Carbapenem stewardship: positive impact on hospital ecology

INTRODUCTION: Excessive group 2 carbapenem use may result in decreased bacterial susceptibility. OBJECTIVE: We evaluated the impact of a carbapenem stewardship program, restricting imipenem and meropenem use. METHODS: Ertapenem was mandated for ESBL-producing Enterobacteriaceae infections in the absence of non-fermenting Gram-negative bacilli (GNB) from April 2006 to March 2008. Group 2 carbapenems were restricted for use against GNB infections susceptible only to carbapenems and suspected GNB infections in unstable patients. Cumulative susceptibility tests were done for nosocomial pathogens before and after restriction using Clinical and Laboratory Standards Institute (CLSI) guide-lines.Vitek System or conventional identification methods were performed and susceptibility testing done by disk diffusion according to CLSI.Antibiotic consumption (t-test) and susceptibilities (McNemar's test) were determined. RESULTS: The defined daily doses (DDD) of group 2 carbapenems declined from 61.1 to 48.7 DDD/1,000 patient-days two years after ertapenem introduction (p = 0.027). Mean ertapenem consumption after restriction was 31.5 DDD/1,000 patient-days. Following ertapenem introduction no significant susceptibility changes were noticed among Gram-positive cocci. The most prevalent GNB were P. aeruginosa, Klebsiella pneumoniae, and Acinetobacter spp. There was no change in P. aeruginosa susceptibility to carbapenems. Significantly improved P. aeruginosa and K. pneumoniae ciprofloxacin susceptibilities were observed, perhaps due to decreased group 2 carbapenem use. K. pneumoniae susceptibility to trimethoprim-sulfamethoxazole improved. CONCLUSION: Preferential use of ertapenem resulted in reduced group 2 carbapenem use, with a positive impact on P. aeruginosa and K. pneumoniae susceptibility.

Immediate reconstruction following breast-conserving surgery: management of the positive surgical margins and influence on secondary reconstruction

The efficacy of breast-conserving surgery for the local control of early breast cancer has been repeatedly evidenced. Although immediate reconstruction following breast-conserving surgery has been described, little information is available regarding surgical management in reoperative settings due to positive margins. We studied the influence of intraoperatively assessed and postoperatively controlled surgical margin status on the type of breast-conserving surgery and report our results regarding complications in a reoperative breast reconstruction scenario. All patients were seen by a multidisciplinary team who recommended breast-conserving surgery. According to the breast volume, ptosis and tumor size/location, the patients were also evaluated by a plastic surgeon, who recommended reconstruction with the appropriate technique. Intraoperative assessment of surgical margins was determined by histological examination of frozen sections. The mean follow-up time was 48months. Two hundred and eighteen patients (88.5 per cent ) underwent breast-conserving surgery and immediate reconstruction. Twelve (5.5 per cent ) patients had a positive tumor margin after review of the permanent section. All patients underwent re-exploration. In 1.3 per cent , a second reconstructive technique was indicated and in 2.2 per cent a skin-sparing mastectomy with total reconstruction was performed. Our findings support the important role of the intraoperative assessment of surgical margins and its interference in the selection of reconstruction techniques and negative margins; however, it will not guarantee complete excision of the tumor. Success depends on coordinated planning with the oncologic surgeon and careful intraoperative management

Positive Selection Results in Frequent Reversible Amino Acid Replacements in the G Protein Gene of Human Respiratory Syncytial Virus

Human respiratory syncytial virus (HRSV) is the major cause of lower respiratory tract infections in children under 5 years of age and the elderly, causing annual disease outbreaks during the fall and winter. Multiple lineages of the HRSVA and HRSVB serotypes co-circulate within a single outbreak and display a strongly temporal pattern of genetic variation, with a replacement of dominant genotypes occurring during consecutive years. In the present study we utilized phylogenetic methods to detect and map sites subject to adaptive evolution in the G protein of HRSVA and HRSVB. A total of 29 and 23 amino acid sites were found to be putatively positively selected in HRSVA and HRSVB, respectively. Several of these sites defined genotypes and lineages within genotypes in both groups, and correlated well with epitopes previously described in group A. Remarkably, 18 of these positively selected tended to revert in time to a previous codon state, producing a ""flipflop'' phylogenetic pattern. Such frequent evolutionary reversals in HRSV are indicative of a combination of frequent positive selection, reflecting the changing immune status of the human population, and a limited repertoire of functionally viable amino acids at specific amino acid sites.

Hemoplasma Infection in HIV-positive Patient, Brazil

Hemotrophic mycoplasmas infect a variety of mammals. Although infection in humans is rarely reported, an association with an immunocompromised state has been suggested. We report a case of a Mycoplasma haemofelis-like infection in an HIV-positive patient co-infected with Bartonella henselae.

A positive growth response to NaCl applications in Eucalyptus plantations established on K-deficient soils

Contrasting responses of Eucalyptus trees to K fertilizer applications have been reported on soils with low K contents. A complete randomized block experiment was set up in Brazil to test the hypothesis that large atmospheric deposits of NaCl in coastal regions might lead to a partial substitution of K by Na in Eucalyptus physiology and enhance tree growth. Treatments with application of 1.5, 3.0, 4.5 kmol K ha(-1) (K(1.5), K(3.0), 1(4.5, respectively) as KCl, 3.0 kmol K ha(-1) applied as K(2)SO(4), 3.0 kmol Na ha(-1) (Na(3.0)) as NaCl commercialized for cattle feeding, and a mixture of 1.5 kmol K + 1.5 kmol Na ha(-1) (K(1.5) + Na(1.5)) were compared to a control treatment (C) with no K and Na applications. All the plots were fertilized with large amounts of the other nutrients. A positive effect of NaCl applications on the growth of E. grandis trees was observed. NaCl and KCl additions in treatments Na(3.0) and K(3.0) increased above-ground biomass by 56% and 130% three years after planting, respectively, in comparison with the C treatment. By contrast, accumulated litterfall up to age 3 years was not significantly modified. NaCl applications in the Na(3.0) treatment significantly increased Na accumulation in above-ground tree components but did not modify K accumulation, whatever the sampling age. A partial substitution of K by Na in tree physiology, as observed for various agricultural crops, might explain this behaviour. Our results suggest the possibility of applying inexpensive K fertilizers, which are less purified in Na, and explain why high yields are achieved without K fertilizer applications in areas with large dry depositions of marine aerosols. Further investigations are necessary to identify the processes involving Na in Eucalyptus tree physiology. (C) 2009 Elsevier B.V. All rights reserved.

The influence of positive or negative charges in the passive and iontophoretic skin penetration of porphyrins used in photodynamic therapy

Meso-tetra-(N-methylpiridinium-4-yl)-porphyrin (TMPyP) and meso-tetra-(4-sulfonatophenyl)-porphyrin (TPPS(4)) are photosensitizing drugs (PS) used in photodynamic therapy (PDT). Based on the fact that these compounds present similar chemical structures but opposite charges at pH levels near physiological conditions, this work aims to evaluate the in vitro and in vivo influence of these electrical charges on the iontophoretic delivery of TMPyP and TPPS4, attempting to achieve maximum accumulation of PS in skin tissue. The iontophoretic transport of these drugs from a hydrophilic gel was investigated in vitro using porcine ear skin and vertical, flow-through diffusion cells. In vivo experiments using rats were also carried out, and the penetration of the PSs was analyzed by fluorescence microscopy to visualize the manner of how these compounds were distributed in the skin after a short period of iontophoresis application. In vitro, both passive and iontophoretic delivery of the positively charged TMPyP were much greater (20-fold and 67-fold, respectively) than those of the negatively charged TPPS(4). TPPS(4) iontophoresis in vivo increased the fluorescence of the skin only in the very superficial layers. On the other hand, iontophoresis of the positively charged drug expressively increased the rat epidermis and dermis fluorescence, indicating high amounts of this drug throughout the skin layers. Moreover, TMPyP was homogeneously distributed around and into the nuclei of the skin cells, suggesting its potential use in topical PDT. (C) 2010 Elsevier B.V. All rights reserved.

Antimicrobial ent-pimarane diterpenes from Viguiera arenaria against Gram-positive bacteria

The dichloromethane crude extract from the roots of Viguiera arenaria (VaDRE) has been employed in an antimicrobial screening against several bacteria responsible for human pathologies. The main diterpenes isolated from this extract, as well as two semi-synthetic pimarane derivatives, were also investigated for the pathogens that were significantly inhibited by the extract (MIC values lower than 100 mu g mL(-1)). The VaDRE extract was significantly active only against Gram-positive microorganisms. The compounds ent-pimara-8(14),15-dien-19-oic acid (PA): PA sodium salt; ent-8(14),15-pimaradien-3 beta-ol; ent-15-pimarene-8 beta,19-diol; and ent-8(14),15-pimaradien-3 beta-acetoxy displayed the highest antibacterial activities (MIC values lower than 10 mu g mL(-1) for most pathogens). In conclusion, our results suggest that pimaranes are an important class of natural products for further investigations in the search of new antibacterial agents. (c) 2009 Elsevier B.V. All rights reserved.

Geographic variation and positive selection on M7 lysin, an acrosomal sperm protein in mussels (Mytilus spp.)

Successful fertilization in free-spawning marine organisms depends on the interactions between genes expressed on the surfaces of eggs and sperm. Positive selection frequently characterizes the molecular evolution of such genes, raising the possibility that some common deterministic process drives the evolution of gamete recognition genes and may even be important for understanding the evolution of prezygotic isolation and speciation in the marine realm. One hypothesis is that gamete recognition genes are subject to selection for prezygotic isolation, namely reinforcement. In a previous study, positive selection on the gene coding for the acrosomal sperm protein M7 lysin was demonstrated among allopatric populations of mussels in the Mytilus edulis species group (M. edulis, M. galloprovincialis, and M. trossulus). Here, we expand sampling to include M7 lysin haplotypes from populations where mussel species are sympatric and hybridize to determine whether there is a pattern of reproductive character displacement, which would be consistent with reinforcement driving selection on this gene. We do not detect a strong pattern of reproductive character displacement; there are no unique haplotypes in sympatry nor is there consistently greater population structure in comparisons involving sympatric populations. One distinct group of haplotypes, however, is strongly affected by natural selection and this group of haplotypes is found within M. galloprovincialis populations throughout the Northern Hemisphere concurrent with haplotypes common to M. galloprovincialis and M. edulis. We suggest that balancing selection, perhaps resulting from sexual conflicts between sperm and eggs, maintains old allelic diversity within M. galloprovincialis.

The case for the ability-based model of emotional intelligence in organizational behavior

In this second counterpoint article, we refute the claims of Landy, Locke, and Conte, and make the more specific case for our perspective, which is that ability-based models of emotional intelligence have value to add in the domain of organizational psychology. In this article, we address remaining issues, such as general concerns about the tenor and tone of the debates on this topic, a tendency for detractors to collapse across emotional intelligence models when reviewing the evidence and making judgments, and subsequent penchant to thereby discount all models, including the ability-based one, as lacking validity. We specifically refute the following three claims from our critics with the most recent empirically based evidence: (1) emotional intelligence is dominated by opportunistic academics-turned-consultants who have amassed much fame and fortune based on a concept that is shabby science at best; (2) the measurement of emotional intelligence is grounded in unstable, psychometrically flawed instruments, which have not demonstrated appropriate discriminant and predictive validity to warrant/justify their use; and (3) there is weak empirical evidence that emotional intelligence is related to anything of importance in organizations. We thus end with an overview of the empirical evidence supporting the role of emotional intelligence in organizational and social behavior.

The effects of Australian tall poppy attitudes on American value based leadership theory

A survey study of twenty-two Australian CEOs and their subordinates assessed relationships between Australian leader motives, Australian value based leader behaviour, subordinate tall poppy attitudes and subordinate commitment, effectiveness, motivation and satisfaction (CEMS). On the whole, the results showed general support for value based leadership processes. Subsequent regression analyses of the second main component of Value Based Leadership Theory, value based leader behaviour, revealed that the collectivistic, inspirational, integrity and visionary behaviour sub-scales of the construct were positively related with subordinate CEMS. Although the hypothesis that subordinate tall poppy attitudes would moderate value based leadership processes was not clearly supported, subsequent regression analyses found that subordinate tall poppy attitudes were negatively related with perceptions of value based leader behaviour and CEMS. These findings suggest complex relationships between the three constructs, and the proposed model for the Australian context is accordingly amended. Overall, the research supports the need to consider cultural-specific attitudes in management development.

Positive selection on an acrosomal sperm protein, M7 lysin, in three species of the mussel genus Mytilus

Marine invertebrate sperm proteins are particularly interesting because they are characterized by positive selection and are likely to be involved in prezyogotic isolation and, thus, speciation. Here, we present the first survey of inter and intraspecific variation of a bivalve sperm protein among a group of species that regularly hybridize in nature. M7 lysin is found in sperm acrosomes of mussels and dissolves the egg vitelline coat, permitting fertilization. We sequenced multiple alleles of the mature protein-coding region of M7 lysin from allopatric populations of mussels in the Mytilus edulis species group (M. edulis, M. galloprovincialis, and M. trossulus). A significant McDonald-Kreitman test showed an excess of fixed amino acid replacing substitutions between species, consistent with positive selection. In addition, Kolmogorov-Smirnov tests showed significant heterogeneity in polymorphism to divergence ratios for both synonymous variation and combined synonymous and non-synonymous variation within M. galloprovincialis. These results indicate that there has been adaptive evolution at M7 lysin and, furthermore, shows that positive selection on sperm proteins can occur even when post-zygotic reproductive isolation is incomplete.

Leadership in the Asian Century: Lessons from GLOBE

In this paper, based on the results of the Global Leadership and Organizational Behavior Effectiveness (GLOBE) 61-nation study of culture and leadership, we present findings related to three ‘clusters’ of countries. These clusters are: (1) the ‘Anglo culture’ cluster (Australia, Canada, Ireland, New Zealand, white South Africa, UK, and USA), the ‘Southern Asia’ cluster (Iran, India, Thailand, Malaysia, Indonesia, and the Philippines), and the ‘Confucian Asia’ cluster (China, Hong Kong, Japan, Singapore, South Korea, and Taiwan). Data from the GLOBE study, reporting middle managers’ perceptions of societal practices and values, and of the factors that facilitate and inhibit effective leadership will be compared across the three clusters. Results demonstrate that, despite differences in cultures, especially cultural values, perceptions of effective leadership vary substantially only in respect of the extent that participation is seen to facilitate leadership. In the Anglo cluster, participative leadership is seen as much more facilitative of leadership, than in either of the Asian clusters. Results are discussed in terms of effective leadership styles suitable for management in the twenty-first century, where Asian economies are likely to play a more dominant role than they have in recent history.

Leadership Attributes and Cultural Values in Australia and New Zealand Compared: An Initial Report Based on GLOBE Data.

This paper reports a comparative study of Australian and New Zealand leadership attributes, based on the GLOBE (Global Leadership and Organizational Behavior Effectiveness) program. Responses from 344 Australian managers and 184 New Zealand managers in three industries were analyzed using exploratory and confirmatory factor analysis. Results supported some of the etic leadership dimensions identified in the GLOBE study, but also found some emic dimensions of leadership for each country. An interesting finding of the study was that the New Zealand data fitted the Australian model, but not vice versa, suggesting asymmetric perceptions of leadership in the two countries.

Emotional awareness and emotional intelligence in leadership teaching

Recent research has highlighted the importance of emotional awareness and emotional intelligence in organizations, and these topics are attracting increasing attention. In this article, the authors present the results of a preliminary classroom study in which emotion concepts were incorporated into an undergraduate leadership course. In the study, students completed self report and ability tests of emotional intelligence. The test results were compared with students' interest in emotions and their performance in the course assessment. Results showed that interest in and knowledge of emotional intelligence predicted team performance, whereas individual performance was related to emotional intelligence.

Closing the gap in curriculum development leadership

“Closing the gap in curriculum development leadership” is a Carrick-funded University of Queensland project which is designed to address two related gaps in current knowledge and in existing professional development programs for academic staff. The first gap is in our knowledge of curriculum and pedagogical issues as they arise in relation to multi-year sequences of study, such as majors in generalist degrees, or core programs in more structured degrees. While there is considerable knowledge of curriculum and pedagogy at the course or individual unit of study level (e.g. Philosophy I), there is very little properly conceptualised, empirically informed knowledge about student learning (and teaching) over, say, a three-year major sequence in a traditional Arts or Sciences subject. The Carrick-funded project aims to (begin to) fill this gap through bottom-up curriculum development projects across the range of UQ’s offerings. The second gap is in our professional development programs and, indeed, in our recognition and support for the people who are in charge of such multi-year sequences of study. The major convener or program coordinator is not as well supported, in Australian and overseas professional development programs, as the lecturer in charge of a single course (or unit of study). Nor is her work likely to be taken account of in workload calculations or for the purposes of promotion and career advancement more generally. The Carrick-funded project aims to fill this gap by developing, in consultation with crucial stakeholders, amendments to existing university policies and practices. The attached documents provide a useful introduction to the project. For more information, please contact Fred D’Agostino at f.dagostino@uq.edu.au.