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Mycobacterium tuberculosis infection outcomes have been described as active tuberculosis or latent infection but a spectrum of outcomes is now recognized. We used a nonhuman primate model, which recapitulates human infection, to characterize the clinical, microbiologic, and radiographic patterns associated with developing latent M. tuberculosis infection. Four patterns were identified. "Controllers" had normal erythrocyte sedimentation rate (ESR) without M. tuberculosis growth in bronchoalveolar lavage or gastric aspirate (BAL/GA). "Early subclinicals" showed transient ESR elevation and/or M. tuberculosis growth on BAL/GA for 60 days postinfection, "mid subclinicals" were positive for 90 days, and "late subclinicals" were positive intermittently, despite the absence of clinical disease. Variability was noted regarding granuloma formation, lung/lymph node metabolic activity, lung/lymph node bacterial burden, gross pathology, and extrapulmonary disease. Like human M. tuberculosis infection, this highlights the heterogeneity associated with the establishment of latent infection, underscoring the need to understand the clinical spectrum and risk factors associated with severe disease. [ABSTRACT FROM AUTHOR]

Objective: To assess the effectiveness of introducing condom-catheter uterine balloon tamponade (UBT) for postpartum haemorrhage (PPH) management in low- and middle-income settings.Design: Stepped wedge, cluster-randomised trial.Setting: Eighteen secondary-level hospitals in Uganda, Egypt and Senegal.Population: Women with vaginal delivery from October 2016 to March 2018.Methods: Use of condom-catheter UBT for PPH management was introduced using a half-day training and provision of pre-packaged UBT kits. Hospitals were randomised to when UBT was introduced. The incident rate (IR) of study outcomes was compared in the control (i.e. before UBT) and intervention (i.e. after UBT) periods. Mixed effects regression models accounted for clustering (random effect) and time period (fixed effect).Main Outcome Measures: Combined IR of PPH-related invasive surgery and/or maternal death.Results: There were 28 183 and 31 928 deliveries in the control and intervention periods, respectively. UBT was used for 9/1357 and 55/1037 women diagnosed with PPH in control and intervention periods, respectively. PPH-related surgery or maternal death occurred in 19 women in the control period (IR = 6.7/10 000 deliveries) and 37 in the intervention period (IR = 11.6/10 000 deliveries). The adjusted IR ratio was 4.08 (95% confidence interval 1.07-15.58). Secondary outcomes, including rates of transfer and blood transfusion, were similar in the trial periods.Conclusions: Introduction of condom-catheter UBT in these settings did not improve maternal outcomes and was associated with an increase in the combined incidence of PPH-related surgery and maternal death. The lack of demonstrated benefit of UBT introduction with respect to severe outcomes warrants reflection on its role.Tweetable Abstract: Stepped wedge trial shows UBT introduction does not reduce the combined incidence of PPH-related surgery or death. [ABSTRACT FROM AUTHOR]

Bacille Calmette-Guerin (BCG), the only approved Mycobacterium tuberculosis (Mtb) vaccine, provides limited durable protection when administered intradermally. However, recent work revealed that intravenous (i.v.) BCG administration yielded greater protection in macaques. Here, we perform a dose-ranging study of i.v. BCG vaccination in macaques to generate a range of immune responses and define correlates of protection. Seventeen of 34 macaques had no detectable infection after Mtb challenge. Multivariate analysis incorporating longitudinal cellular and humoral immune parameters uncovered an extensive and highly coordinated immune response from the bronchoalveolar lavage (BAL). A minimal signature predicting protection contained four BAL immune features, of which three remained significant after dose correction: frequency of CD4 T cells producing TNF with interferon γ (IFNγ), frequency of those producing TNF with IL-17, and the number of NK cells. Blood immune features were less predictive of protection. We conclude that CD4 T cell immunity and NK cells in the airway correlate with protection following i.v. BCG. [Display omitted] • An i.v. Bacille Calmette-Guerin (BCG) dose-ranging study generated a range of protection against tuberculosis in macaques • Immune measurements from blood and BAL were integrated for correlates analysis • Multivariate analysis of BAL features revealed a highly coordinated immune network • Tuberculosis-specific CD4 Th1/Th17 and NK cells in the airway correlated with protection Vaccination with intravenous Bacille Calmette-Guerin (i.v. BCG) protects macaques from tuberculosis. Using a dose-ranging i.v. BCG strategy, Darrah, Zeppa, Wang, et al. elicited graded immune responses and 50% protection in macaques. Multivariate analysis of longitudinal cellular and humoral parameters identified antigen-specific CD4 T cells and NK cells in the airway as strong correlates of protection. [ABSTRACT FROM AUTHOR]

Occupational health nurses are key players in formulating a diagnosis, designing a plan of care, and implementing any interventions needed to promote safety. While adhering to accepted confidentiality parameters, occupational health nurses share findings with appropriate individuals and teams when they are relevant to the health and safety of others. No individual or department works alone to effect successful safety outcomes. Members of Occupational Health Services, Human Resources and Personnel, and the Safety Team depend on each other to improve work processes and create a safer work environment. [ABSTRACT FROM AUTHOR]

Avoidable complications after successful carotid endarterectomy surgery typically occur in the immediate postoperative period; most of these complications are related to hemodynamic instability. At Saint Agnes Medical Center, process variation resulted from 22 anesthesiologists and 11 surgeons doing the same process 242 ways. We introduced a Post-Anesthesia Care Unit Carotid Order Set to standardize the process, drug sequence, and drug choices for postoperative carotid endarterectomy patients. Ongoing monitoring demonstrated that this reduction in process variability resulted in a lower complication rate for stroke and wound hematoma. Copyright © 2001 by Aspen Publishers, Inc. [ABSTRACT FROM AUTHOR]