Streptococcus pneumoniae capsule determines disease severity in experimental pneumococcal meningitis.

Streptococcus pneumoniaebacteria can be characterized into over 90 serotypes according to the composition of their polysaccharide capsules. Some serotypes are common in nasopharyngeal carriage whereas others are associated with invasive disease, but when carriage serotypes do invade disease is often particularly severe. It is unknown whether disease severity is due directly to the capsule type or to other virulence factors. Here, we used a clinical pneumococcal isolate and its capsule-switch mutants to determine the effect of capsule, in isolation from the genetic background, on severity of meningitis in an infant rat model. We found that possession of a capsule was essential for causing meningitis. Serotype 6B caused significantly more mortality than 7F and this correlated with increased capsule thickness in the cerebrospinal fluid (CSF), a stronger inflammatory cytokine response in the CSF and ultimately more cortical brain damage. We conclude that capsule type has a direct effect on meningitis severity. This is an important consideration in the current era of vaccination targeting a subset of capsule types that causes serotype replacement.

Effects of breastfeeding and naturally acquired immunity on infection with {\it Giardia lamblia}: A study in a cohort of Mexican infants

Giardia lamblia is one of the most common causes of gastrointestinal tract infection among young children worldwide. Yet host protection against this parasite and the effect of infection with Giardia on infant growth are poorly understood. It was hypothesized that among young children, protection against infection with Giardia is afforded by breastfeeding and previous infection with the parasite and further, that infection with Giardia decreases growth velocity. From 4/88 to 4/90, 197 infants in a poor area of Mexico City were followed from 0 to 18 months of age, with stool specimens, symptoms and feeding status data collected weekly. A total of 6,031 stool specimens were tested for Giardia antigen by enzyme-linked immunosorbent assay. There were 1.0 Giardia infections per child-year; 25% were symptomatic and 54% lasted more than 1 month; 94 infants had 1, and 33 had 2 or more infections. Breastfeeding status was coded and analyzed for each child-week of follow up. 91% of study infants were breastfed from birth, 57% at 6 months and 38% at 12 months of age. Rate ratios for non-breastfeeding adjusted for confounding factors were calculated from stratified analyses and the Cox proportional hazards model. Not breastfeeding was a significant risk factor for first infection with Giardia vs. any breastfeeding (adjusted RR = 1.8; 1.1, 2.8) at all ages; a dose response was demonstrated by degree of breastfeeding. The adjusted rate ratio for non-breastfeeding vs. partial breastfeeding was 1.6 (1.03, 2.6) and for non-breastfeeding vs. complete breastfeeding was 4.7 (1.4, 15.9). Among Giardia infected infants, breastfeeding did not protect against diarrheal symptoms or shorten the duration of carriage. First and repeat infections with Giardia did not differ in duration or the percent symptomatic. The analysis of growth and Giardia infection was inconclusive but suggested that a history of Giardia infection might be associated with decreased weight velocity, while an immediate chronic infection might be associated with increased weight velocity. In summary, these data indicate that breastfeeding protects infants against infection with Giardia; provide no evidence of protection against repeat infections resulting from a prior infection and suggest but do not establish that a history of Giardia infection might be associated with decreased growth in young children. ^

Implementation of active surveillance cultures and associated infection control practices for the reduction of methicillin resistant Staphylococcus aureus in the healthcare setting: An interrupted time series analysis

OBJECTIVE. To determine the effectiveness of active surveillance cultures and associated infection control practices on the incidence of methicillin resistant Staphylococcus aureus (MRSA) in the acute care setting. DESIGN. A historical analysis of existing clinical data utilizing an interrupted time series design. ^ SETTING AND PARTICIPANTS. Patients admitted to a 260-bed tertiary care facility in Houston, TX between January 2005 through December 2010. ^ INTERVENTION. Infection control practices, including enhanced barrier precautions, compulsive hand hygiene, disinfection and environmental cleaning, and executive ownership and education, were simultaneously introduced during a 5-month intervention implementation period culminating with the implementation of active surveillance screening. Beginning June 2007, all high risk patients were cultured for MRSA nasal carriage within 48 hours of admission. Segmented Poisson regression was used to test the significance of the difference in incidence of healthcare-associated MRSA during the 29-month pre-intervention period compared to the 43-month post-intervention period. ^ RESULTS. A total of 9,957 of 11,095 high-risk patients (89.7%) were screened for MRSA carriage during the intervention period. Active surveillance cultures identified 1,330 MRSA-positive patients (13.4%) contributing to an admission prevalence of 17.5% in high-risk patients. The mean rate of healthcare-associated MRSA infection and colonization decreased from 1.1 per 1,000 patient-days in the pre-intervention period to 0.36 per 1,000 patient-days in the post-intervention period (P<0.001). The effect of the intervention in association with the percentage of S. aureus isolates susceptible to oxicillin were shown to be statistically significantly associated with the incidence of MRSA infection and colonization (IRR = 0.50, 95% CI = 0.31-0.80 and IRR = 0.004, 95% CI = 0.00003-0.40, respectively). ^ CONCLUSIONS. It can be concluded that aggressively targeting patients at high risk for colonization of MRSA with active surveillance cultures and associated infection control practices as part of a multifaceted, hospital-wide intervention is effective in reducing the incidence of healthcare-associated MRSA.^

The epidemiology of antibiotic resistance in hospitals: Paradoxes and prescriptions

A simple mathematical model of bacterial transmission within a hospital was used to study the effects of measures to control nosocomial transmission of bacteria and reduce antimicrobial resistance in nosocomial pathogens. The model predicts that: (i) Use of an antibiotic for which resistance is not yet present in a hospital will be positively associated at the individual level (odds ratio) with carriage of bacteria resistant to other antibiotics, but negatively associated at the population level (prevalence). Thus inferences from individual risk factors can yield misleading conclusions about the effect of antibiotic use on resistance to another antibiotic. (ii) Nonspecific interventions that reduce transmission of all bacteria within a hospital will disproportionately reduce the prevalence of colonization with resistant bacteria. (iii) Changes in the prevalence of resistance after a successful intervention will occur on a time scale of weeks to months, considerably faster than in community-acquired infections. Moreover, resistance can decline rapidly in a hospital even if it does not carry a fitness cost. The predictions of the model are compared with those of other models and published data. The implications for resistance control and study design are discussed, along with the limitations and assumptions of the model.

Description of near attack, [1819 August]

One leaf containing a description by Croswell of nearly being run over by a carriage. The document is undated, but the date can be inferred from other diary entries in the collection.

Left: Livery & Sale Stables, J.A. Polhemus & Son, Proprs., Ann Arbor, Mich. Left: Buchoz's Block, Ann Arbor, Mich. Bottom: Orchestrian Hall, Fred Rettich, Proprietor, Ann Arbor, Mich.

Ann Arbor, Mich. businesses. Publication information: Chicago, Ill. : Everts & Stewart, 1874.

Constitution and by-laws ... Organized October 4th, 1865.

Mode of access: Internet.

Catalogs of Michigan-based automobile companies.

Mode of access: Internet.

Stockton's stories ...

Contains publisher's advertisements.

The novels and stories.

v. 1. The late Mrs. Null.--v. 2. The Squirrel Inn. The Merry Chanter.--v. 3. Rudder Grange.--v. 4. The hundredth man.--v. 5. Ardis Claverden.--v. 6. The great war syndicate. The stories of the three burglars. The knife that killed Po Hancy. Dusky philosophy.--v. 7. The house of Martha.--v. 8. Pomona's travels. Euphemia among the pelican's. The Rudder Grangers in England. Pomona's daughter.--v. 9. The adventures of Captain Horn.--v. 10. Mrs. Cliff's yacht.--v. 11. The great stone of Sardis. The water-devil.--v. 12. The girl at Cobhurst.--v. 13. The casting away of Mrs. Lecks and Mrs. Aleshine. The vizier of the two-horned Alexander.--v. 14. The associate hermits.--v. 15. Stories. [v.]1: The lady or the tiger? The discourager of hesitancy. The transferred ghost. The spectral mortgage. Every man his own letter-writer. Thar same old coon. Our story. Derelict. On the training of parents. A borrowed month. The baker of Barnbury. The watchmaker's wife.--v. 16. Stories. [v.]2: A tale of negative gravity. Asaph. The remarkable page. The Cloverfield's carriage. A story of assisted fate. My bull-calf. As one woman to another. Our fire-screen. My terminal moraine. Plain fishing.--v. 17. Stories. [v.]3: The griffin and the minor canon. Old Pipes and the dryad. The bee-man of Orn. The queen's museum. The clocks of Rondaine. Christmas before last; or, the fruit of the fragile palm. Prince Hassak's march. The battle of the third cousins. The banished king. The philopena. Amos Kilbright: his adscititious experiences. The Christmas shadrach. The bishop's ghost and the printer's baby. The philosophy of relative existences.--v. 18. Stories. [v.]4: The magic egg. "His wife's deceased sister." The widow's cruise. Captain Eli's best ear. Love before breakfast. The staying power of Sir Rohan. A piece of red calico. The Christmas wreck. My well and what came out of it. Mr. Tolman. My unwilling neighbor. Our archery club.--v. 19. Afield and afloat: The Buller-Podington compact. The romance of a mule-car. The governor-general. Old Applejoy's ghost. Struck by a boomerang. The skipper and El Capitan. "Come in, new year." A sailor's knot. The great staircase at Landover Hall. The ghosts in my toewer. The landsman's tale.--v. 20. Kate Bonnet: the romance of a pirate's daughter.--v. 21. John Gayther's garden.--v. 22. The captain's toll-gate.--v. 23. A bicycle of Cathay. With a memorial sketch of Mr. Stockton and a bibliography of his works.

A treatise of the law relative to merchant ships and seamen /

Includes bibliographical references and index.

Edward William Staebler in a Toledo steamer car

On verso: Ann Arbor

Walker Building - Ann Arbor

Plates. 12 pts. in 1 v. Publication information: Chicago : The W. H. Parish publishing co., 1893

Michigan float at 1948 Tournament of Roses Parade

[float recreates the carriage that Michigan players rode in Tournament of Roses Parade in 1902]

The Backus Farm, Grosse Pointe

Stereograph, people by dwelling house, some in carriage