Community-onset Escherichia coli infection resistant to expanded- spectrum cephalosporins in low-prevalence countries

Background
By global standards the prevalence of community onset expanded-spectrum cephalosporin resistant Escherichia coli (ESC-R-EC) remains 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 neighbours with high ESC-R-EC rates. We aim to characterize the risks and dynamics of community onset ESC-R-EC in our low-prevalence region.

Methods
A case-control methodology was used. Patients with ESC-R-EC or susceptible E. coli isolated from blood or urine were recruited at six geographically dispersed tertiary hospitals in Australia and New Zealand. Epidemiological data was prospectively collected and bacteria were retained for analysis.

Results
In total, 182 patients (91 cases and 91 controls) were recruited. Multivariate logistic regression identified risk factors for ESC-R amongst E. coli including birth on the Indian subcontinent (OR=11.13, 2.17-56.98, p=0.003), urinary tract infection in the past year (per infection OR=1.430, 1.13-1.82, p=0.003), travel to South East Asia, China, Indian subcontinent, Africa and the Middle East (OR=3.089, 1.29-7.38, p=0.011), prior exposure to trimethoprim+/-sulfamethoxazole &/or an expanded-spectrum cephalosporin (OR=3.665, 1.30-10.35, p=0.014) and healthcare exposure in the previous six months (OR=3.16, 1.54-6.46, p=0.02).

Amongst our ESC-R-EC the blaCTX-M ESBLs was dominant (83% of ESC-R-EC), and the worldwide pandemic clone ST-131 was frequent (45% of ESC-R-EC).

Conclusion
In our low prevalence setting, ESC-R amongst community onset E. coli may be associated with both ‘export’ from healthcare facilities into the community and direct ‘import’ into the community from high-prevalence regions.

Improving access to the justice system for people with communication difficulties : a training program for people working in the justice system

This training package is provided as a guide and resource to promote awareness and understanding of people who have complex communication needs and give people who work in law and justice system strategies to facilitate successful communication interactions. Complex communication needs are defined as communication problems associated with a wide range of physical, sensory and environmental causes which restrict/limit an individual's ability to participate independently in society. They and their communication partners may benefit from using Alternative and Augmentative Communication (AAC) methods. Alternative and Augmentative Communication (AAC) is an approach or communication system that makes it possible for a person without speech to communicate. AAC includes gestures and sign language, picture and alphabet boards and high technology electronic communication devices that produce computerised speech. Many people with complex communication needs use a combination of AAC communication to express themselves. It is hoped that this package will facilitate access to the justice system for a group of people who may experience social disadvantage as a result of their complex communication needs. The information included in the package is not exhaustive. It is designed to : provide the trainer and staff with a general understanding of complex communication needs; challenge misconceptions about people who have little or no functional speech; provide practical strategies and guidelines to assist staff to more successfully communicate with people with complex communication needs.

Communicating with nurses: the experiences of 10 individuals with an acquired severe communication impairment

Successful communication is integral to quality health care and successful nursing practice. Ten people who had been in hospital in the 12 months prior to the study and who had no functional speech at that time were interviewed about their communication experiences with nurses. Overall, these individuals experienced difficulties, some of which appeared to be related to a lack of augmentative and alternative communication (AAC) resources and a lack of knowledge of AAC among nurses. In addition, the participants noted that nurses did not always have the time or the skills to communicate effectively with them. The participants suggested strategies to improve communication interactions between patients with no or limited functional speech and nurses. These strategies include pre-admission briefing and training nurses about effective strategies for communicating with patients who are unable to speak, including the use of augmentative and alternative communication systems.

Focus group discussions of literacy assessment and world wide web-based reading intervention

Focus groups provide a means for participants in research to take on a greater role in the evaluation of the research and planning of its various stages. The role and outcomes of focus groups conducted with participants in a World Wide Web Project in literacy assessment and intervention are reported. Thirteen individuals with severe communication impairments participated in one of three focus groups. The groups were held after an assesment of reading skills and a trial period of intervention as part of the Web Project. The aim of the focus groups was to obtain feedback from participants about their involvement in the project and to discuss strategies for the next stage of the intervention. The focus groups offered a forum for participants to talk about what they did and did not like about the assessment and trial intervention. The discussions provided information about issues of both a practical and emotional nature that might have otherwise been unavailable to the researchers. Brainstorming of strategies provided valuable input for the next stage of the project and involved both the researchers and participants in a form of participatory action research.

Preparing for the future: ageing and alternative and augmentative communication

Despite a large body of literature focusing on how the normal aging process affects quality of life, little is known about how aging influences the lives of those who use alternative and augmentative communication (AAC). This article explores issues relevant to aging and AAC, examining the responses of 78 augmented communicators aged 30 years and older who participated in a larger national survey of 270 adults with cerebral palsy. The survey sought information about health, modes of communication, and access to information. The results indicate that those involved in the AAC field must work with individuals who use augmentative communication to ensure that they maintain their health, well-being, and effective communication as they age.

Crews, wusses, and whoppas: core and fringe vocabularies of Australian meal-break conversations in the workplace

Conversational samples were collected from 34 nondisabled subjects across four worksites. The total sample was analyzed for core vocabulary, and the five most frequently referenced topics were analyzed for core and fringe vocabularies and the commonality of fringe vocabulary across topics. The results indicated that there was a small stable core vocabulary of 347 words containing words unique to this study, which accounted for 78% of the conversational sample. A total of 21 words in the fringe vocabulary was common to all topics. Implications of this study for vocabulary selection for augmented communicators in employment are discussed.

A few well-chosen words

Ten professionals (five speech pathologists, three rehabilitation counsellors, and two teachers) participated in a survey to investigate their ability to predict the topics and vocabulary of meal-break conversations at work. Participants selected two topics that they thought were likely to occur during meal-break conversations between nondisabled employees for each day of the week. They selected five key words appropriate to each chosen topic. The topics and key words were analyzed for frequency and commonality and compared to the topics and vocabulary from actual meal-break conversations in the workplace. The professionals accurately predicted some topics that occurred in the actual conversational sample. However, one-third of the key words (33%) predicted by the participants did not occur in the conversational sample. The implications of these findings for vocabulary selection for augmented communicators are discussed.

Topics of meal-break conversations

Meal-break conversational samples were collected from 34 nondisabled participants across four worksites. The samples were analyzed for topics referenced and also for patterns of topics associated with days of the week. The results of the analysis indicated that the participants referenced 73 different topics. Analysis of the 10 most frequently referenced topics in each composite day file revealed 19 topics, of which 5 (i.e., work, fact finding, judgments, food, and family life) were referenced every day. Analysis of the number of communication segments in each of the 19 topics indicated that fact finding was the most frequently referenced topic, but work was the largest topic (i.e., contained the greatest number of words). There was some pattern to topic reference associated with the day of the week. Implications of this information for individuals with severe communication impairments who wish to access the work force are discussed.

Alternative service delivery models for families with a new speech generating device: perspectives of parents and therapists

Purpose: Research has revealed limitations in the provision of in-person services to families with a new speech generating device (SGD), both in Australia and overseas. Alternative service models such as parent training, peer support and telepractice may offer a solution, but their use with this population has not been researched to date.

Method: Using interviews and focus groups, this study explored the experiences and opinions of 13 speech-language pathologists and seven parents regarding alternatives to in-person support and training for families with a new SGD. Data were analysed using grounded theory. Themes explored in this paper include the benefits and drawbacks of alternative service models as well as participants’ suggestions for the optimal implementation of these approaches.

Result: Participants confirmed the utility of alternative service models, particularly for rural/remote and underserviced clients. Benefits of these models included reduced travel time for families and therapists, as well as enhanced information access, support and advocacy for parents.

Conclusion: Participants viewed the provision of ongoing professional support to families as critical, regardless of service modality. Additional issues arising from this study include the need for development of organizational policies, resources and training infrastructure to support the implementation of these alternative service models.