Differences in antimicrobial susceptibility testing complicating management of IMP carbapenemase-producing Enterobacterales infection.

OBJECTIVES: IMP-type carbapenemases are rarely detected in Europe and limited information is available to guide the treatment of infections caused by carbapenemase-producing Enterobacterales (CPE) producing these carbapenemases. Accurate antimicrobial susceptibility testing (AST) results are essential for optimal antibiotic management. Here we report discrepancies in AST of IMP-producing Enterobacterales (IMP-CPE) complicating the management of severe sepsis. METHODS: Antimicrobial susceptibilities were analysed by in-house VITEK® 2, Etest and broth microdilution (BMD). Carbapenemase-encoding genes were detected by PCR. Whole-genome sequencing (WGS) was performed using an Illumina MiSeq platform. RESULTS: Minimum inhibitory concentrations (MICs) determined by VITEK® 2 for Enterobacter hormaechei and Klebsiella oxytoca blood culture isolates were ≥16 mg/L for meropenem and ≤0.5 mg/L for ertapenem. In contrast, Etest analysis and BMD returned MICs of 2 mg/L and 1 mg/L, respectively. Both isolates tested positive for IMP carbapenemase-encoding genes by PCR. WGS revealed that both isolates carried the same blaIMP-4 gene. Based on VITEK® 2 susceptibilities, initial treatment was with tigecycline and amikacin. After subsequent deterioration, the patient was successfully treated with ertapenem and amikacin. CONCLUSION: This case highlights that automated AST by VITEK® 2 can over-report meropenem resistance for IMP carbapenemase-producers compared with Etest and BMD. Clinicians need to be cautious deciding against carbapenem treatment based on VITEK® 2 susceptibility testing results for IMP-positive Enterobacterales. Tigecycline was inferior to carbapenem treatment for pyelonephritis caused by isolates expressing IMP carbapenemases, however specific evidence guiding the treatment of these infections is lacking.

Mental illness self-management: a randomised controlled trial of the Wellness Recovery Action Planning intervention for inpatients and outpatients with psychiatric illness.

OBJECTIVE: Wellness Recovery Action Planning (WRAP) is a cross-diagnostic, patient-centred, self-management intervention for psychiatric illness. WRAP utilises an individualised Wellness Toolbox, a six part structured monitoring and response system, and a crisis and post-crisis plan to promote recovery. The objective of this study was to evaluate the effect of WRAP on personal recovery, quality of life, and self-reported psychiatric symptoms. METHOD: A prospective randomised controlled trial, based on the CONSORT principles was conducted using a sample of 36 inpatients and outpatients with a diagnosis of a mental disorder. Participants were randomly allocated to Experimental Group or Waiting List Control Group conditions in a 1:1 ratio. Measures of personal recovery, personal recovery life areas, quality of life, anxiety, and depression were administered at three time points: (i) pre-intervention, (ii) post-Experimental Group intervention delivery, and (iii) 6-month follow-up. Data was analysed by available case analysis using univariate and bivariate methodologies. RESULTS: WRAP had a significant effect on two personal recovery life areas measured by the Mental Health Recovery Star: (i) addictive behaviour and (ii) identity and self-esteem. WRAP did not have a significant effect on personal recovery (measured by the Mental Health Recovery Measure), quality of life, or psychiatric symptoms. CONCLUSIONS: Findings indicate that WRAP improves personal recovery in the areas of (i) addictive behaviour and (ii) identity and self-esteem. Further research is required to confirm WRAP efficacy in other outcome domains. Efforts to integrate WRAP into recovery-orientated mental health services should be encouraged and evaluated.

The Skeleton Coast Diet Plan: body mass and body fat changes on an arduous expedition.

OBJECTIVES: No one has ever walked the 500 Km Skeleton Coast of Namibia totally unsupported. Fourteen explorers overcame this by carrying, along with all their other equipment, hand-held pumps to desalinate sea water on a daily basis to produce sufficient potable water. This paper highlights the changes in body mass, waist circumference and body fat in the group on this unique 20 day expedition. METHODS: Eight males (mean (SD)) 42.3 (9.7) years, height 1.741 (0.043) m, weight 78.7 (8.6) kg, body mass index (BMI) 24.8 (2.0) kg/m(2)) and six females (mean (SD) 40.0 (5.3) years, height 1.628 (0.043) m, weight 63.2 (5.5) kg, BMI 23.8 (1.8) kg/m(2)) undertook the expedition. Average pack weight at the start of the expedition for the men was 32.5 kg, and 26.5 kg for the women. On most days, the team walked for 8 - 10 hours on varying terrain then pumped water for a further 4 hours. Measurements taken included height, body mass, waist circumference and skin-fold thickness at four regions of the body, and were taken before, during and at the end of the expedition. The approximate daily calorific intake for each team member was 2400 - 3000 kcal. RESULTS: Significant decreases in mean body mass (p < 0.001, d=0.50) and mean BMI (p < 0.001, d = 0.67) were observed after the 20 day trek compared to baseline values. Mean waist circumference decreased during the expedition (p < 0.001, d = 0.67). There were significant reductions in all measures of skinfold thicknesses and overall percentage body fat at Day 13 (p < 0.001, d = 1.19) and Day 21 (p < 0.001, d = 1.98) in comparison to baseline values CONCLUSIONS: All participants lost significant amounts of both body mass and body fat, with body fat reducing by over 30%.

Common functional principal components analysis: a new approach to analyzing human movement data.

In many human movement studies angle-time series data on several groups of individuals are measured. Current methods to compare groups include comparisons of the mean value in each group or use multivariate techniques such as principal components analysis and perform tests on the principal component scores. Such methods have been useful, though discard a large amount of information. Functional data analysis (FDA) is an emerging statistical analysis technique in human movement research which treats the angle-time series data as a function rather than a series of discrete measurements. This approach retains all of the information in the data. Functional principal components analysis (FPCA) is an extension of multivariate principal components analysis which examines the variability of a sample of curves and has been used to examine differences in movement patterns of several groups of individuals. Currently the functional principal components (FPCs) for each group are either determined separately (yielding components that are group-specific), or by combining the data for all groups and determining the FPCs of the combined data (yielding components that summarize the entire data set). The group-specific FPCs contain both within and between group variation and issues arise when comparing FPCs across groups when the order of the FPCs alter in each group. The FPCs of the combined data may not adequately describe all groups of individuals and comparisons between groups typically use t-tests of the mean FPC scores in each group. When these differences are statistically non-significant it can be difficult to determine how a particular intervention is affecting movement patterns or how injured subjects differ from controls. In this paper we aim to perform FPCA in a manner allowing sensible comparisons between groups of curves. A statistical technique called common functional principal components analysis (CFPCA) is implemented. CFPCA identifies the common sources of variation evident across groups but allows the order of each component to change for a particular group. This allows for the direct comparison of components across groups. We use our method to analyze a biomechanical data set examining the mechanisms of chronic Achilles tendon injury and the functional effects of orthoses.

Initial motor axon outgrowth from the developing central nervous system.

Rat and chick studies show that the earliest motor rootlet axon bundles emerge from all levels of the neural tube between radial glial end feet which comprise the presumptive glia limitans. The loose arrangement of the end feet at the time of emergence facilitates this passage. The points of emergence are regularly spaced in relation to the long axis of the neural tube and are not defined by any cell contact with its surface. Each rootlet carries a covering of basal lamina from the neural tube surface, which forms a sleeve around it. It is only after bundles of ventral rootlet axons have emerged that cells associate with them, forming clusters on the rootlet surface at a distance peripheral to the CNS surface of both species. A tight collar of glial end feet develops around the axon bundle at the neural tube surface shortly after initial emergence. These arrangements are in sharp contrast to those seen in the sensory rootlets, where clusters of boundary cap cells prefigure the sensory entry zones at the attachments of the prospective dorsal spinal and cranial sensory rootlets. Boundary cap cells resemble cluster cells and a neural crest origin seems the most likely for them. The study clearly demonstrates that no features resembling boundary caps are found in relation to the developing motor exit points.