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Despite evidence supporting earlier discharge of well-appearing febrile infants at low risk of serious bacterial infection (SBI), admissions for ≥48 hours remain common. Prospective safety monitoring may support broader guideline implementation.A sequential Bayesian safety monitoring framework was used to evaluate a new hospital guideline recommending early discharge of low-risk infants. Hospital readmissions within 7 days of discharge were regularly assessed against safety thresholds, derived from historic rates and expert opinion, and specified a priori (8 per 100 infants). Infants aged under 3 months admitted to 2 Western Australian metropolitan hospitals for management of fever without source were enrolled (August 2019–December 2021), to a prespecified maximum 500 enrolments.Readmission rates remained below the prespecified threshold at all scheduled analyses. Median corrected age was 34 days, and 14% met low-risk criteria (n = 71). SBI was diagnosed in 159 infants (32%), including urinary tract infection (n = 140) and bacteraemia (n = 18). Discharge occurred before 48 hours for 192 infants (38%), including 52% deemed low-risk. At study completion, 1 of 37 low-risk infants discharged before 48 hours had been readmitted (3%), for issues unrelated to SBI diagnosis. In total, 20 readmissions were identified (4 per 100 infants; 95% credible interval 3, 6), with >0.99 posterior probability of being below the prespecified noninferiority threshold, indicating acceptable safety.A Bayesian monitoring approach supported safe early discharge for many infants, without increased risk of readmission. This framework may be used to embed safety evaluations within future guideline implementation programs to further reduce low-value care.

AbstractWe investigated the validity and screening effectiveness of the PHQ-2 and PHQ-9 scores in 229 college students in a cross-sectional design. PHQ associations with Minnesota Multiphasic Personality Inventory-3 internalizing scales suggest PHQ scores are effective screening tools for college students and may aid in effective triage and service needs.

Background: Outpatient parenteral antimicrobial therapy (OPAT) delivery using peripherally inserted central catheters is associated with a risk of catheter related thrombosis (CRT). Individualised preventative interventions may reduce this occurrence, however patient selection is hampered by a lack of understanding of risk factors. We aimed to identify patient, infection or treatment related risk factors for CRT in the OPAT setting.Methods: Retrospective case control study (1:3 matching) within OPAT services at two tertiary hospitals within Australia.Results: Over a 2 year period, encompassing OPAT delivery to 1803 patients, there were 19 cases of CRT, giving a prevalence of 1.1% and incidence of 0.58/1000 catheter days. Amongst the cases of CRT, there were nine (47%) unplanned readmissions and two (11%) pulmonary emboli. Compared to controls, cases had a higher frequency of malposition of the catheter tip (4/19 (21%) vs 0/57 (0%), p= 0.003) and complicated catheter insertion (3/19 (16%) vs 1/57 (2%), p= 0.046).Conclusions: Although CRTs during OPAT are infrequent, they often have clinically significant sequelae. Identification of modifiable vascular access related predictors of CRT should assist with patient risk stratification and guide risk reduction strategies.

The paraeducator workforce as well as the breadth of their responsibilities to serve students in special education has increased considerably in public schools. Unfortunately, research to identify the most effective methods for training paraeducators has not kept pace. Addressing this dynamic, through an implementation science framework, requires a better understanding of contextual factors. In this study, focus groups (FGs) with paraeducators and teachers were conducted to examine (a) responsibilities, training needs, and related issues of paraprofessionals; (b) training needs and related issues of teachers as supervisors of paraeducators; and (c) factors that support or impede special educators’ self-efficacy and their perception of competence of their colleagues. Four FGs, homogeneous based on role and assignment (mild vs. moderate-to-severe disabilities), were conducted utilizing a semistructured interview protocol. Qualitative content analysis revealed important challenges and training-related deficiencies experienced by both teachers and paraeducators, as well as suggestions for addressing these issues.

We examined adherence to antimicrobial stewardship prospective audit and feedback rounds in a rehabilitation service compared with the remainder of the acute hospital, and explored the reasons for this. Between October 2014 and December 2015, we retrospectively assessed the rate of non-adherence to advice from antimicrobial stewardship prospective audit and feedback rounds between the rehabilitation service and the acute hospital, along with the source of the patient referral. Compared with the rehabilitation service, acute hospital medical staff were almost twice as likely to not adhere to advice provided on antimicrobial stewardship prospective audit and feedback rounds (13.8% vs. 7.6%, p < 0.0001, relative risk 1.8 [95% confidence interval 1.3, 2.5]). In the rehabilitation service, referrals were more likely to come from medical staff (61.9% vs. 16.3%, p < 0.0001). These findings may be explained by regular, direct engagement of the antimicrobial stewardship team with the rehabilitation service clinical team, a model potentially applicable to other settings.

The economic effects of social structure are dependent on culture and must be understood in their cultural context. The authors demonstrate this with an analysis of the Liverpool slave trade. They show that as abolitionism became more salient in British culture, connections in a coinvestment network to both slavers and nonslavers mattered much more for predicting entry into the slave trade. As abolitionism rose, nonslavers in that public network gained relatively more influence than slavers, but the reverse was true in the private network of an elite social club. Furthermore, the status of a potential slaver mattered much more during the abolition era, as the emergent clarity of norms against slaving constrained high-status traders less than middle-status traders. The authors present advice to network and status theorists as to how they can reflect cultural contingency even in studies conducted in stable cultural contexts, thereby creating a more integrated and robust economic sociology.

ABSTRACTblaNDMhas been reported in different Enterobacteriaceaespecies and on numerous plasmid replicon types (Inc). Plasmid replicon typing, in combination with genomic characteristics of the bacterial host (e.g., sequence typing), is used to infer the spread of antimicrobial resistance determinants between genetically unrelated bacterial hosts. The genetic context of blaNDMis heterogeneous. In this study, we genomically characterized 12 NDM-producing Enterobacteriaceaeisolated in Australia between 2012 and 2014: Escherichia coli(n= 6), Klebsiella pneumoniae(n= 3), Enterobacter cloacae(n= 2) and Providencia rettgeri(n= 1). We describe their blaNDMgenetic contexts within Tn125, providing insights into the acquisition of blaNDMinto Enterobacteriaceae. IncFII-type (n= 7) and IncX3 (n= 4) plasmids were the most common plasmid types found. The IncHI1B (n= 1) plasmid was also identified. Five different blaNDMgenetic contexts were identified, indicating four particular plasmids with specific blaNDMgenetic contexts (NGCs), three of which were IncFII plasmids (FII-A to -C). Of note, the blaNDMgenetic context of P. rettgeriwas not conjugative. Epidemiological links between our NDM-producing Enterobacteriaceaewere established by their acquisition of these five particular plasmid types. The combination of different molecular and genetic characterization methods allowed us to provide insight into the spread of plasmids transmitting blaNDM.

ABSTRACTActive surveillance is part of a multifaceted approach used to prevent the spread of vancomycin-resistant enterococci (VRE). The impact of fecal density, the vancomycin MIC of the isolate, and the vancomycin concentration in liquid medium on test performance are uncertain. Using fecal specimens spiked with a collection of 18 VRE (predominantly vanB) with a wide vancomycin MIC range, we compared the performances of commercial chromogenic agars (CHROMagar VRE, chromID VRE, Brilliance VRE, and VRE Select) and 1 liquid medium (Enterococcosel enrichment broth) for VRE detection. The specificity of solid media was excellent; however, the sensitivity at 48 h varied from 78 to 94%. Screening using liquid medium was less sensitive than screening with solid media, particularly as the vancomycin content increased. Sensitivity declined (i) as the fecal VRE density decreased, (ii) when the media were assessed at 24 h (versus 48 h), and (iii) for isolates with a low vancomycin MIC (sensitivity, 25 to 75% versus 100% for isolates with vancomycin MIC of <16 mg/liter versus >32 mg/liter on solid medium using 106CFU/ml of feces). Depending on local epidemiology and in particular VRE vancomycin MICs, the sensitivity of culture-based methods for VRE screening of stool or rectal specimens may be suboptimal, potentially facilitating secondary transmission.

ABSTRACTBy global standards, the prevalence of community-onset expanded-spectrum-cephalosporin-resistant (ESC-R) Escherichia coliremains low in Australia and New Zealand. Of concern, our countries are in a unique position, with high extramural resistance pressure from close population and trade links to Asia-Pacific neighbors with high ESC-R E. colirates. We aimed to characterize the risks and dynamics of community-onset ESC-R E. coliinfection in our low-prevalence region. A case-control methodology was used. Patients with ESC-R E. colior ESC-susceptible E. coliisolated from blood or urine were recruited at six geographically dispersed tertiary care hospitals in Australia and New Zealand. Epidemiological data were prospectively collected, and bacteria were retained for analysis. In total, 182 patients (91 cases and 91 controls) were recruited. Multivariate logistic regression identified risk factors for ESC-R among E. colistrains, including birth on the Indian subcontinent (odds ratio [OR] = 11.13, 95% confidence interval [95% CI] = 2.17 to 56.98, P= 0.003), urinary tract infection in the past year (per-infection OR = 1.430, 95% CI = 1.13 to 1.82, P= 0.003), travel to southeast Asia, China, the Indian subcontinent, Africa, and the Middle East (OR = 3.089, 95% CI = 1.29 to 7.38, P= 0.011), prior exposure to trimethoprim with or without sulfamethoxazole and with or without an expanded-spectrum cephalosporin (OR = 3.665, 95% CI = 1.30 to 10.35, P= 0.014), and health care exposure in the previous 6 months (OR = 3.16, 95% CI = 1.54 to 6.46, P= 0.02). Among our ESC-R E. colistrains, the blaCTX-MESBLs were dominant (83% of ESC-R E. colistrains), and the worldwide pandemic ST-131 clone was frequent (45% of ESC-R E. colistrains). In our low-prevalence setting, ESC-R among community-onset E. colistrains may be associated with both “export” from health care facilities into the community and direct “import” into the community from high-prevalence regions.

Global economic transactions such as foreign direct investment FDI must extend over an institutional abyss between the jurisdiction, and therefore protection, of the states involved. Intergovernmental organizations IGOs represent an important attempt to span this abyss. The authors use a network approach to demonstrate that the connections between two countries, through joint membership in the same IGOs, are associated with a large positive influence on the FDI that flows between them. Moreover, they show that this effect occurs not only in the case of connections through economic IGOs but also through those with social and cultural mandates. This demonstrates that relational governance is important and feasible in the global context, even for the most risky transactions. The authors also examine the interdependence between the IGO network and the domestic institutions of states. Social and cultural IGO connections do more and economic IGO connections less to increase FDI when the target country is more democratic.

The article discusses the draft text of the North Atlantic Treaty Organization (NATO) report Deterrence and Defense Posture Review approved by NATO foreign and defense ministers in a meeting held from April 18-19, 2012. If approved during the scheduled May 20-21, 2012 NATO Summit to be held in Chicago, Illinois, the report establishes guidance for debate over the nuclear sharing agreements of NATO and a stronger role for NATO in nuclear arms control and disarmament.

The article points out the meager time left for the 28-member states of the North Atlantic Treaty Organization (NATO) to resolve disagreements on disarmament. One of the key problems is the future role of nuclear weapons in NATO's defense posture. It recommends a review of NATO's nuclear policy within the context of the Strategic Concept at the Lisbon summit in November 2010 in Portugal that will reduce NATO's reliance on nuclear weapons through the reduction of U.S. and Russian tactical nuclear bombs and to reduce ambiguities in its nuclear policies.

The authors consider how uncertainty over protest occurrence shapes the strategic interaction between companies and activists. Analyzing WalMart, the authors find support for their theory that companies respond to this uncertainty through a “test for protest” approach. In WalMart’s case, this consists of lowcost probes in the form of new store proposals. They then withdraw if they face protests, especially when those protests signal future problems. WalMart is more likely to open stores that are particularly profitable, even if they are protested. This uncertaintybased account stands in sharp contrast to fullinformation models that characterize protests as rare miscalculations.

This article examines how managers' tendency to discuss new ideas with others in their professional networks depends on the density of shared ties surrounding a given relationship. Consistent with prior research which found that embeddedness enhances information flow, an egocentric network survey of mid-level executives shows that managers tend to discuss new ideas with those who are densely embedded in their professional networks. More specifically, embeddedness increases the likelihood to discuss new ideas by engendering affect-based trust, as opposed to cognition-based trust. Implications for network and creativity research are discussed.

Courses in tertiary level Science Technology, Engineering and Mathematics (STEM) are perceived by some students as time-consuming, tedious and difficult. The increasing “attrition rate” of this cohort of college students is usually attributed to several factors. Retention and intervention programs under the umbrella of student support services can be put in place to mitigate the worsening situation. Most universities and colleges offer tutoring as part of academic support. In this pilot study, we collected tutoring-related data. We focused mainly on mathematics majors and found unexpectedly that there is no difference in grades for mathematics majors who visited and did not visit the tutoring centre, i.e., there is no strong correlation between the number of hours spent in the tutoring centre and grades in the courses tutored in.

Membership in certain intergovernmental organizations (IGOs), such as the World Trade Organization, has long been argued to stimulate trade. Yet, evidence linking IGOs to trade is mixed. The authors argue that identifying the influence of IGOs requires attention not only to the institutions IGOs enact, but also to the network through which they enact them. This approach allows them to demonstrate that trade between two countries increases by an average of 58% with every doubling of the strengthof IGO connection between the countries. They also contribute to debates regarding the mechanisms through which structural relationships influence economic behavior by showing that substantial trade benefits occur not only through economic IGOs, but also through IGOs that were formed for social and cultural purposes, and that connections through IGOs that are organizationally strong have more impact than those through minimalist IGOs.

ABSTRACTWe have developed and optimized a 96-well microtiter plate assay, based on the reduction of alamarBlue, to assess the efficacies of much needed new antimicrobials against Acanthamoebaspecies. This assay has been optimized for determination of drug efficacy against two potentially pathogenic species, Acanthamoeba castellaniiand Acanthamoeba polyphaga, and has been validated by comparison of their relative susceptibilities to chlorhexidine, a drug widely used to treat Acanthamoebakeratitis. The results demonstrate that the assay is comparable to a manual counting assay and that A. polyphagais more resistant to chlorhexidine than A. castellanii. Thus, by use of the manual counting assay, 3.125 µM chlorohexidine was almost completely effective against A. castellanii, whereas this concentration was less than 20% effective against A. polyphaga. Similar results were obtained by the alamarBlue assay. The new assay was used to determine the relative susceptibilities of A. castellaniiand A. polyphagato the alkylphosphocholines (APCs) hexadecylphosphocholine (hexadecyl-PC; miltefosine) and octadecylphosphocholine (octadecyl-PC) as well as an alkylgycerolphosphocholine, edelfosine. Both APCs studied were equally effective against A. castellanii, but octadecyl-PC was less effective than hexadecyl-PC against A. polyphaga. Both APCs were more effective than edelfosine against both Acanthamoebaspecies. A. polyphagawas found to be significantly less susceptible to each of the phosphocholine analogues. The newly described assay offers a number of advantages over those described previously. It is less labor-intensive than previously described assays and is sensitive and rapid, and the results can be read in a nonsubjective manner. As it is based on a standard 96-well, microtiter plate, it is amenable to automation and high throughput.

Competition between organizational forms manifests itself in political contention over the law. The authors analyze the political strength and organization of the groups that supported and opposed state antichainstore laws. The enactment of these laws depended on intrastate political activity and the interstate diffusion of antichainstore legislation. The repeal process relied on suprastate activity, as nationally organized prochainstore forces shifted the arena of contention to the Supreme Court and forged national alliances with labor unions and agricultural cooperatives. In both enactment and repeal, the political resources and strategies of organziational forms interacted with existing institutions to determine the trajectory of institutional change.

Cardiac hypertrophy is an early landmark during the clinical course of heart failure, and is an important risk factor for subsequent morbidity and mortality. The hypertrophy response to different types of cardiac overload is distinguished both at the molecular and cellular levels. These changes have been extensively characterized for pressure load hypertrophy; however, similar information for volume load hypertrophy is still needed. This study was undertaken to improve the existing method of producing experimental cardiac volume load. Previous investigators have employed surgical aorto-caval shunt (ACS) as a model for volume load hypertrophy (VO) in rats. The procedure is relatively simple and involves glue to seal the aortic hole after ACS. However, it has several limitations mostly related to the use of glue e.g. poor visualization due to hardening of tissues, imperfect sealing of the puncture site and glue seeping through the aortic hole resulting in shunt occlusion. We have modified the procedure using aortic adventitial suture instead of glue and 18G angiocatheter instead of 16G needle, which eliminated the technical difficulties from the former method. The ACS was visually confirmed at sacrifice, and the VO demonstrated by time-related changes in the heart weight/body weight ratio which increased from 78% at 4 weeks to 87% at 10 weeks and increased liver/body weight ratio by 22% at 10 weeks of post aorto-caval shunt. Cardiac expression of atrial natriuretic peptide (ANF) also demonstrated time-related increase in ANF mRNA (+275% increase at 4 weeks, p < 0.05, and +370% increase at 10 weeks, p < 0.001). This modified technique of aorto-caval shunt offers simpler, reproducible and consistent model for VO hypertrophy in rats.

Premature deterioration of multilane hot-mix asphalt pavements can occur at the longitudinal joints in the form of cracking and raveling. The National Center for Asphalt Technology initiated a national study that evaluated various longitudinal joint construction techniques in 1992 in an effort to select the technique(s) that improves the performance of longitudinal joints. Test sections were constructed in Michigan, Wisconsin, Colorado, Pennsylvania, and New Jersey. The 6-year performance evaluation of eight different techniques used on a paving project in Pennsylvania in 1995 is provided. In Pennsylvania, longitudinal joint constructed with rubberized joint material gave the best performance, closely followed by the joint made with a cutting wheel. Test sections on which rolling from the hot side 152 mm away from the joint and the New Jersey wedge joint were used also performed reasonably well, with no significant cracking. The remaining four test sections on which the edgerestraining device, joint maker, rolling from the hot side, and rolling from the cold side were used developed cracking at the longitudinal joint to different extents. It has been recommended that the minimum compaction level at the longitudinal joint be specified to ensure its improved performance.

Premature deterioration of multilane hot-mix asphalt pavements can occur at the longitudinal joints in the form of cracking and raveling. The National Center for Asphalt Technology initiated a national study that evaluated various longitudinal joint construction techniques in 1992 in an effort to select the technique(s) that improves the performance of longitudinal joints. Test sections were constructed in Michigan, Wisconsin, Colorado, Pennsylvania, and New Jersey. The 6-year performance evaluation of eight different techniques used on a paving project in Pennsylvania in 1995 is provided. In Pennsylvania, longitudinal joint constructed with rubberized joint material gave the best performance, closely followed by the joint made with a cutting wheel. Test sections on which rolling from the hot side 152 mm away from the joint and the New Jersey wedge joint were used also performed reasonably well, with no significant cracking. The remaining four test sections on which the edgerestraining device, joint maker, rolling from the hot side, and rolling from the cold side were used developed cracking at the longitudinal joint to different extents. It has been recommended that the minimum compaction level at the longitudinal joint be specified to ensure its improved performance.

Friendships with competitors can improve the performance of organizations through the mechanisms of enhanced collaboration, mitigated competition, and better information exchange. Moreover, these benefits are best achieved when competing managers are embedded in a cohesive network of friendships (i.e., one with many friendships among competitors), since cohesion facilitates the verification of information culled from the network, eliminates the structural holes faced by customers, and facilitates the normative control of competitors. The first part of this analysis examines the performance implications of the friendshipnetwork structure within the Sydney hotel industry, with performance being the yield (i.e., revenue per available room) of a given hotel. This shows that friendships with competitors lead to dramatic improvements in hotel yields. Performance is further improved if a manager’s competitors are themselves friends, evidencing the benefit of cohesive friendship networks. The second part of the analysis examines the structure of friendship ties among hotel managers and shows that friendships are more likely between managers who are competitors.

Cardiac hypertrophy has been observed in newborn infants treated with dexamethasone (DEX). This study was undertaken to examine whether DEX-induced hypertrophy in newborn rats is associated with redistribution of cardiac myosin heavy chain (MHC) isoforms and if so, the effects involve transcriptional regulation. Newborn rats were injected with either DEX (1 mg/kg/day; s.c.) or equivalent volume normal saline for 1, 3, 5, 7 or 9 days. Hypertrophy was quantified by heart dry/wet wt ratios, heart/body wt ratios, and total protein content of the myocardium. Changes in the expression of cardiac MHC mRNA were characterized by northern blot and slot blot analyses, using isoform specific probes for a- and β-MHC genes. DEX effect on α-MHC gene transcription was analyzed by transiently transfecting various α-MHC promoter/CAT reporter constructs into primary cultures of cardiac myocytes derived from one day old rat pups. DEX administration into newborn rats produced significant cardiac hypertrophy ranging from 23% at day 1 to 59% at 9 days. The hypertrophy was accompanied by immediate increase (83%) in steady state level of the α-MHC mRNA within one day and a maximum increase (148%) at 7 days of treatment. The steady state level of β-MHC mRNA declined by 25% at day 1 and a maximum decrease of 54% at day 7 of DEX treatment. The changes in MHC mRNA were also reflected in their protein levels as determined by V1 and V3 isozyme analysis. DEX treatment of primary cultures of cardiomyocytes following transfection with a-MHC promoter/CAT reporter constructs resulted in increased CAT expression in a dose dependent manner. The minimum α-MHC gene sequences responding to DEX treatment were located between the -200 to -74-bp region of the gene, resulting in 2-fold and 6-fold activation of CAT reporter after 0.05 and 0.1 mM doses of DEX, respectively. Our data indicate that DEX induced cardiac hypertrophy in newborn rats is accompanied by increased expression of α-MHC and decreased expression of β-MHC. The α-MHC effects are mediated in part through transcriptional mechanisms.

“The notion that the historian of religions should seek disinterested, impersonal, descriptive knowledge about religious ‘matters of fact’ understood as existing independently of concrete persons should be outrightly rejected as an inadequate metaphor. … No methodology is developed prior to the process of understanding and discovery … for method is essentially a way of interpreting the implications of insights which have their roots in the tacit forms of inarticulate knowledge.”

ABSTRACTTubulin is essential to eukaryotic cells and is targeted by several antineoplastics, herbicides, and antimicrobials. We demonstrate that Acanthamoebaspp. are resistant to five antimicrotubule compounds, unlike any other eukaryote studied so far. Resistance correlates with critical amino acid differences within the inhibitor binding sites of the tubulin heterodimers.

Several letters to the editor are presented in response to articles in previous issues including "2006 San Diego Thanksgiving Dixieland Jazz Festival," by Hal Smith in the October 2006 issue, "New Member Greater Olympia Jazz Society," by Howard Dorin and "Dan's Dixie Dictionary," by Morris L. Ostrian.

Several letters to the editor are presented in response to articles in the August 10, 2009 and August 17, 2009 issues including "Forget the Great in Britain" and "The Search for Sanctuary: Orphan Apes."

Several letters to the editor are presented in response to articles in the August 10, 2009 and August 17, 2009 issues including "Forget the Great in Britain" and "The Search for Sanctuary: Orphan Apes."

To characterise the emm type distribution and antibiotic susceptibility of non-invasive group A streptococci (GAS) in Perth, Western Australia.