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Objectives There is clinical uncertainty over the optimal treatment for penicillin-susceptible Staphylococcus aureus (PSSA) infections. Furthermore, there is concern that phenotypic penicillin susceptibility testing methods are not reliably able to detect some blaZ -positive S. aureus. Methods Nine S. aureus isolates, including six genetically diverse strains harbouring blaZ , were sent in triplicate to 34 participating laboratories from Australia (n  = 14), New Zealand (n  = 6), Canada (n  = 12), Singapore (n  = 1) and Israel (n  = 1). We used blaZ PCR as the gold standard to assess susceptibility testing performance of CLSI (P10 disc) and EUCAST (P1 disc) methods. Very major errors (VMEs), major error (MEs) and categorical agreement were calculated. Results Twenty-two laboratories reported 593 results according to CLSI methodology (P10 disc). Nineteen laboratories reported 513 results according to the EUCAST (P1 disc) method. For CLSI laboratories, the categorical agreement and calculated VME and ME rates were 85% (508/593), 21% (84/396) and 1.5% (3/198), respectively. For EUCAST laboratories, the categorical agreement and calculated VME and ME rates were 93% (475/513), 11% (84/396) and 1% (3/198), respectively. Seven laboratories reported results for both methods, with VME rates of 24% for CLSI and 12% for EUCAST. Conclusions The EUCAST method with a P1 disc resulted in a lower VME rate compared with the CLSI methods with a P10 disc. These results should be considered in the context that among collections of PSSA isolates, as determined by automated MIC testing, less than 10% harbour blaZ. Furthermore, the clinical relevance of phenotypically susceptible, but blaZ -positive S. aureus , remains unclear. [ABSTRACT FROM AUTHOR]

Here a new depth effect evoked by the spatial and temporal interaction in 2-D of a slowly moving circle (optimally at 0.6 rads/sec.) with an identical static circle is reported. Typically, respondents report that with increasing adjacency, commencing with separations of a few diameters, the moving circle appears in a different plane of depth to the static circle, it then usually appears to 'dip' onto the static circle and after complete coincidence with it to rise away from it. This effect, together with a number of associated descriptions are commented upon, in addition to observations when viewing overlapped static circles and overlapped circles in motion, this latter stimulus condition evoking the stereokinetic effect. The authors have previously suggested that contour 'sliding,' which simulates motion parallax, is the key to understanding stereokinesis. The stimulus conditions giving rise to this new effect directly simulate the motion parallax information present in a retinal image.

To the Editor: Community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) infection was first described in our region over 15 years ago (1). More recently, CAMRSA has become a global concern and is [...]

Objectives: Most outpatient parenteral antimicrobial therapy (OPAT) services use a hospital-based model of care in which patients remain in proximity to large hospitals facilitating clinical review. We aimed to evaluate clinical outcomes and complication rates for patients living in geographically isolated locations managed by telemedicine-supported OPAT. Methods: This was a retrospective cohort study.Results: Between 2011 and 2015, we delivered 88 episodes of care involving 83 adult patients resulting in 2261 days of OPAT. The median age was 56 years, 8 of 83 (10%) were indigenous Australian and the median Charlson comorbidity index score was 2 (IQR 1-4). The median distance of patients' residence from our hospital was 288 km (IQR 201-715) and the median duration on the programme was 26 days (IQR 14-34). Bone and joint infections accounted for 75% of infections treated. Favourable clinical outcomes (improvement or cure) were achieved in 87% of patients and the unplanned, OPAT-related readmission rate was 8%. Nineteen percent and 10% of patients had drug-related and line-related adverse effects, respectively.Conclusions: Despite a complex case mix, our adverse event and readmission rates are similar to the published literature describing a non-telemedicine model to deliver OPAT. High rates of favourable clinical outcomes and likely cost benefits suggest that telemedicine-supported OPAT is an efficacious and safe substitute for inpatient care in our setting. [ABSTRACT FROM AUTHOR]

Background: Methicillin-resistant Staphylococcus aureus (MRSA) bacteraemia is a serious infection resulting in 20-50 % 90-day mortality. The limitations of vancomycin, the current standard therapy for MRSA, make treatment difficult. The only other approved drug for treatment of MRSA bacteraemia, daptomycin, has not been shown to be superior to vancomycin. Surprisingly, there has been consistent in-vitro and in-vivo laboratory data demonstrating synergy between vancomycin or daptomycin and an anti-staphylococcal β-lactam antibiotic. There is also growing clinical data to support such combinations, including a recent pilot randomised controlled trial (RCT) that demonstrated a trend towards a reduction in the duration of bacteraemia in patients treated with vancomycin plus flucloxacillin compared to vancomycin alone. Our aim is to determine whether the addition of an anti-staphylococcal penicillin to standard therapy results in improved clinical outcomes in MRSA bacteraemia.Methods/design: We will perform an open-label, parallel-group, randomised (1:1) controlled trial at 29 sites in Australia, New Zealand, Singapore, and Israel. Adults (aged 18 years or older) with MRSA grown from at least one blood culture and able to be randomised within 72 hours of the index blood culture collection will be eligible for inclusion. Participants will be randomised to vancomycin or daptomycin (standard therapy) given intravenously or to standard therapy plus 7 days of an anti-staphylococcal β-lactam (flucloxacillin, cloxacillin, or cefazolin). The primary endpoint will be a composite outcome at 90 days of (1) all-cause mortality, (2) persistent bacteraemia at day 5 or beyond, (3) microbiological relapse, or (4) microbiological treatment failure. The recruitment target of 440 patients is based on an expected failure rate for the primary outcome of 30 % in the control arm and the ability to detect a clinically meaningful absolute decrease of 12.5 %, with a two-sided alpha of 0.05, a power of 80 %, and assuming 10 % of patients will not be evaluable for the primary endpoint.Discussion: Key potential advantages of adding anti-staphylococcal β-lactams to standard therapy for MRSA bacteraemia include their safety profile, low cost, and wide availability.Trial Registration: ClinicalTrials.gov Identifier: NCT02365493 . Registered 24 February 2015. [ABSTRACT FROM AUTHOR]

Background: In vitro laboratory and animal studies demonstrate a synergistic role for the combination of vancomycin and antistaphylococcal β-lactams for methicillin-resistant Staphylococcus aureus (MRSA) bacteremia. Prospective clinical data are lacking. Methods: In this open-label, multicenter, clinical trial, adults with MRSA bacteremia received vancomycin 1.5 g intravenously twice daily and were randomly assigned (1:1) to receive intravenous flucloxacillin 2 g every 6 hours for 7 days (combination group) or no additional therapy (standard therapy group). Participants were stratified by hospital and randomized in permuted blocks of variable size. Randomization codes were kept in sealed, sequentially numbered, opaque envelopes. The primary outcome was the duration of MRSA bacteremia in days. Results: We randomly assigned 60 patients to receive vancomycin (n = 29), or vancomycin plus flucloxacillin (n = 31). The mean duration of bacteremia was 3.00 days in the standard therapy group and 1.94 days in the combination group. According to a negative binomial model, the mean time to resolution of bacteremia in the combination group was 65% (95% confidence interval, 41%-102%; P = .06) that in the standard therapy group. There was no difference in the secondary end points of 28- and 90-day mortality, metastatic infection, nephrotoxicity, or hepatotoxicity. Conclusions: Combining an antistaphylococcal β-lactam with vancomycin may shorten the duration of MRSA bacteremia. Further trials with a larger sample size and objective clinically relevant end points are warranted. [ABSTRACT FROM AUTHOR]

Background Aim Methods Results Conclusion Infective endocarditis (IE) is a severe infection with considerable mortality. It is associated with geographical variation, complicating diagnosis and treatment of patients in a standardised manner.To evaluate the characteristics and management outcomes of patients with IE in Royal Perth Hospital (RPH).A single‐centre, retrospective cohort study. Data were collected from medical records of 131 patients with a diagnosis of IE admitted to RPH between 2016 and 2021.Eighty‐four patients with definite IE were included for analysis. The median age of patients was 51.5 years and 77.4% were male. Compared to the general Australian population, there was disproportionately greater representation of Indigenous Australians (21.4%), those with a history of injecting drug use (IDU) (27.4%), rheumatic heart disease (14.3%) and previous IE (13.1%). The most commonly affected valve was the mitral valve in 46.4% of patients, and the most common pathogen was Staphylococcus aureus in 47.6% of patients. Twelve‐month mortality was 16.7%, with significantly increased mortality in those treated non‐surgically (25.6% vs 7.3%, P = 0.025). Factors associated with undergoing surgery included the presence of aortic valve disease, perivalvular extension of infection and infection with Enterococcus faecalis, whereas IDU, tricuspid valve disease and S. aureus infection were associated with non‐surgical management. Adherence to multidisciplinary team review was 75.0%, and surgical management was performed in 70.7% of patients meeting an indication for surgery.IE mortality rates remain high, particularly in patients who do not undergo surgical management. Streamlined MDT assessment and referral for surgical management where appropriate is necessary to improve outcomes. [ABSTRACT FROM AUTHOR]

Examines the relationship between psychological resources and cigarette use in adolescents. Profile of adolescents who are more likely to use cigarettes; Example of characteristics associated with smoking in teenagers.

SUMMARY The first case of a phæochromocytoma of the urinary bladder occurring in a male is reported. The presenting symptom was hcematuria though on questioning the patient admitted to having lieadaches and palpitations on occasions after micturition. The tumour was resected with improvement in symptoms. The blood-pressure was raised before operation; it fell immediately after operation, and since then has, with the exception of one reading, been within normal limits. [ABSTRACT FROM AUTHOR]

A STUDY of the Health Education Council publica tion The Pregnancy Book1 was undertaken. A group of nulliparous pregnant women were sent this book with the information about their first hospital anten atal appointment. Two other groups were sent either the BMA publication You and Your Baby 2, or the Scottish Health Education Group Book of the Child3. The women's reactions to the book were assessed according to a wide range of criteria, including how much of it they had read, what they liked or disliked about it, and their knowledge of the material covered by the book. The responses to all the criteria were positive, and the overall reaction of the women was favourable. The majority had read at least some of the book before their first attendance at the clinic. No obvious social class differences were apparent. There were no significant differences in reaction to The Pregnancy Book over the other two books sent, but this seemed to be a result of the women thinking well of whichever particular book they had received. Though it should be noted that a number disliked the labour illustrations and two were not keen on the sections about when pregnancy goes wrong, there was nothing to suggest that the women would dislike receiving this book. [ABSTRACT FROM PUBLISHER]

The article profiles the health condition of Napoleon Buona Parte in Great Britain. Buona Parte was influenced to England and join the Royal Navy, and he was commissioned as second Lieutenant at the age of 16 and entered the crack artillery regiment of France. On the other hand, he developed malaria and a condition which was diagnosed as neurodermatitis when he was in Paris. On the other hand, on May 5, he died of carcinoma of the stomach, and the body was feminized.