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Candida auris is a multidrug-resistant yeast which has emerged in healthcare facilities worldwide, however little is known about identification methods, patient colonization, spread, environmental survival, and drug resistance. Colonization on both biotic and abiotic surfaces, along with travel, appear to be the major factors for the spread of this pathogen across the globe. In this investigation, we present laboratory findings from an ongoing C. auris outbreak in NY from August 2016 through 2018. A total of 540 clinical isolates, 11,035 patient surveillance specimens, and 3,672 environmental surveillance samples were analyzed. Laboratory methods included matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) for yeast isolate identification, real-time PCR for rapid surveillance sample screening, culture on selective/non-selective media for recovery of C. auris and other yeasts from surveillance samples, antifungal susceptibility testing to determine the C. auris resistance profile, and Sanger sequencing of ribosomal genes for C. auris genotyping. Results included: a) identification and confirmation of C. auris in 413 clinical isolates and 931 patient surveillance isolates, as well as identification of 277 clinical cases and 350 colonized cases from 151 healthcare facilities including 59 hospitals, 92 nursing homes, 1 long-term acute care hospital (LTACH), and 2 hospices, b) successful utilization of an in-house developed C. auris real-time PCR assay for the rapid screening of patient and environmental surveillance samples, c) demonstration of relatively heavier colonization of C. auris in nares compared to the axilla/groin, and d) predominance of the South Asia Clade I with intrinsic resistance to fluconazole and elevated minimum inhibitory concentration (MIC) to voriconazole (81%), amphotericin B (61%), 5-FC (3%) and echinocandins (1%). These findings reflect greater regional prevalence and incidence of C. auris and the deployment of better detection tools in an unprecedented outbreak.

Objective To evaluate body image in adolescents with and without craniofacial conditions and to examine relationships between body image and quality of life. Design Case-control design. Setting A pediatric hospital's craniofacial center and primary care practices. Participants Seventy adolescents with visible craniofacial conditions and a demographically matched sample of 42 adolescents without craniofacial conditions. Main Outcome Measure Adolescents completed measures of quality of life and body image including satisfaction with weight, facial and overall appearance, investment in appearance (importance of appearance to self-worth), and body image disturbance (appearance-related distress and impairment in functioning). Results Adolescents with craniofacial conditions reported lower appearance investment ( P < .001) and were more likely to report concerns about facial features ( P < .02) compared with nonaffected youth. Females in both groups reported greater investment in appearance, greater body image disturbance, and lower weight satisfaction compared with males ( P < .01). Within both groups, greater body image disturbance was associated with lower quality of life ( P < .01). The two groups did not differ significantly on measures of quality of life, body image disturbance, or satisfaction with appearance. Conclusions Body image and quality of life in adolescents with craniofacial conditions are similar to nonaffected youth. Relationships between body image and quality of life emphasize that appearance perceptions are important to adolescents’ well-being regardless of whether they have a facial disfigurement. Investment in one's appearance may explain variations in body image satisfaction and serve as an intervention target, particularly for females.

Objectives: Strategies for oxygen therapy for preterm infants, such as the Vermont-Oxford's ‘Breathsavers' guidelines, seek to strike a balance between the potential risks of the extremes of hyperoxia and hypoxia in preterm infants. Using an algorithm based on those guidelines, we aimed to compare the proportion of time spent within the SpO2 target range during algorithm-based management of oxygen delivery compared with routine nursing care. Study Design: In a randomised crossover trial, maintenance of SpO2 over a 4-hour period during routine care was compared with algorithm-based control (administered by a dedicated research nurse). SpO2 target (88-92%) and alarm limits (86-94%) were identical in both arms. Infants 8 desaturations episodes to Results: 16 infants with a gestation of 26.7 ± 1.3 weeks (mean ± SD) and birth weight 901 ± 193 g were studied at a postmenstrual age of 30.5 ± 2.4 weeks. The percentage of time spent within target range was 34.6 ± 28.5% during routine care versus 38.3 ± 29.3% during algorithm-based care (p = 0.23). Compliance with alarm limits was 58.4 ± 21.8% during routine versus 64.7 ± 22.1% for algorithm-based care (p = 0.091). The frequency of desaturations, episode severity or number of FiO2 adjustments did not differ between the two care strategies. Conclusions: The observation that algorithm-based control did not improve time spent within the SpO2 target and alarm limits suggests nursing care has reached an optimum in the unit studied. Our finding indicates that significant modifications to the algorithm are likely to be necessary to improve target range compliance. © 2014 S. Karger AG, Basel