Search

Background Infection by Staphylococcus aureus (S. aureus) is a major cause of morbidity and mortality. Colonization by S. aureus increases the risk of infection. Little is known about decolonization strategies for S. aureus beyond antibiotics, however probiotics represent a promising alternative. A randomized controlled trial was conducted to determine the efficacy of Lactobacillus rhamnosus (L. rhamnosus) HN001 in reducing carriage of S. aureus at multiple body sites. Methods One hundred thirteen subjects, positive for S. aureus carriage, were recruited from the William S. Middleton Memorial Medical Center, Madison, WI, USA, and randomized by initial site of colonization, either gastrointestinal (GI) or extra-GI, to 4-weeks of oral L. rhamnosus HN001 probiotic, or placebo. Nasal, oropharyngeal, and axillary/groin swabs were obtained, and serial blood and fecal samples were collected. Differences in prevalence of S. aureus carriage at the end of the 4-weeks of treatment were assessed. Results The probiotic and placebo groups were similar in age, gender, and health history at baseline. S. aureus colonization within the stool samples of the extra-GI group was 15% lower in the probiotic than placebo group at the endpoint of the trial. Those in the probiotic group compared to the placebo group had 73% reduced odds (OR 0.27, 95% CI 0.07–0.98) of methicillin-susceptible S. aureus presence, and 83% reduced odds (OR 0.17, 95% CI 0.04–0.73) of any S. aureus presence in the stool sample at endpoint. Conclusion Use of daily oral L. rhamnosus HN001 reduced odds of carriage of S. aureus in the GI tract, however it did not eradicate S. aureus from other body sites. Trial registration ClinicalTrials.gov Identifier: NCT01321606. Registered March 21, 2011. Electronic supplementary material The online version of this article (10.1186/s12879-018-3028-6) contains supplementary material, which is available to authorized users.

Background Clostridium difficile is the most common cause of hospital-acquired infections, responsible for >450000 infections annually in the USA. Probiotics provide a promising, well-tolerated adjunct therapy to standard C. difficile infection (CDI) treatment regimens, but there is a paucity of data regarding their effectiveness for the treatment of an initial CDI. Objectives We conducted a pilot randomized controlled trial of 33 participants from February 2013 to February 2015 to determine the feasibility and health outcomes of adjunct probiotic use in patients with an initial mild to moderate CDI. Methods The intervention was a 28 day, once-daily course of a four-strain oral probiotic capsule containing Lactobacillus acidophilus NCFM, Lactobacillus paracasei Lpc-37, Bifidobacterium lactis Bi-07 and B. lactis Bl-04. The control placebo was identical in taste and appearance. Registered at clinicaltrials.gov: trial registration number = NCT01680874. Results Probiotic adjunct therapy was associated with a significant improvement in diarrhoea outcomes. The primary duration of diarrhoea outcome (0.0 versus 1.0 days; P = 0.039) and two exploratory outcomes, total diarrhoea days (3.5 versus 12.0 days; P = 0.005) and rate of diarrhoea (0.1 versus 0.3 days of diarrhoea/stool diary days submitted; P = 0.009), all decreased in participants with probiotic use compared with placebo. There was no significant difference in the rate of CDI recurrence or functional improvement over time between treatment groups. Conclusions Probiotics are a promising adjunct therapy for treatment of an initial CDI and should be further explored in a larger randomized controlled trial.

Background Staphylococcus aureus ( S. aureus ) is an organism of great public health importance, causing 20,000 deaths annually. Decolonization of patients with S. aureus may prevent infections, yet current options are limited to antimicrobials that promote antibiotic resistance and can cause adverse side effects. Probiotics have potential to reduce colonization of pathogenic bacteria, representing a promising alternative for S. aureus decolonization, but thus far lack rigorous evaluation. Methods Potential subjects were recruited from inpatient and outpatient settings within a VA medical center and screened for S. aureus gastrointestinal (GI) or extra-GI colonization using swabs at multiple body sites. Positive, eligible, consenting participants were stratified by colonization site and randomized in a 1:1 ratio to 4-weeks of daily placebo or Lactobacillus rhamnosus ( L. rhamnosus ) HN001 probiotic treatment. Blood and stool samples, and treatment adherence reports were collected from each subject throughout the study, along with a final set of swabs at study completion to detect S. aureus carriage. The outcomes of this study are GI or extra-GI carriage by S. aureus at the end of 4 weeks of therapy, change in phagocytic activity of polymorphonuclear cells from pre-intervention to post-intervention, and symptomatic S. aureus infection at any site during the study period. Conclusion 114 participants have been recruited for this study. Analysis of outcomes is underway. This is the first clinical trial to examine the efficacy of L. rhamnosus HN001 for decolonization of S. aureus , and investigates the mechanism by which L. rhamnosus HN001 mediates its effect on S. aureus colonization. ClinicalTrials.gov Identifier NCT01321606

Background Clostridium difficile is a pathogen of rapidly increasing public health importance. An estimated quarter of a million Clostridium difficile infections (CDI) occur in the United States annually, at a resultant cost of 14,000 deaths and 1 billion dollars. Clostridium difficile related deaths have risen 400% over the last decade, and current standard antibiotic treatments are only 75 to 85% successful. Besides increasing the risk of antibiotic resistance and side effects, these treatments are very expensive. The most vulnerable population for Clostridium difficile is older adults, who make up approximately half of the cases, but account for 90% of the related deaths. Probiotics may have potential as adjunctive therapeutic agents for CDIs, however, current data is limited. Methods This pilot study is a single-site, randomized, placebo-controlled, double-blind, phase two clinical trial. The trial primarily evaluates the effect of four weeks of probiotic therapy in addition to standard of care on Clostridium difficile diarrhea duration and recurrence. Secondary outcomes include effect on fecal cytokines, fecal lactoferrin, and Clostridium difficile toxin density in stool, as well as patient functional status. Discussion This pilot study will determine the feasibility and effect size to conduct larger randomized controlled trials of probiotic interventions in patients with CDI, to determine the impact of probiotics on the symptoms of CDI. ClinicalTrials.gov Identifier: NCT01680874

The prevalence of Clostridium difficile (C. difficile) spores was assessed in 48 observations of infected inpatients. Participants were randomized to hand hygiene with either alcohol based hand rub or soap and water. C. difficile was recovered in 14.6% of pre-hand hygiene observations. It was still present on five of these seven participants after hand hygiene (3/3 alcohol based hand rub; 2/4 soap and water).

BackgroundSmoking increases hospitalization and healthcare-associated infection. Our primary aim of this pilot, randomized-controlled trial was to examine the feasibility and acceptability of a tobacco cessation intervention compared with usual care in inpatients. S. aureus carriage, healthcare-associated infections and infections post discharge were exploratory outcomes.MethodsCurrent inpatient smokers from a university hospital facility were randomized to usual care or a face to face tobacco cessation counseling session where patients' tobacco use and strategies for quitting were discussed. Patient engagement, satisfaction and withdrawal symptoms were measured at 1week and 12weeks post discharge. Nasal swabs were collected at enrollment and discharge and assessed for S. aureus colonization. P-values were calculated using Fisher's exact and t-tests were used to compare groups.ResultsFor the study's primary outcome, participants reported the intervention as being generally acceptable and reported high overall levels of satisfaction, with a Likert scale score of at least 4/5 for all measures of satisfaction. No subjects utilized free tobacco cessation services after discharge. 83% of the intervention group and 93% of the control group smoked at least one cigarette after discharge. Secondary outcomes with regard to infections showed that, at discharge, 12% of the intervention group (n = 17) and 18% of the control group (n = 22) tested positive for S. aureus. After 3months, 9% of the intervention group developed infection, 41% visited an emergency room, and 24% were readmitted within 3months post-discharge, compared to 27, 32 and 36% of the control group respectively.ConclusionsWith regards to the primary aim of this study, there were overall high levels of satisfaction with the intervention, indicating good feasibility and acceptance among patients. However, more intensive interventions in hospitalized patients and impact on healthcare-associated infections and post-discharge infections should be explored.

Screening for vancomycin-resistant Enterococcus (VRE) has not been universally implemented within the Department of Veterans Affairs (VA). A prospective study was conducted to identify the admission prevalence rate of VRE in patients admitted to the intensive care unit in 2 VA facilities. Significant regional differences were found between the 2 facilities. Further studies are needed to account for regional differences in VRE admission prevalence, to optimize infection control interventions.

A prospective study was conducted to identify risk factors for vancomycin-resistant Enterococcus, including co-colonization with methicillin-resistant Staphylococcus aureus and Clostridium difficile infection in patients admitted to the intensive care unit in 2 Veterans Affairs facilities. Methicillin-resistant Staphylococcus aureus and Clostridium difficile infection co-colonization were significant risk factors for vancomycin-resistant Enterococcus colonization. Further studies are needed to identify measures for preventing co-colonization of these major organisms in veterans.

We investigated whether sex role stereotyping, adversarial sexual beliefs, acceptance of interpersonal violence, sex of the subject, characteristics of the child (age, sex), and characteristics of the alleged perpetrator (stranger, father) affect judgments of the credibility of children’s reports that they have been sexually abused. Two hundred and fifty-five college students in a 3 x 2 x 2 factorial arrangement were given the Burt (1980) scales and asked to read a short vignette in which a child alleged that he/she was sexually abused and the accused male denied the abuse. Although the vast majority of subjects indicated that they believed the child was telling the truth, females rated the child’s credibility significantly higher than males F(l, 253) = 6.29, p = .01226. No other significant relationships were found. The results imply that the vast majority of individuals in a college sample tended to believe children’s sexual abuse allegations and that this credibility assessment is not influenced by characteristics of the child or perpetrator examined in this study. Implications of the truncated range of the dependent variable and of the Burt scales are discussed.

While Peter Abelard (10791142) has always received scholarly attention for his philosophical works, his relationship with Heloise (d. 1164) and the letters between them have often been something of a curiosity, not useful for serious historians of religion but only for literary study, or rejected altogether for the uncertainty of their authorship. Mary Magdalene appears in devotional works, in the liturgy and hagiography, and in more expressly didactic forms, like sermons and letters or treatises of spiritual advice, throughout the late eleventh and early twelfth centuries in Northern France and England. The Magdalene inherited by the late eleventh and early twelfth century was the result of a long process of amalgamation and accretion. In the Problemata , Heloise poses a direct question about the Magdalenes role in the drama of resurrection. Keywords: Heloise; Mary Magdalene; While Peter Abelard

Methods: Medical records of 55 patients with OP who received ZA between February 2008 and November 2009 were reviewed. Data collected included demographics, bone mineral density (BMD) results, prior fracture history and steroid use. Physician’s reasons for utilizing ZA were recorded as were any documented side effects (SE). Patients were categorized by their physicians as ‘‘high risk for fracture’’ if they had prior fragility fractures or prednisone use. Results: Of 55 patients receiving ZA, 84% were Caucasian and 9% African American. All but 1 were female and the median age was 69 (Interquartile range (IQR) 62 to 80) years. 53% of patients had prior fragility fractures. History of prednisone use was reported in 38%. Median BMD for L-spine was 0.801 gm/ cm2 (IQR 0.74-0.95 gm/cm2) with a median T-score of 2.3 (IQR 2.8 to 1.07). Median BMD for total hip was 0.706 gm/cm2 (IQR 0.64-0.79) with a median T-score of 2.0 (IQR 2.6 to 1.3). Of 80% who had been on OBP before, 14% had been non-compliant. Of the compliant group, reasons for ZA use were: SE to OBP (35%), ‘‘high risk of fracture’’ (27%), loss of BMD on OBP (25%) and fracture on OBP (11%). Of the 20 % of patients receiving ZA first line, 64% were considered ‘‘high risk for fracture’’ and the remaining 36% were unable to take OBP due to gastroesophageal reflux. SE to ZA were documented in 3 cases (5%), these included flu-like symptoms in 2 patients and hypocalcemia in one. Conclusions: ZA was usually used as a second line agent for treatment of OP. The majority of patients receiving ZA first line were considered high risk for fracture by their physicians. This observation suggests that physicians perceived ZA as superior to OBP in high risk patients. However, further comparative studies are needed. ZA administration resulted in few side effects in our patient population.

The Glen Canyon Dam has severely altered the riparian zone of the Colorado River in the Grand Canyon. One result of the controlled river discharge is more efficient prediction of water stages at the major rapids, leading to higher visitor use. Increased visitation results in heavy foot traffic, trampling along the river banks, erosion of the campsite soils, and the destruction of vegetation. Erosion occurs when the surfaces are roughened, exposing them to wind transport and runoff. In addition, each footstep physically displaces sand downhill. The results of a field experiment designed to measure the amount of sand displaced by footsteps show that each year trampling alone displaces 230 m3 of sand downslope and into the river. With the controlled river flow, no natural processes exist to replace the lost sediment.

Relationships of student and academic variables with nursing licensure examination scores were examined. During the years 1978-1984, 164 graduates of an integrated baccalaureate program took the old State Board examination and 159 took the new examination. Among the pre-admission variables, gradepoint average and student age were most useful in predicting exam scores. Nursing lecture courses were better predictors of success than clinical courses. Students who received A-grades in lecture courses scored relatively higher and B-students scored lower on the new licensure examination compared to the old examinations. Compared with their classmates, students entering the program as LPNs did markedly better on the new licensure examination than they did on the old examinations.