Our weekly wrap-up of antimicrobial stewardship & antimicrobial resistance scans Four CRE cases reported in WisconsinOriginally published Sep 1.Investigators with the Centers for Disease Control and Prevention (CDC) today describe a small cluster of the worrisome “superbug” known as carbapenem-resistant Enterobacteriaceae (CRE) at two Wisconsin hospitals in Morbidity and Mortality Weekly Report (MMWR).According to the report, officials with the Wisconsin State Laboratory of Hygiene notified the Wisconsin Division of Public Health in June 2015 that five carbapenemase-producing CRE isolates had been identified among four inpatients at two hospitals in southeastern Wisconsin. They all contained the KPC gene, which codes for Klebsiella pneumoniae carbapemenase.The KPC-CRE isolates were identified among 49 isolates obtained from 46 patients from February to May 2015. The median age of the four patients (two men and two women) was 65, and median hospitalization length was 83 days. All four patients had been intubated and undergone a tracheostomy.Further investigation revealed that the five isolates exhibited a high degree of genetic relatedness but did not uncover how the bacteria traveled between the two facilities. Active surveillance conducted at the two hospitals in July 2015 identified no further cases. Site visits, reviews of infection prevention protocols, and interviews with infection prevention staff members, primary care providers, and patients found no breaches in recommended practices.The authors of the report say the findings demonstrate the importance of routine hospital- and laboratory-based surveillance for the detection of healthcare-related CRE. In this case, staff at neither of the two hospitals was aware of the possibility of CRE transmission among their patients. The authors also say the use of molecular subtyping methods (like whole-genome sequencing) to determine the genetic similarities in the isolates was particularly valuable.Sep 2 MMWR report ASP intervention not found to improve outcomes in C diff patientsOriginally published Sep 1.A study today out of the University of Michigan has found a real-time antibiotic stewardship program (ASP) intervention in patients with Clostridium difficile infection (CDI) improved process measures but did not improve outcomes.The study, published in the American Journal of Infection Control, details the results of what the authors call a “quasiexperimental” study of adult CDI patients before and after a real-time ASP review was initiated.In the intervention group (285 patients), an ASP pharmacist was called in after diagnosis to review each case with the medical team and make recommendations on optimal treatment, antibiotic therapy and acid-suppressing therapy, and surgical/infectious disease consultation. In the control group (307 patients), CDI treatment was left to the discretion of the patient’s primary medical team. Overall, ASP pharmacists provided treatment recommendations for 129 of the 285 patients in the intervention group.The primary measurement of the study was a composite of several outcomes—including 30-day mortality, intensive care unit admission, surgery, and CDI recurrence. But process measures that may influence outcomes in CDI patients were also measured, with researchers looking at whether acid-suppressive therapy was reduced in CDI patients and whether patients with severe CDI received infectious disease consultation and appropriate and timely antibiotic therapy.In the end, the researchers found that ASP intervention reduced unnecessary acid-suppressing therapy when compared with the control group. And patients with severe CDI who received ASP intervention were more likely to be treated with vancomycin, receive vancomycin therapy more quickly, and receive infectious disease consultation than the patients in the pre-intervention group. This finding is in line with previous studies on ASP intervention in CDI patients.However, the investigators were not able to demonstrate a statistically significant improvement in primary clinical outcomes among the patients who received ASP intervention. Occurrence of primary composite outcome was 14.7% in the pre-intervention group and 12.3% in the intervention groups. The authors of the study say this may be due to the low baseline rates of these outcomes among the patients.In conclusion, the authors say their findings, when added to previous literature on the topic, raise questions about whether ASP involvement in the conventional management of CDI is worthwhile, especially in institutions with low rates of CDI-attributable complications.Sep 1 Am J Infect Control study Study: Written reports help dentists reduce antibiotic prescribingOriginally published Aug 31.A new UK study has found that dentists prescribe fewer antibiotics to their patients after receiving a report on their past prescribing habits.According to the study, published yesterday in PLoS Medicine, dentists prescribe roughly 10% of the antibiotics dispensed in UK community pharmacies, often in the absence of clinical need. Using dental prescribing and treatment claim data routinely collected by the UK National Health Service (NHS), researchers with the RAPiD (Reducing Antibiotic Prescribing in Dentistry) trial set out to determine whether an individualized audit and feedback intervention could have an impact on prescribing habits.The trial included 795 dental practices in Scotland, with 632 practices in an intervention group and 163 in a control group. The intervention group was further subdivided into two groups: one that received a line graph showing an individual dentist’s monthly prescribing rate, and another that received a line graph with a written “behavior change” message containing national guidelines for dental antibiotic prescribing.At the start of trial, the rate of antibiotics prescribed per 100 NHS treatment claims was 8.3 in the control group and 8.5 in the intervention group. After 12 months, the researchers found that both groups were prescribing fewer antibiotics. But the drop in the prescribing rate in the intervention group—from 8.5 to 7.5—was 5.7% greater than it was for the control group. And the subset of dentists who received a written message saw their prescribing rate drop by an additional 6%.The authors of the study wrote that the findings are significant because they indicate that a “relatively straightforward, low-cost public health and patient safety intervention” could help the entire healthcare system address antimicrobial resistance.Aug 30 PLoS Med study Review outlines economic incentives for antibiotic developmentOriginally published Aug 31.Limited commercial returns are considered a primary factor in why pharmaceutical companies are not investing in antibiotic development. That’s why a “constellation of economic incentives” will be needed to promote antibacterial drug development going forward, according to an article published yesterday in Clinical Infectious Diseases.The article, written by members of the Trans-Atlantic Task Force on Antimicrobial Resistance (TATFAR), is a review of the various economic incentives identified in policy documents, peer-reviewed publications, organization proposals, and government-sponsored reviews that have addressed the question of how to spur new antibiotic development. In October 2015, TATFAR agreed to make an informed recommendation on a package of economic incentives to be considered and implemented in the future.In those documents, the authors found a consensus around the idea that economic incentives must contain both “push and pull” mechanisms that will guarantee return on investment. Push incentives include subsidies (in the form of grants, public-private partnerships, and tax credits) to fund early-stage development of antimicrobials, which is often risky and expensive. The idea is to provide incentives to academic institutions and companies by providing up-front money for research and development.Pull incentives, on the other hand, are meant to encourage antibacterial drug development by promising a substantial financial reward to companies that successfully develop new antibiotics. Examples include large milestone or prize payments, patent buy-outs, advanced market commitments, and extended market exclusivity.Pull incentives, the authors found, will be most successful if they rely on a “de-linkage” model that would remove the motivation for pharmaceutical companies to market and oversell their product. Negating the need for high product sales, they argue, would ensure that new antibiotics are not overused, thereby linking new antibiotic development to conservation and stewardship.Finally, the authors found widespread agreement that global coordination will be needed to administer the funding of these incentive programs. Aug 30 Clin Infect Dis literature review Growing polymyxin resistance reported in CRE in BrazilOriginally published Aug 31.Brazilian researchers are reporting increasing resistance to polymyxin antibiotics in clinical Klebsiella Pneumoniae strains that are already resistant to carbapenem antibiotics.In a letter to Emerging Infectious Diseases, the researchers report on an analysis of more than 3,000 K pneumoniae isolates recovered from patients at 10 private tertiary-care hospitals in Sao Paulo from January 2011 to December 2015.The analysis showed a dramatic increase in carbapenem resistance in the K pneumoniae isolates—from 6.8% in 2011 to 35.5% in 2015. And among the carbapenem-resistant K pneumoniae isolates, polymyxin resistance rose from 0% in 2011 to 27.1% in 2015. Polymyxin resistance among carbapenem-susceptible K pneumoniae isolates also rose, from 0.7% in 2011 to 3.9% in 2015.The authors said the findings are worrisome because carbapenem-resistant Enterobacteriaceae (CRE) are more deadly than carbapenem-susceptible strains, and carbapenem-resistant K pneumoniae bacteria are endemic in Brazil. Furthermore, most resistant infections are treated with polymyxins.Aug 30 Emerg Infect Dis letter UN experts warn antibiotic resistance will put mothers, infants at riskOriginally published Aug 30.Every year, more than 30,000 women and 400,000 newborns die from infections that occur shortly after a woman has given birth. And those numbers will likely grow as rising drug resistance renders antibiotics less effective.That’s the central message in a commentary yesterday by Anthony Costello, MD, WHO director of maternal, newborn, child, and adolescent health, and Stefan S. Peterson, MD, PhD, MPH, UNICEF chief of health. The global health experts write that overuse of antibiotics in humans, along with “needless use” in animals, has created a “recipe for disaster” by accelerating the process in which exposed microbes build resistance.Antibiotic resistance, they say, will have a major impact on newborns, who lack fully developed immune systems and are therefore more susceptible to infections they might pick up from their mother or from the hospital. Even more at risk will be children born in low-income countries, where healthcare facilities often lack basic sanitary conditions and lifesaving antibiotics are scarce.”More children in Africa die from a lack of access to antibiotics than from antibiotic-resistant infections,” Costello and Peterson write. “Indeed, many still die from infections, such as bacterial pneumonia, that should be easily treatable.”To solve this problem of “access and excess” and save the lives of infants and mothers, Costello and Peterson write, healthcare providers need to begin by stopping the spread of infection and negating the need for antibiotics. This means that all healthcare facilities must have running water and basic sanitation, and that staff must follow good hygiene practices. They also recommend implementing policies to discharge mothers and newborns from the hospital sooner, in order to reduce exposure to infectious microbes.And lastly, healthcare providers should use antibiotics only when they can confirm that they are absolutely needed. “Simply put, those who need lifesaving antibiotics must get them, and those who do not must not,” they write.Aug 29 WHO commentary MCR-1 found for the first time on the Arabian PeninsulaOriginally published Aug 29.An international team of researchers is reporting the first case of the colistin-resistance gene MCR-1 on the Arabian Peninsula.In a study published in the International Journal of Infectious Diseases, the researchers reported that out of 75 colistin-resistant Enterobacteriaceae strains isolated from clinical cases in Bahrain, Kuwait, Oman, Saudi Arabia, and the United Arab Emirates, 4 Escherichia coli isolates were found to harbor the MCR-1 gene on mobile pieces of DNA known as plasmids. Two of the isolates were from blood samples; the two others were from urine and a bed sore.The researchers noted that the plasmids on the four isolates all carried various genes that confer resistance to carbapenem and beta-lactam antibiotics, with one of the isolates expressing high levels of carbapenem resistance. Besides colistin—which is considered an antibiotic of last resort—all four strains were uniformly resistant to third-generation cephalosporins, tetracycline, trimetoprime/sulfamethoxasole and gentamicin.The researchers also said that one of the plasmids identified is the first found in a human E coliisolate to carry both MCR-1 and resistance genes to other classes of antibiotics. The findings are a concern because they suggest antibiotics commonly used in humans could facilitate the spread of MCR-1-carrying bacteria.The MCR-1 gene was first identified in China in 2015, when researchers detected its presence in E colisamples from food, food animals, and humans. Since then, it’s been found in bacteria in more than 30 countries.Aug 26 Int J Infect Dis study British scientists warn about drug-resistant fungal infectionsOriginally published Aug 29.UK scientists say that fungal infections are becoming increasingly resistant to the drugs used to treat them and warn that deaths will likely increase with rising resistance.Fungi can cause a host of illnesses, from minor skin infections such as ringworm to more dangerous conditions like valley fever. While many of these conditions can be treated easily, fungal infections become more of a threat when they occur in people with compromised immune systems, like cancer patients, HIV patients, and premature babies. They’re also a bigger problem in developing nations.The Guardian reports that UK doctors are becoming increasingly alarmed about rising resistance to a class of antifungal agents known as azoles, which are used to treat a variety of fungal infections. Fungal resistance is similar to antibiotic resistance, but experts say it may be even more worrisome because there are far fewer drugs to treat fungal infections than there are antibiotics to treat bacterial infections.”We cannot afford to lose the few drugs we have—particularly as very little funding is being made available for research into fungi and fungal infections,” said Adilia Warris, MD, co-director of the Centre for Medical Mycology at Aberdeen University.Warris and other experts said the widespread use of fungicides on agricultural crops is one of the factors in rising fungal resistance.Fungal infections take more than 1.3 million lives each year globally, according to Rutgers University scientists.Aug 26 Guardian storyDec 23, 2013 Rutgers news release “Attacking fungal infection, one of world’s major killers”
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Gauke: ‘For too long legal support focused solely on funding court disputes’Defending the reforms, Lord Chancellor David Gauke said today that part one of LASPO, which came into force in April 2013, was designed to target limited resources at the most vulnerable, following a ‘long period of expansion of legal aid’ that resulted in an annual spend of over £2bn.Gauke said the government’s year-long review, which involved speaking to more than 100 organisations, has highlighted that ‘for too long legal support has been focused solely on funding court disputes, with less emphasis on how problems can be resolved earlier and avoid them escalating into more problematic issues that require a court visit’.As part of the action plan the department will pilot face-to-face early legal advice in a specific area of social welfare law. Frazer told a media briefing today that this area could be housing. The ministry will also:Review the legal aid means test (by summer 2020);Bring forward proposals to expand legal aid to include separated migrant children in immigration cases (by spring 2019);Bring forward proposals to expand legal aid to cover special guardianship orders in private family law (by autumn 2019);Work with the Law Society to explore an ‘alternative model’ for family legal aid;Consider introducing an emergency procedure for urgent matters to access the exceptional case funding scheme (by the end of 2019);Remove the mandatory requirements from the telephone gateway for debt, discrimination and special educational needs, and reinstate access to immediate face-to-face advice (by spring 2020).Following a separate review on legal aid for inquests, plans include simplifying the ECF forms and enabling backdating of the legal help waiver for inquest cases.The findings of a review of part 2 of LASPO, designed to reduce the cost of civil litigation, encourage early settlement and discourage unmeritorious claims, is also being published today. Frazer told journalists that ‘largely people think the changes are working well’.The Law Society said the ministry’s proposals reflect a ‘considerable number’ of recommendations Chancery Lane put forward.Christina Blacklaws, the Society’s president, said: ‘We hope these changes will make it easier for ordinary people to qualify for legal aid and access essential help and support. However, welcome as this further work is, the government must give urgent attention to amending the means test thresholds because the current levels are preventing families in poverty from accessing justice; and remuneration rates for solicitors undertaking this vital work must be reviewed for civil as well as criminal work, to address the medium term viability of the system. As a first step, they should be uprated in line with inflation ahead of further work to make the system sustainable.’The Bar Council was quick to criticise the response, saying it was ‘disappointed’. Richard Atkins QC, chair, said: ‘Whilst we welcome the MoJ commitment to early intervention to reduce the distress and cost to all of court proceedings and the willingness to include the Bar Council and others in the proposed continuing review we consider that this is a wasted opportunity. The 500-page report offers little of substance to ease the impact of LASPO on vulnerable individuals seeking justice.’Although up to £5m investment has been promised to improve technology for accessing legal advice and £3m over two years to help litigants in person navigate the court system, such monies are but a drop in the ocean given the impact LASPO has had on restricting individuals’ access to justice. We fully understand that the MoJ is constrained by budgetary limits, but this review provides clear evidence that the Treasury must find a way to properly fund the justice system and reverse a decade of cuts.’ While we wait for the @MoJGovUK#LASPO review, here’s a reminder of how much was cut so far: £751million, or nearly a third of the #legalaid budget. Without change, the ailing system will continue to shrink, helping ever fewer people! [source: @NAOorguk] #accesstojusticepic.twitter.com/7SQzCIU0oD— Law Centres Network (@LawCentres) February 6, 2019And here it is. 293 pages to tell you what most #familylaw ‘ers could have predicted on a postage stamp. Costs “saved” moved elsewhere. #legalaid#laspohttps://t.co/iIyjEL5ueE— Chris Fairhurst (@Fairygodlawyer) February 7, 2019V Disappointing Government has decided not to extend costs protection to discrimination claims. Disabled people continue to have no effective way of enforcing their rights – Post-Implementation Review of Part 2 of LASPO – https://t.co/3EjJTpSMADhttps://t.co/YcesAYt4sj— Samantha Fothergill (@MsSFothergill) February 7, 2019 Ministers today promised new money to fill the gaps in access to justice created by the 2013 legal aid reforms. Publishing a long-awaited review of the Legal Aid, Sentencing and Punishment of Offenders Act (LASPO), the Ministry of Justice announced a legal support ‘action plan’. Promises include:£5m for ‘innovative’ forms of legal support. Justice minister Lucy Frazer QC told journalists such support could be a Skype tool or a program that converts lengthy written arguments into an appropriate presentation which people can automatically put into a claim form;£3m over two years to support litigants in person. The ministry will also test ‘legal support hubs’, which Frazer said could be in a GP setting.The pledges acknowledge the damage done by the coalition government’s decision to cut vast swaths of civil law from the scope of legal aid. However they are unlikely to assuage critics. The Bar Council described the money as ‘a drop in the ocean’. Twitter reactsDocument here https://t.co/LKTzgOqNiu promises “comprehensive review of legal aid eligibility scheme”. Lucy Frazer QC, justice minister at @MoJGovUK, said work had already begun on it. She was unable to explain why this needed to take a year and a half. So no changes before 2021.— Joshua Rozenberg (@JoshuaRozenberg) February 7, 2019
Players in Spain’s top-flight and Segunda division were allowed to carry out individual work at training grounds last week.The move was the beginning of a staggered training programme, with the aim to restart competitive games in the middle of June. La Liga insist identifying infected players through positive tests are part of that plan. The five players, who have not been officially named, will now be quarantined at home and tested again “in the next few days”. They will be allowed to rejoin their club’s training programme only after obtaining two consecutive negative test results. A La Liga statement read: “Among La Liga Santander and La Liga SmartBank (Segunda) clubs, five positive cases were detected in players, all of them asymptomatic and in the final phase of the disease.” “One of the objectives of these medical tests, according to the La Liga’s protocol for returning to training, according to recommendations of the CSD (Supreme Sports Council) and the Ministry of Health, was precisely to detect the denominated or asymptomatic, that is, those people who are infected and that, without presenting symptoms, they can infect other people,” the statement added. “In this way, we guarantee everyone’s safety when returning to work according to the occupational risk regulations.” La Liga’s training plan includes players initially carrying out work individually before then expanding into small groups and finally taking part in larger team sessions. Barcelona’s players were back for their first session on Friday while Real Madrid’s will return on Monday. The medical protocol for training is strict and includes players arriving already changed and at specific times to avoid contact with others. They wear masks and gloves, and have their temperatures taken before entering the premises. At the end of training, they take away a bag of fresh kit for the next day and shower at home. The league have not officially announced the timing for the resumption of competitive matches although Leganes coach Javier Aguirre said last week the proposed date is June 20. That could correspond with the Spanish government’s de-escalation programme, which includes outside events being allowed to go ahead in their fourth and final phase, as long as they are attended by fewer than 400 people. Football matches are expected to be staged behind closed doors for several months. La Liga president Javier Tebas has said “it is not an option” to cancel the top flight given he estimates the economic fallout would cost clubs around a billion euros ($1.08 billion). But the third and fourth tiers in Spain will not complete their seasons, as confirmed by the Spanish football federation (RFEF) on Wednesday. Instead, promotions will be decided through play-offs and there will be no relegations.
By Kyra Gillespie Lakeside families enjoyed a fun-filled day at the annual Lakeside Kids’ Christmas Party on Sunday 17 December….[To read the rest of this story Subscribe or Login to the Gazette Access Pass] Thanks for reading the Pakenham Berwick Gazette. Subscribe or Login to read the rest of this content with the Gazette Digital Access Pass subscription.
By The Nelson Daily SportsIf this keeps up fans will not want to be late for the start of games featuring the Nelson Leafs.For the second straight game the boys in the Green and White blasted out of the starting games, this time scoring three times in the opening frame to edge the Grand Forks Border Bruins 3-2 in Kootenay International Junior Hockey League action Thursday night in the Boundary City.Dallon Stoddart, Colton Schell on the power play and Patrick Martens bolted Nelson into the early lead.Zachary Thompson scored single markers in each of the next two periods but that was all the scoring Darren Hogg would allow as the Leafs held onto the victory.Nelson, improving to a record of 12-11 on the season, out shot the Bruins 42-25. In the third period Nelson went wild, holding a wide margin of 23-8.The two newest Leaf players, Joel Stewart and Brennan Foreman, both were in the lineup Thursday.Stewart and Foreman were acquired in separate deals— Stewart from Spokane and Foreman, in a deal involving Nelson Minor Hockey grad Adrian Moyls, from Kimberley.Both players earned assists during the first tests in the Green and White.The Leafs return home to host to one of the hottest teams in the entire KIJHL, when the Kamloops Storm visits the Heritage City Saturday at 7 p.m. in the NDCC Arena. Kamloops has reeled off nine wins in its last 10 games.Sunday Nelson hosts Columbia Valley Rockies in a 1 p.m. affair.GAME NOTES: This was the second game in six days between the two Murdoch Division rivals, and the second time tempers flared with a pair of fights. Evan J. Moir of the Leafs battled Joey Cormano in the first period while Colton Malmsten went toe-to-toe with Bruins’ Cody Robertson in the third. . . .The Leafs welcomed Connor McLaughlin back to the lineup after the veteran winger spent last weekend as an affiliate player on a northern road swing with Trail of the B.C. Hockey [email protected]
Martin Mulkerrins became National Senior One Wall Handball Champion last weekend with a 2-1 win over defending champion Conor McElduff of Tyrone in Breaffy. Martin Mulkerrins on his National One Wall Title Win Currently Playing Audio Playerhttps://s3-eu-west-1.amazonaws.com/sports.podcast/MARTIN+MULKERRINS.mp300:0000:0000:00Use Up/Down Arrow keys to increase or decrease volume. 更多 Back 15 seconds Martin Mulkerrins on his National One Wall Title Win Forward 60 seconds Galway Bay FM Sport On Sunday, he spoke to John Mulligan on Sunday Sport Forward 60 seconds Galway Bay FM Sport Martin Mulkerrins on his National One Wall Title Win Back 15 seconds Galway Bay FM Sport print WhatsApp Facebook Twitter Email
A 20-year-old Chatham man was arrested after police responded to a reported disturbance involving a couple at a Chatham home on Sunday afternoon.Police allege this was not the first incident of domestic violence between the couple during their relationship.The accused was charged with three counts of assault, two counts of forcible confinement, assault causing bodily harm and uttering threats.He was taken into custody pending a bail hearing.Neighbour disputeA 24-year-old Chatham man was arrested after police responded to a neighbour dispute in Chatham.Police allege the accused threatened his neighbour while in possession of a pellet gun and baseball bat.He is facing charges of being in possession of a weapon for a dangerous purpose and uttering threats, police said.He was taken into custody pending a bail hearing.Motorists, cyclist charged in crashA motorists and a cyclist were both charged in connection to a crash around 7 a.m. Monday on Fifth Street near Thames Street in Chatham.Chatham-Kent police said the driver, a 55-year-old Chatham man, was charged with failing to yield the right of way.The cyclist, a 29-year-old Chatham man, was charged with having improper bicycle lighting.Police said no one was injured and total damage is estimated at $500.
Facebook Twitter Google+LinkedInPinterestWhatsApp Facebook Twitter Google+LinkedInPinterestWhatsAppFOR IMMEDIATE RELEASE31 MARCH 2015ON THE PASSING OF SANDRA EDGECOMBEI am deeply saddened to learn of the passing of Sandra Edgecombe, the Deputy Director of Education in Freeport, Grand Bahama. This is shocking news. It is hard to absorb. She was a friend and a traveler in the journey of the progressive movement. She brought her love of life and of The Bahamas and its people to all that she did. She was the daughter in law of my late mentor in Parliament Frank Edgecombe. I worked with her on policy issues even when I served in Opposition and gained great respect for her talents and her even handedness. She was a beloved fixture of the Grand Bahama scene. She will be sorely missed. I extend to her husband Godfrey and their family my deepest condolences on her passing. It only goes to remember, we never know the day or the hour so we must be ready. May she rest in peace. Recommended for you Lighthouse Pointe at Grand Lucayan on Grand Bahama Island Reopens Bahamas Govt bids to buy Lucayan Strip resorts, PM Minnis tours site Related Items:freeport, grand bahama, SANDRA EDGECOMBE Freeport Man Killed in ‘The Ghetto’, Homicide Count Now At 100