to work, thereby increasing the number of people who can benefit from supported employment and competitive work.

Background Biocides play an integral role in infection control. Paralleling concern about rising incidence of multidrug-resistant (MDR) organisms is a concern for resistance to biocides. In small studies, several genes involved in the production of efflux pump proteins have been identified as markers of biocide resistance in Klebsiella spp., namely cepA, qacA, qacE, qac∆E, and acrA. This study aimed to analyze the Klebsiella spp. isolates of a previously defined military trauma group with a high incidence of MDR organisms for the presence of these genes and their correlation with other resistance. Methods All infecting K. pneumoniae, K. variicola, and K. quasipneumoniae isolates archived by the Trauma Infectious Disease Outcomes Study (June 2009–December 2014) were selected. Additionally, all colonizing isolates linked with infecting isolates were included; the remainder to total 50 MDR and 46 non-MDR colonizing isolates were chosen randomly. Antimicrobial identification and susceptibilities were determined by CLSI criteria using the BD Phoenix Automated Microbiology System. PCR according to published methods for cepA, qacA, qacE, qac∆E, and acrA was accomplished in duplicate. MDR was defined as either resistance to ≥3 classes of aminoglycosides, β-lactams, carbapenems and/or fluoroquinolones or production of an ESBL or KPC. Results A total of 237 isolates (221 K. pneumoniae, 10 K. variicola, 6 K. quasipneumoniae) met inclusion criteria, of which 149 (63%) were MDR. All isolates had been exposed to antimicrobials prior to isolation. Of all isolates, 234 (98%) carried cepA: 218 (98%) K. pneumoniae carried cepA, 10 (100%) K. variicola carried cepA, and 6 (100%) of K. quasipneumoniae carried cepA. In addition, 148 (62%) isolates with cepA were MDR. One (10%) K. variicola isolate carried qacE along with cepA. This isolate was the only MDR K. variicola. None of the isolates carried qacA, qac∆E, or acrA. Conclusion We confirmed the near universal presence of the cepA biocide resistance gene in Klebsiella spp. isolated from trauma patients in Iraq and Afghanistan. In the largest evaluation of biocide resistance genes in Klebsiella spp. to our knowledge, the presence of qacA, qacE, qac∆E, and acrA was less common than has been reported elsewhere. Disclosures All authors: No reported disclosures.

A school-based program of mindful awareness practices (MAPs) was evaluated in a randomized control study of 64 second- and third-grade children ages 7–9 years. The program was delivered for 30 minutes, twice per week, for 8 weeks. Teachers and parents completed questionnaires assessing children's executive function immediately before and following the 8-week period. Multivariate analysis of covariance on teacher and parent reports of executive function (EF) indicated an interaction effect between baseline EF score and group status on posttest EF. That is, children in the MAPs group who were less well regulated showed greater improvement in EF compared with controls. Specifically, those children starting out with poor EF who went through the MAPs training showed gains in behavioral regulation, metacognition, and overall global executive control. These results indicate a stronger effect of MAPs on children with executive function difficulties. The finding that both teachers and parents reported changes sugg...

Mindfulness training offers one approach to promote self-regulation, and potentially, to improve long-term developmental outcomes. Although mindfulness training programs are geared primarily for adults, there have been advancements in the development of programs designed for children and adolescents. In this chapter, we focus on one mindfulness training program called Inner Kids and the impact it might have on self-regulation and other important health constructs. The objectives of this chapter are to define self-regulation and consider its relation to other conceptually similar constructs and its developmental trajectory across childhood and adolescence; provide a brief overview of mindfulness; and offer a discussion of how mindfulness training might promote self-regulation. We then turn to a discussion of Inner Kids, as well as to results of a randomized controlled trial testing the program’s beneficial effect on self-regulation in second- and third-grade children. We conclude with specific recommendations for future research.

Background: Traditionally important components of the surgical clerkship curriculum include lectures, small-group sessions, readings, clinical exposure, and testing. Time constraints require compromise among all these elements. At our institution, clinical exposure of medical students varies according to their team assignments. They differ primarily in exposure to such topics as trauma, inflammatory bowel disease (IBD), and vascular surgery. Purpose: The goal of this study was to quantify the influence of clinical exposure on medical student education, testing whether it influences examination performance. Methods: At the beginning of the clerkship, students were given a written multiple-choice examination covering these three topics. They completed two 4-week blocks on surgery services in various settings. At the end of the clerkship, they were reexamined. Differences between pretest and posttest overall mean rank were analyzed using the Wilcoxon signed ranks test. Differences in improvement based on clinical exposure were analyzed using the Mann-Whitney U test. Results: Statistically significant improvement was seen in overall examination performance, as well as in each of the subsections. However, these improvements could not be accounted for by clinical exposure. There was no statistically significant difference in mean rank in improvement based on clinical exposure to vascular, IBD, or trauma. Conclusions: Student examination scores improved over the course of the clerkship. No improvement could be attributed to greater clinical exposure to a topic.

In their everyday efforts to put together how they “look,” adolescents visually capture and articulate complex issues that society finds difficult to express verbally. In this paper we explore these “looks” as one example of youth appearance style and as a reflection of, and an impetus for, cultural anxieties. In doing so we draw on a series of multi‐method field studies conducted over the last ten years. A key feature of these studies has been the involvement of young people themselves as key informants and co‐investigators. Data from these studies can help clarify relationships between youth appearance style and cultural themes of sexuality and violence.

The following proposal for an MA and Ph.D. programme at the University of California, Davis, is the culmination of four years of meetings and other organizing activities focused on the formal institutionalization of cultural studies at UC Davis. Groundwork for the proposed cultural studies programme began in a series of discussions held by an interdisciplinary group of faculty about how to create the opportunity for structured graduate teaching, advising and research in cultural studies at UC Davis. The Dean of Graduate Studies at that time encouraged this group to submit a pre‐proposal for an MA and Ph.D. in cultural studies. Faculty involved in the original discussions subsequently drew up a pre‐proposal and held further informal meetings. E‐mail lists were created and information was disseminated. Eventually, an executive committee, whose charge it was to draw up a formal proposal, was formed. The following proposal grew out of the executive committee's early efforts. Cultural studies at UC Da...

Practicing within the paradigm of compartmentalized specially treatment without a collaborative practice is ineffective for the chemical dependency and dual diagnosis population. Chemical dependency is not well understood as a disease, evidenced by barriers cited from the 2005 Survey on Drug Use and Health. Recovery from addiction and dual diagnosis logically demands an integrated and science-based treatment approach with unified standards for care and improved educational standards for preparation of care providers. Consultation and collaboration with addiction and psychiatric specialists is needed to establish consistency in standards for treatment and holistic care, essential for comorbidity. Continued learning and research about the complexity of the addiction process and comorbidity will provide continued accurate information about the harmful effects of alcoholism and drug abuse which in turn will empower individuals to make informed choices and result in better treatment and social policies.

The objective of this article is to heighten awareness of the need for increased collaboration between treating clinicians and the chemical-dependency population. For this increased collaboration to occur, changes are required in treatment practices, including eradicating prescriptive medications that are contraindicated by the chemical dependency diagnosis. Case studies and professional literature suggest that such an increase would lead to more successful treatment outcomes for the chemical-dependency population as a whole. In addition, treatment parameters are discussed for the condition of pain coupled to the condition of substance abuse. Some of the recommendations proposed include increased collaboration between medical/mental health providers and substance-abuse treatment providers as a norm, valid screening for patients' comorbid mental illness and substance use in clinical settings, improved practices in prescribing medications that are contraindicated in the treatment of the chemical-dependency population, and evidence-based boundaries delineation for safe prescribing practice.

Background: Although women make up nearly half of medical school classes in the United States, just over 20% of residents in surgery are women (excluding obstetrics/gynecology). The objective of this study was to identify whether the proportion of women surgeons on the faculty who have frequent encounters with medical students during their surgery rotation influences the student’s perceptions about women surgeons or their career choice. Methods: Seven US medical schools with proportions of women surgeons on the fulltime faculty varying from 10% to 40% were selected to participate in this survey. Women medical students graduating in the spring of 2000 were asked to complete an anonymous 29 question survey designed to assess their perceptions of women surgeons’ career satisfaction. Demographic information about the students such as career choice, age, and marital status was also collected. The differences in responses between those schools with 40% women faculty and those with less than 15% were analyzed. Results: The overall response rate was 74% (305 of 413). Forty-five percent of students had daily or weekly contact with a woman surgery attending. There were no differences in perceptions of women surgeons’ career satisfaction for those students at schools with 40% women surgeons versus those with less than 15%. However, 21 of 24 (88%) students choosing surgery as a career were from the three schools with a greater number of women surgical role models (P

Background Standardized patient (SP) exercises are expensive and time consuming. We hypothesized that self-evaluation would further the goals of teaching and evaluation for a group of medical students. Methods Students were given self-evaluation checklists (essentially identical to those filled out by the SPs) and completed them prior to reviewing the SP checklists. Agreement between student and SP checklists (whether each item was checked or not) and the extent of agreement on the interactional skills rating scales were assessed. Results: Overall agreement was 93%, with 98% agreement on interactional items, 92% on physical examination items, and 89% on history items. Disagreements tended to be clustered on a few items in each scale. Scores on the interactional skills rating scales also showed strong agreement. Conclusion The use of checklists and rating scales in this context is well established. At virtually no cost, a self-evaluation tool adds a valuable dimension to the exercise.