Detection, treatment, and prevention of carbapenemase-producing Enterobacteriaceae : Recommendations from an International Working Group

The prevalence of carbapenemase-producing Enterobacteriaceae (CPE) has increased during the past 10 years. Its detection is frequently difficult, because they do not always show a minimum inhibitory concentration (MIC) value for carbapenems in the resistance range. Both broth microdilution and agar dilution methods are more sensitive than disk diffusion method, Etest and automated systems. Studies on antimicrobial treatment are based on a limited number of patients; therefore, the optimal treatment is not well established. Combination therapy with two active drugs appears to be more effective than monotherapy. Combination of a carbapenem with another active agent — preferentially an aminoglycoside or colistin — could lower mortality provided that the MIC is #4 mg/l and probably #8 mg/l, and is administered in a higher-dose/prolonged-infusion regimen. An aggressive infection control and prevention strategy is recommended, including reinforcement of hand hygiene, using contact precautions and early detection of CPE through use of targeted surveillance.

Analysis of caesarean section rates over time in a single Swiss centre using a ten-group classification system.

OBJECTIVE Caesarean section (CS) rates have risen over the past two decades. The aim of this observational study was to identify time-dependent variations in CS and vaginal delivery rates over a period of 11 years. METHOD All deliveries (13,701 deliveries during the period 1999-2009) at the University Women's Hospital Bern were analysed using an internationally standardised and approved ten-group classification system. Caesarean sections on maternal request (CSMR) were evaluated separately. RESULTS We detected an overall CS rate of 36.63% and an increase in the CS rate over time (p <0.001). Low-risk profile groups were the two largest populations and displayed low CS rates, with significantly decreasing relative size over time. The relative size of groups with induced labour increased significantly, but this did not have an impact on the overall CS rate. Pregnancies complicated by breech position, multiple pregnancies and abnormal lies did not have an impact on overall CS rate. The biggest contributor to a high CS rate was preterm delivery and the existence of a uterine scar from a previous CS. CSMR was 1.45% and did not have an impact on the overall CS rate. CONCLUSION The observational study identified wide variations in caesarean section and vaginal delivery rates across the groups over time, and a shift towards high-risk populations was noted. The biggest contributors to high CS rates were identified; namely, previous uterine scar and preterm delivery. Interventions aiming to reduce CS rates are planned.

An Unscathed Past in the Face of Death: Mortality Salience Reduces Individuals’ Regrets

Folk wisdom and popular literature hold that, in the face of death, individuals tend to regret things in their lives that they have done or failed to do. Terror Management Theory (TMT), in contrast, allows for the prediction that individuals who are confronted with death try to minimize the experience of regret in order to retain a positive self-esteem. Three experiments put these competing perspectives to test. Drawing on TMT, we hypothesized and found that participants primed with their own death regret fewer things than control-group participants. This pattern of results cannot be attributed to differing types of regrets (Study 1). Furthermore, we provide evidence suggesting that the effect is not purely a product of cognitive mechanisms such as differing levels of construal (Study 2), cognitive contrast, or deficits (Study 3). Rather, the reported results are best explained in terms of a motivational coping mechanism: When death is salient, individuals strive to bolster as well as protect their self-esteem and accordingly try to minimize the experience of regret. The results add to our conceptual understanding of regret and TMT, and suggest that a multitude of lifestyle guidebooks need updating.

Preconceptional use of folic acid in the region of the Kantonsspital Münsterlingen/Thurgau: has it changed over the past 10 years?

BACKGROUND  Numerous studies have shown that the preconceptional use of folic acid prevents neural tube defects. We created a study to find out whether the preconceptional use of folic acid has improved in the past 10 years, in the area of Münsterlingen, Switzerland. MATERIAL AND METHODS  We interviewed 2 groups of patients who delivered at our Institution, namely between 2000 and 2002 (period A) involving 287 women and from 2009 to 2010 (period B) involving 305 pregnant women. We asked them whether they used folic acid by means of a standardised questionnaire. RESULTS  In period B significantly more women have taken folic acid preconceptionally (period A: 27.5% vs. period B: 40.7%; p=0.001). A significant increase in folic acid intake was seen in the German speaking group from period A to B (30.3% vs. 52.7%; p=0.0005), while this was not the case in the non-German speaking group (21.4% in both periods). More multiparaé women were taking folic acid compared to nulliparae. A significant increase from period A to B was noted only in the German speaking group. Unexpectedly, in nulliparae non-German speaking women, folic acid supplementation decreased from 14% to 6.1%. DISCUSSION  We have found a significant increase in preconceptional folic acid supplementation from 2001 to 2010. The percentage of women taking folic acid is disappointingly low in all groups, particularly in nulliparae women of non-German ethnicity.

Links between atmospheric carbon dioxide, the land carbon reservoir and climate over the past millennium

The stability of terrestrial carbon reservoirs is thought to be closely linked to variations in climate 1, but the magnitude of carbon–climate feedbacks has proved dificult to constrain for both modern 2–4 and millennial 5–13 timescales. Reconstructions of atmospheric CO2 concentrations for the past thousand years have shown fluctuations on multidecadal to centennial timescales 5–7, but the causes of these fluctuations are unclear. Here we report high-resolution carbon isotope measurements of CO2 trapped within the ice of the West Antarctic Ice Sheet Divide ice core for the past 1,000 years. We use a deconvolution approach 14 to show that changes in terrestrial organic carbon stores best explain the observed multidecadal variations in the 13 C of CO2 and in CO2 concentrations from 755 to 1850 CE. If significant long-term carbon emissions came from pre-industrial anthropogenic land-use changes over this interval, the emissions must have been offset by a natural terrestrial sink for 13 C-depleted carbon, such as peatlands. We find that on multidecadal timescales, carbon cycle changes seem to vary with reconstructed regional climate changes. We conclude that climate variability could be an important control of fluctuations in land carbon storage on these timescales.

The new final Clinical Skills examination in human medicine in Switzerland: Essential steps of exam development, implementation and evaluation, and central insights from the perspective of the national Working Group

Objective: Since 2011, the new national final examination in human medicine has been implemented in Switzerland, with a structured clinical-practical part in the OSCE format. From the perspective of the national Working Group, the current article describes the essential steps in the development, implementation and evaluation of the Federal Licensing Examination Clinical Skills (FLE CS) as well as the applied quality assurance measures. Finally, central insights gained from the last years are presented. Methods: Based on the principles of action research, the FLE CS is in a constant state of further development. On the foundation of systematically documented experiences from previous years, in the Working Group, unresolved questions are discussed and resulting solution approaches are substantiated (planning), implemented in the examination (implementation) and subsequently evaluated (reflection). The presented results are the product of this iterative procedure. Results: The FLE CS is created by experts from all faculties and subject areas in a multistage process. The examination is administered in German and French on a decentralised basis and consists of twelve interdisciplinary stations per candidate. As important quality assurance measures, the national Review Board (content validation) and the meetings of the standardised patient trainers (standardisation) have proven worthwhile. The statistical analyses show good measurement reliability and support the construct validity of the examination. Among the central insights of the past years, it has been established that the consistent implementation of the principles of action research contributes to the successful further development of the examination. Conclusion: The centrally coordinated, collaborative-iterative process, incorporating experts from all faculties, makes a fundamental contribution to the quality of the FLE CS. The processes and insights presented here can be useful for others planning a similar undertaking. Keywords: national final examination, licensing examination, summative assessment, OSCE, action research

Clinical characteristics and outcomes in children hospitalised with pandemic influenza A/H1N1/09 virus infection – a nationwide survey by the Pediatric Infectious Diseases Group of Switzerland

OBJECTIVE To describe all patients admitted to children's hospitals in Switzerland with a diagnosis of influenza A/H1N1/09 virus infection during the 2009 influenza pandemic, and to analyse their characteristics, predictors of complications, and outcome. METHODS All patients ≤18-years-old hospitalised in eleven children's hospitals in Switzerland between June 2009 and January 2010 with a positive influenza A/H1N1/09 reverse transcriptase polymerase chain reaction (RT-PCR) from a nasopharyngeal specimen were included. RESULTS There were 326 PCR-confirmed patients of whom 189 (58%) were younger than 5 years of age, and 126 (38.7%) had one or more pre-existing medical condition. Fever (median 39.1 °C) was the most common sign (85.6% of all patients), while feeding problems (p = 0.003) and febrile seizures (p = 0.016) were significantly more frequent in children under 5 years. In 142 (43.6%) patients there was clinical suspicion of a concomitant bacterial infection, which was confirmed in 36 patients (11%). However, severe bacterial infection was observed in 4% of patients. One third (n = 108, 33.1%) of the patients were treated with oseltamivir, 64 (59.3%, or 20% overall) within 48 hours of onset of symptoms. Almost half of the patients (45.1%) received antibiotics for a median of 7 days. Twenty patients (6.1%) required intensive care, mostly for complicated pneumonia (50%) without an underlying medical condition. The median duration of hospitalisation was 2 days (range 0-39) for 304 patients. Two children (<15 months of age with underlying disease) died. CONCLUSIONS Although pandemic influenza A/H1N1/09 virus infection in children is mostly mild, it can be severe, regardless of past history or underlying disease.

Biological and physical controls in the Southern Ocean on past millennial-scale atmospheric CO2 changes

Millennial-scale climate changes during the last glacial period and deglaciation were accompanied by rapid changes in atmospheric CO2 that remain unexplained. While the role of the Southern Ocean as a ’control valve’ on ocean–atmosphere CO2 exchange has been emphasized, the exact nature of this role, in particular the relative contributions of physical (for example, ocean dynamics and air–sea gas exchange) versus biological processes (for example, export productivity), remains poorly constrained. Here we combine reconstructions of bottom-water [O2], export production and 14C ventilation ages in the sub-Antarctic Atlantic, and show that atmospheric CO2 pulses during the last glacial- and deglacial periods were consistently accompanied by decreases in the biological export of carbon and increases in deep-ocean ventilation via southern-sourced water masses. These findings demonstrate how the Southern Ocean’s ’organic carbon pump’ has exerted a tight control on atmospheric CO2, and thus global climate, specifically via a synergy of both physical and biological processes.

Recuerdos, espejos y lugares en el teatro comunitario argentino contemporáneo : Memoria colectiva, identidades y espacios público en las prácticas del Grupo de Teatro Popular de Sansinea [2010-2012]

La tesis de maestría 'Recuerdos, espejos y lugares en el teatro comunitario argentino contemporáneo. Memoria colectiva, identidades, y espacio público en las prácticas del Grupo de Teatro Popular de Sansinena [2010-2012]', indaga en las operaciones de memoria, la constitución de identidades y los procesos construcción/ reapropiación del espacio público, que tienen lugar en las prácticas de este grupo de teatro. Dentro del proceso de creación colectiva de la obra, se reconstruyen interpretaciones del pasado compartido, tensiones que dan cuenta de las lógicas que estructuran la selección de los hechos a contar, valores y representaciones que visibilizan un modo de percibir/ construir las identidades. El Grupo de Teatro Popular de Sansinena, la primera organización social que existe en el pueblo, configura un experiencia colectiva novedosa, que instaura nuevas lógicas de sociabilidad, genera vínculos con el 'afuera' y reivindica la bandera de resistencia y el reclamo de visibilización a través de la práctica cultural. Dentro de las dinámicas relacionales que atraviesan el grupo, observamos ciertas tendencias jerárquicas en los vínculos entre la directora y los vecinos que conforman el grupo 'lo que se percibe como una dificultad a superar- estructuradas en el fuerte liderazgo construido por la directora. Una Legitimidad configurada sobre los saberes reconocidos, virtudes heredadas y capacidades comprobadas en la práctica, que se perciben en los testimonios de los vecinos-actores. La conformación del Grupo de Teatro Comunitario de Rivadavia -compuesto por doscientos vecinos de seis pueblos del Partido de Rivadavia (incluido Sansinena)-, da cuenta de los alcances de este fenómeno, que deberá seguir estudiándose desde diversas perspectivas, a fin de visibilizar la relevancia que esta práctica cultural adquiere, tanto a nivel local como nacional

Que ningún desgraciado muera de hambre: agricultura, reciprocidad y reelaboración de identidades entre los ranqueles en la década de 1840

La imagen de las sociedades indígenas que habitaron las pampas rioplatenses con posterioridad al siglo XVI - y especialmente la visión acerca de su economía - ha sido objeto de una profunda revisión historiográfica y antropológica en las últimas décadas. La perspectiva que sólo se limitaba a consignar diversas formas predatorias fue reemplazada por un enfoque más amplio que reconoce la variedad y complejidad de la organización productiva. El propósito de este artículo - inscripto en ese enfoque - consiste en analizar las condiciones históricas que rodearon la incorporación y actualización de prácticas agrícolas por parte de los ranqueles durante la década de 1840, utilizando como fuente principal un texto descriptivo de las profundas transformaciones experimentadas por aquellos, redactado por el joven cautivo Santiago Avendaño y omitido en las versiones editadas de sus memorias. Luego de las gravosas derrotas sufridas en los años 30, los ranqueles lograron reconstruir su deteriorada base demográfica y económica, entre otros medios, incorporando contingentes boroganos, y con ellos ciertos manejos agrícolas de origen trasandino. La combinación de estos últimos con los tradicionales dio como resultado un conjunto flexible y diversificado que, unido a una nueva política de comensalidad consistente en la extensión fuera de sus límites normales de la reciprocidad generalizada, fue capaz de sustentar la recuperación social del grupo.

Recuerdos, espejos y lugares en el teatro comunitario argentino contemporáneo : Memoria colectiva, identidades y espacios público en las prácticas del Grupo de Teatro Popular de Sansinea [2010-2012]

La tesis de maestría 'Recuerdos, espejos y lugares en el teatro comunitario argentino contemporáneo. Memoria colectiva, identidades, y espacio público en las prácticas del Grupo de Teatro Popular de Sansinena [2010-2012]', indaga en las operaciones de memoria, la constitución de identidades y los procesos construcción/ reapropiación del espacio público, que tienen lugar en las prácticas de este grupo de teatro. Dentro del proceso de creación colectiva de la obra, se reconstruyen interpretaciones del pasado compartido, tensiones que dan cuenta de las lógicas que estructuran la selección de los hechos a contar, valores y representaciones que visibilizan un modo de percibir/ construir las identidades. El Grupo de Teatro Popular de Sansinena, la primera organización social que existe en el pueblo, configura un experiencia colectiva novedosa, que instaura nuevas lógicas de sociabilidad, genera vínculos con el 'afuera' y reivindica la bandera de resistencia y el reclamo de visibilización a través de la práctica cultural. Dentro de las dinámicas relacionales que atraviesan el grupo, observamos ciertas tendencias jerárquicas en los vínculos entre la directora y los vecinos que conforman el grupo 'lo que se percibe como una dificultad a superar- estructuradas en el fuerte liderazgo construido por la directora. Una Legitimidad configurada sobre los saberes reconocidos, virtudes heredadas y capacidades comprobadas en la práctica, que se perciben en los testimonios de los vecinos-actores. La conformación del Grupo de Teatro Comunitario de Rivadavia -compuesto por doscientos vecinos de seis pueblos del Partido de Rivadavia (incluido Sansinena)-, da cuenta de los alcances de este fenómeno, que deberá seguir estudiándose desde diversas perspectivas, a fin de visibilizar la relevancia que esta práctica cultural adquiere, tanto a nivel local como nacional

Que ningún desgraciado muera de hambre: agricultura, reciprocidad y reelaboración de identidades entre los ranqueles en la década de 1840

La imagen de las sociedades indígenas que habitaron las pampas rioplatenses con posterioridad al siglo XVI - y especialmente la visión acerca de su economía - ha sido objeto de una profunda revisión historiográfica y antropológica en las últimas décadas. La perspectiva que sólo se limitaba a consignar diversas formas predatorias fue reemplazada por un enfoque más amplio que reconoce la variedad y complejidad de la organización productiva. El propósito de este artículo - inscripto en ese enfoque - consiste en analizar las condiciones históricas que rodearon la incorporación y actualización de prácticas agrícolas por parte de los ranqueles durante la década de 1840, utilizando como fuente principal un texto descriptivo de las profundas transformaciones experimentadas por aquellos, redactado por el joven cautivo Santiago Avendaño y omitido en las versiones editadas de sus memorias. Luego de las gravosas derrotas sufridas en los años 30, los ranqueles lograron reconstruir su deteriorada base demográfica y económica, entre otros medios, incorporando contingentes boroganos, y con ellos ciertos manejos agrícolas de origen trasandino. La combinación de estos últimos con los tradicionales dio como resultado un conjunto flexible y diversificado que, unido a una nueva política de comensalidad consistente en la extensión fuera de sus límites normales de la reciprocidad generalizada, fue capaz de sustentar la recuperación social del grupo.

Recuerdos, espejos y lugares en el teatro comunitario argentino contemporáneo : Memoria colectiva, identidades y espacios público en las prácticas del Grupo de Teatro Popular de Sansinea [2010-2012]

La tesis de maestría 'Recuerdos, espejos y lugares en el teatro comunitario argentino contemporáneo. Memoria colectiva, identidades, y espacio público en las prácticas del Grupo de Teatro Popular de Sansinena [2010-2012]', indaga en las operaciones de memoria, la constitución de identidades y los procesos construcción/ reapropiación del espacio público, que tienen lugar en las prácticas de este grupo de teatro. Dentro del proceso de creación colectiva de la obra, se reconstruyen interpretaciones del pasado compartido, tensiones que dan cuenta de las lógicas que estructuran la selección de los hechos a contar, valores y representaciones que visibilizan un modo de percibir/ construir las identidades. El Grupo de Teatro Popular de Sansinena, la primera organización social que existe en el pueblo, configura un experiencia colectiva novedosa, que instaura nuevas lógicas de sociabilidad, genera vínculos con el 'afuera' y reivindica la bandera de resistencia y el reclamo de visibilización a través de la práctica cultural. Dentro de las dinámicas relacionales que atraviesan el grupo, observamos ciertas tendencias jerárquicas en los vínculos entre la directora y los vecinos que conforman el grupo 'lo que se percibe como una dificultad a superar- estructuradas en el fuerte liderazgo construido por la directora. Una Legitimidad configurada sobre los saberes reconocidos, virtudes heredadas y capacidades comprobadas en la práctica, que se perciben en los testimonios de los vecinos-actores. La conformación del Grupo de Teatro Comunitario de Rivadavia -compuesto por doscientos vecinos de seis pueblos del Partido de Rivadavia (incluido Sansinena)-, da cuenta de los alcances de este fenómeno, que deberá seguir estudiándose desde diversas perspectivas, a fin de visibilizar la relevancia que esta práctica cultural adquiere, tanto a nivel local como nacional