Global Epidemiology and Evolutionary History of Staphylococcus aureus ST45.

Staphylococcus aureus ST45 is a major global MRSA lineage with huge strain diversity and a high clinical impact. It is one of the most prevalent carrier lineages but also frequently causes severe invasive disease, such as bacteremia. Little is known about its evolutionary history. In this study, we used whole-genome sequencing to analyze a large collection of 451 diverse ST45 isolates from 6 continents and 26 countries. De novo-assembled genomes were used to understand genomic plasticity and to perform coalescent analyses. The ST45 population contained two distinct sublineages, which correlated with the isolates' geographical origins. One sublineage primarily consisted of European/North American isolates, while the second sublineage primarily consisted of African and Australian isolates. Bayesian analysis predicted ST45 originated in northwestern Europe about 500 years ago. Isolation time, host, and clinical symptoms did not correlate with phylogenetic groups. Our phylogenetic analyses suggest multiple acquisitions of the SCCmec element and key virulence factors throughout the evolution of the ST45 lineage.

Variability of hepatitis E serologic assays in a pediatric liver transplant recipient: challenges to diagnosing hepatitis E virus infection in the United States.

Hepatitis E virus (HEV) is an emerging cause of viral hepatitis among immunocompromised individuals in developed countries. Yet the diagnosis of HEV infection in the United States remains challenging, because of the variable sensitivity and specificity of currently available tests, and the lack of a US Food and Drug Administration-approved test. We report a case of multiple discordant HEV serology results in a pediatric liver transplant recipient with idiopathic hepatitis, and review the challenges to diagnosis of HEV infection in the United States.

What influences youth to operate all-terrain vehicles safely?

The operation of all-terrain vehicles (ATVs) by youth has contributed to the incidence of serious and fatal injuries among children. This study explored factors related to the frequency with which youth wore a helmet and refrained from engaging in three risky driving behaviors (driving at risky speeds, on paved roads and on unfamiliar terrain) while operating an ATV. Youth (n = 248) aged 9-14 from central Ohio and one of their parents completed self-report measures of ATV safety behaviors, youth general propensity for risk taking, protection motivation and parental behaviors to facilitate youth safety. Data from two focus groups provided insight on quantitative results. Analyses revealed considerable variation in the frequency with which youth performed the safety behaviors, with 13- and 14-year-olds reporting less frequent safe behavior than 9- to 12-year-olds. Multiple regression analyses suggested that parental behaviors, such as providing reminders to wear a helmet, were associated with more frequent helmet use but were not associated with risky driving behaviors. Youth's general propensity toward risk taking was not associated with helmet use and only associated with riskydriving behaviors among the 13- and 14-year-olds. Self-efficacy was an important predictor across both age groups and behaviors. Implications for injury prevention are discussed.

Brain biopsies requiring Creutzfeldt-Jakob disease precautions in the Republic of Ireland 2005-2016.

AIMS: Creutzfeldt-Jakob disease (CJD) risk precautions are required when performing brain biopsies on patients with a dementing illness and in 'risk' groups. The impact on a diagnostic neuropathology service is considerable. We sought to determine if better case selection might reduce the necessity for application of CJD risk precautions. METHODS: We reviewed the clinical information, contributory investigations and final neuropathologic diagnosis in a cohort of patients (n = 21), referred to the National CJD Surveillance Centre between January 1, 2005, and December 31, 2016. RESULTS: Of this 21-patient cohort, five were positive for CJD, four belonged to the 'at risk of CJD' category requiring brain surgery, while the remaining 12 were referred to the National CJD Surveillance Unit with CJD as part of their differential diagnosis. CJD was confirmed in 5/21 (three sporadic [s]CJD, one variant [v]CJD and one iatrogenic [i] CJD). CJD was clinically probable in 4/5 proven CJD patients (80%). The patients (n = 4) in the 'at risk of CJD' group were diagnosed with tumour (n = 2), inflammation (n = 1) and non-specific changes (n = 1). Of the remaining 12 patients (in whom CJD was included in the differential diagnosis), the final neuropathologic diagnoses included tumour (n = 2), neurodegenerative (n = 2), inflammatory (n = 1), metabolic (n = 2), vascular (n = 2) and non-specific gliosis (n = 3). CONCLUSIONS: More often than not, the clinical suspicion of CJD was not borne out by the final neuropathological diagnosis. Failure by clinicians to adhere to the recommended CJD investigation algorithm impacts adversely on the neuropathology workload and causes unnecessary concern among operating theatre, laboratory and nursing personnel.

Structural requirements for function of the Crkl adapter protein in fibroblasts and hematopoietic cells.

Crkl is an adapter protein and phosphotyrosine-containing substrate implicated in transformation by the bcr-abl oncogene and in signaling by cytokines. When phosphorylated, Crkl binds through its Src homology 2 (SH2) domain to other tyrosine phosphoproteins such as paxillin and Cbl. Overexpression of Crkl in fibroblasts induces transformation. Here we examine the role of Crkl in hematopoietic cells and find that overexpression of Crkl confers a signal leading to increased adhesion to fibronectin. In both fibroblasts and hematopoietic cells, individual mutations or deletions of each SH2 and SH3 domain abrogated transformation and adhesion, respectively, indicating that interactions with other proteins such as Cbl and paxillin (SH2 domain) and Abl, Sos, and C3G (N-terminal SH3 domain) are essential for biological activity. In vivo and in vitro tryptic phosphopeptide mapping studies show that Crkl is phosphorylated on multiple tyrosine residues when overexpressed or when activated by Bcr-Abl. Mutation at tyrosine 207, a residue conserved in c-Crk, abrogates all in vivo tyrosine phosphorylation of Crkl. Despite this loss of phosphotyrosine, mutation at this site enhanced Crkl function as measured by complex formation with SH2 binding proteins, signal transduction to Jun Kinase, and fibroblast transformation. These observations implicate Crkl in cellular adhesion and demonstrate that Y207 functions as a negative regulatory site.

Occurrence of methicillin-resistant Staphylococcus aureus in surface waters near industrial hog operation spray fields.

Industrial hog operations (IHOs) have been identified as a source of antibiotic-resistant Staphylococcus aureus, including methicillin-resistant S. aureus (MRSA). However, few studies have investigated the presence of antibiotic-resistant S. aureus in the environment near IHOs, specifically surface waters proximal to spray fields where IHO liquid lagoon waste is sprayed. Surface water samples (n=179) were collected over the course of approximately one year from nine locations in southeastern North Carolina and analyzed for the presence of presumptive MRSA using CHROMagar MRSA media. Culture-based, biochemical, and molecular tests, as well as matrix-assisted laser desorption/ionization-time of flight mass spectrometry were used to confirm that isolates that grew on CHROMagar MRSA media were S. aureus. Confirmed S. aureus isolates were then tested for susceptibility to 16 antibiotics and screened for molecular markers of MRSA (mecA, mecC) and livestock adaptation (absence of scn). A total of 12 confirmed MRSA were detected in 9 distinct water samples. Nine of 12 MRSA isolates were also multidrug-resistant (MDRSA [i.e., resistant to ≥3 antibiotic classes]). All MRSA were scn-positive and most (11/12) belonged to a staphylococcal protein A (spa) type t008, which is commonly associated with humans. Additionally, 12 confirmed S. aureus that were methicillin-susceptible (MSSA) were recovered, 7 of which belonged to spa type t021 and were scn-negative (a marker of livestock-adaptation). This study demonstrated the presence of MSSA, MRSA, and MDRSA in surface waters adjacent to IHO lagoon waste spray fields in southeastern North Carolina. To our knowledge, this is the first report of waterborne S. aureus from surface waters proximal to IHOs.

CRKL binding to BCR-ABL and BCR-ABL transformation.

The SH2-SH3 domain-containing adaptor protein CRKL is the predominant tyrosine phosphorylated protein in chronic myelogenous leukemia (CML) neutrophils and BCR-ABL-expressing cell lines. The amino terminal CRKL SH3 domain binds directly to a proline-rich region in the C-terminus of BCR-ABL. BCR-ABL mutants with deletions of this region were constructed to assess biologic effects of eliminating the CRKL binding site. Yeast two-hybrid analysis and gel overlay assays show eradication of the direct interaction of CRKL with BCR-ABL in the proline deletion mutants. However, these BCR-ABL mutants transform myeloid cells to growth factor independence, and in these cells CRKL is tyrosine phosphorylated and associates with BCR-ABL. These findings suggest both direct and indirect interactions of CRKL with BCR-ABL. Thus, disruption of the direct interaction with BCR-ABL has not excluded a role for CRKL in BCR-ABL-mediated transformation.

Chronic job insecurity among automobile workers: effects on job satisfaction and health.

Work conditions characterized by uncertainty and ambiguity are potential stressors for employees. One such stressor is job insecurity. This longitudinal study of 207 automobile manufacturing workers indicates that chronic job insecurity is predictive of changes over time in both job satisfaction and physical symptoms. Extended periods of job insecurity decrease job satisfaction and increase physical symptomatology, over and above the effects of job insecurity at any single point in time. These results indicate that job insecurity acts as a chronic stressor whose effects become more potent as the time of exposure increases. Worksite health professionals should develop strategies for reducing the impact of job insecurity on employee well-being, particularly in industries where employment opportunities are declining.

Are employees who are at risk for cardiovascular disease joining worksite fitness centers?

To effectively serve disease prevention purposes, worksite fitness centers need to attract a large proportion of eligible employees who are at risk for CVD. The results of studies linking risk factor status and the propensity to join worksite fitness centers have been inconsistent and, to a certain extent, methodologically flawed. This study prospectively follows 294 newly hired employees at a large insurance company in the Midwest. Risk factor status was determined during their orientation week. It was then determined if the employees joined the fitness center during their first year of employment. Results indicate that, overall, risk factor status had little impact on employees' decisions to join the worksite fitness center. However, two of the risk factors (being 20% or more overweight and having elevated systolic blood pressure) had opposite influences on the decisions of male and female employees.

The intervention research process in occupational safety and health: an overview from the National Occupational Research Agenda Intervention Effectiveness Research team.

The goal of occupational safety and health intervention effectiveness research is to determine whether specific interventions work to prevent work-related injury and illness. But that is not the whole story. It is also important that the development and implementation of the intervention be evaluated. All three phases (development, implementation, and effectiveness) are central to a model of intervention research proposed by the National Occupational Research Agenda Intervention Effectiveness Research team. Areas for future research are also presented.

Broadening the scope of worksite stress programs: a guiding framework.

Abstract Worksite stress programs have proliferated in recent years. A large proportion of these programs focus on helping individual employees learn about stress and develop better coping skills. Few programs attempt to reduce the stressful aspects of the job or the organizational context. In order to facilitate the development of a broader array of stress reduction programs, the authors provide: 1) a conceptual framework upon which worksite stress programs should be based, 2) a guide to the variety of decision points in the program development process, 3) an exploration of the reasons why a broader range of stress programs have not heretofore been developed, and 4) suggestions for creating a context amenable to innovative worksite stress programs.

Occupational stress, physician-excused absences, and absences not excused by a physician.

PURPOSE: This study explores two possible mechanisms through which occupational stress is linked to absenteeism. The extent to which physician-excused absenteeism and absenteeism not excused by a physician are related to employee reports of perceived stress is assessed. DESIGN: A plant wide survey was conducted in January 1990. Employee reports of occupational stress gained from this survey were linked with 1990 absenteeism data from the employees' records. SETTING: A mid-sized manufacturing plant. SAMPLE: Complete data were available for 998 of the 1534 (65%) unionized employees in the plant. MEASURES: Measures of both physician-excused absences and absences not excused by a physician were created. Stressors included role ambiguity, lack of control over work pace, and being paid on a piece-rate basis. Perceived stresses included role conflict, physical environment stresses, and overall work stress. RESULTS: For physician-excused absenteeism, role conflict (OR, 1.54, p < .01), overall work stress (OR, 1.24, p < .05), and physical environment stress (OR, 1.34, p < .05) had significantly elevated odds ratios, even after adjusting for demographics. For absences not excused by a physician, none of the stressors or stresses had significant odds ratios after controlling for demographic characteristics. CONCLUSIONS: Employees in this plant were not using short-term voluntary absenteeism as a way of coping with work stress. However, high levels of perceived work stress were associated with subsequent physician-excused absences.

A review of health-related outcomes of multi-component worksite health promotion programs.

PURPOSE: The purpose of this article is to critically review evaluation studies of the health-related effects (i.e., health risk modification and reduction in worker absenteeism) of multicomponent worksite health promotion programs. SEARCH METHOD: A comprehensive literature search conducted under the auspices of the Centers for Disease Control and Prevention identified 36 articles that examined health-related outcomes of multi-component programs. The authors identified 11 additional articles through manual searches of recent journal issues and through personal contacts with worksite health promotion researchers. Forty-seven studies describing the results of 35 worksite health promotion programs were reviewed. IMPORTANT FINDINGS: The worksite health promotion programs reviewed for this article varied tremendously in the comprehensiveness, intensity, and duration of the intervention activities. All of the programs provided health education to employees. In a majority of the programs, opportunities to learn and practice new skills were also offered. A smaller number of programs incorporated modifications in organizational policy or the physical work environment. Results from well-conducted randomized trials suggest that providing opportunities for individual risk reduction counseling for high risk employees within the context of comprehensive programming may be the critical component of an effective worksite health promotion program. Just offering low intensity, short duration programs aimed at increasing awareness of health issues for the entire employee population may not be sufficient to achieve desired outcomes. MAJOR CONCLUSIONS: The results of the studies reviewed provide both cautious optimism about the effectiveness of these worksite programs and some general guidance as to the critical components and characteristics of successful programs. Overall, the evidence suggests that a rating of indicative/acceptable may best characterize this literature.

The influence of psychosocial stress, gender, and personality on mechanical loading of the lumbar spine.

STUDY DESIGN: The effects of psychosocial stress on muscle activity and spinal loading were evaluated in a laboratory setting. OBJECTIVE: To evaluate the influence of psychosocial stress, gender, and personality traits on the functioning of the biomechanical system and subsequent spine loading. SUMMARY OF BACKGROUND DATA: Physical, psychosocial, and individual factors all have been identified as potential causal factors of low back disorders. How these factors interact to alter the loading of the spine has not been investigated. METHODS: Twenty-five subjects performed sagittally symmetric lifts under stressful and nonstressful conditions. Trunk muscle activity, kinematics, and kinetics were used to evaluate three-dimensional spine loading using an electromyographic-assisted biomechanical model. A personality inventory characterized the subject's personality traits. Anxiety inventories and blood pressure confirmed reactions to stress. RESULTS: Psychosocial stress increased spine compression and lateral shear, but not in all subjects. Differences in muscle coactivation accounted for these stress reactions. Gender also influenced spine loading; Women's anterior-posterior shear forces increased in response to stress, whereas men's decreased. Certain personality traits were associated with increased spine loading compared with those with an opposing personality trait and explained loading differences between subjects. CONCLUSIONS: A potential pathway between psychosocial stress and spine loading has been identified that may explain how psychosocial stress increases risk of low back disorders. Psychosocially stressful environments solicited more of a coactivity response in people with certain personality traits, making them more susceptible to spine loading increases and suspected low back disorder risk.

Developing effective helping relationships in health education practice.

Health educators who interact directly with the people they serve must be able to establish effective relationships. Helping relationships are effective if they facilitate clients' progress toward health-promoting goals. Health educators are usually well versed in learning activities and spend a significant proportion of their time interacting with clients. However, many health educators have never received explicit training in how to establish effective formal helping relationships. Research on social influence processes has provided a set of empirical findings that suggest interpersonal behaviors that are likely to maximize the effectiveness of formal helping relationships. This literature indicates that formal helping relationships characterized by interpersonal behaviors that enhance client self-esteem and feelings of control are most effective in helping clients achieve specific goals. Interestingly, enhancement of self-esteem and feelings of control are consistent with many definitions of personal empowerment. Since the social influence and empowerment literatures come from very different intellectual roots and have different approaches to power and influence, their convergence is especially notable. These literatures combine to establish the bases for proposing two essential components of effective helping relationships: (1) providing unconditional acceptance and positive regard for clients, and (2) sharing power and control through participatory processes.

Evaluation of a brief intervention based on social cognitive theory to develop problem-solving skills among sixth-grade children.

This study evaluated an intervention based on social cognitive theory (SCT) intended to develop problem-solving skills (PSS) in sixth graders. Psychometrically tested measures were developed for (1) constructs of SCT (situational perception of stressors, expectations of PSS, self-efficacy for PSS, self-efficacy in overcoming barriers, and self control when applying PSS), (2) PSS, and (3) application of PSS to real-life problems. Five classrooms (n = 133) were randomly assigned to the SCT-based intervention and five classrooms (n = 127) to an equivalent knowledge-based intervention. Using a partial nested design, statistically significant improvements for expectations of PSS, self-efficacy for PSS, and PSS were found in the SCT-based intervention. At posttest, 36% of the students in the SCT-based intervention reported applying PSS to real-life problems as compared with 1% in the knowledge-based group. This pilot study suggested that an SCT-based intervention was more efficacious in developing PSS than a knowledge-based intervention.

Predicting recovery using continuous low back pain outcome measures.

BACKGROUND CONTEXT: There is a lack of research evaluating multiple follow-up visits, specifically when using continuous outcome measures. Continuous outcome measures with several follow-up assessments would allow us to evaluate rate of recovery. PURPOSE: To predict low back pain outcomes based on the quantification of initial conditions. STUDY DESIGN/SETTING: This was a prospective study where patients were enrolled within the first month of low back pain symptoms and evaluated for 3 months. Patients were recruited from several primary care facilities. PATIENT SAMPLE: Thirty-two patients with local low back pain symptoms were recruited for the study. OUTCOME MEASURES: There were four major outcome measures, including functional performance probability, symptom intensity, impairment of activities of daily living, and a summary outcome measure. METHODS: Regression models were constructed using the initial conditions, including psychological, psychosocial, physical workplace, and personal factors, to predict the rate of recovery for each outcome measure. RESULTS: Twenty-eight patients completed the study. The r2 value for the rate of recovery regression models were 0.77 symptom intensity prediction, 0.85 activities of daily living prediction, 0.87 functional performance probability prediction, and 0.96 summary outcome measure prediction. Two functional performance patterns of recovery were found, including a steady improvement and a large jump in improvement. A discriminant function model identified the pattern of recovery in 91% of cases given initial conditions. CONCLUSIONS: Continuous outcome measures can be accurately predicted given the initial conditions.

The relationship between psychosocial work characteristics and low back pain: underlying methodological issues.

OBJECTIVE: To evaluate the current epidemiological evidence linking psychosocial work characteristics with low back pain. BACKGROUND: Psychosocial work characteristics have been widely evaluated as potential risk factors for low back injury. However, studies with different study populations and using various types of measures have had conflicting results. METHODS: This review is the most extensive to date, reviewing 66 articles that have provided empirical evidence about the relationship between psychosocial work characteristics and initial reporting of lower back pain. The studies are reviewed with an emphasis on certain methodological issues: controlling for potential confounding; timing of the data collection; and measurement of the exposures and outcomes. RESULTS: The results of this review suggest that controlling for potential confounding from occupational biomechanical demands had a large influence on the associations found between psychosocial work characteristics and lower back pain. In addition, the use of accurate and reliable measures for the occupational exposures (biomechanical and psychosocial) and the lower back pain outcomes appears to influence the strength of the associations found between psychosocial work characteristics and lower back pain. CONCLUSION: Given the methodological concerns discussed in this review, it is difficult to draw strong causal inferences from this literature. However, it does appear that psychosocial characteristics are related to some lower back pain outcomes, and that employees' reactions to psychosocial work characteristics (e.g., job dissatisfaction and job stress) are more consistently related to lower back pain than are the psychosocial work characteristics themselves (e.g., work overload, lack of influence over work, quality of relationships with coworkers). RELEVANCE: This review attempts to identify and address methodological issues in the literature evaluating the relationship between psychosocial work characteristics and lower back pain. Implications for future research are presented.

Occupational stress, safety, and health: conceptual framework and principles for effective prevention interventions.

The authors present an overarching conceptual model of occupational stress, safety, and health, incorporating multiple factors from diverse disciplines. They examine specific implications of the model for the development of prevention interventions (e.g., context-specific interventions and primary, secondary, and tertiary prevention). They review prevention interventions and describe and analyze 4 case studies that address exposure to environmental, ergonomic, and psychosocial stressors and a combination of physical-environmental and psychosocial stressors. The authors examine lessons learned from these interventions in light of the conceptual model (e.g., role of top management and integrating research and intervention).

Shaping advanced nursing practice in the new millennium.

OBJECTIVES: To provide a review of converging themes and trends that are shaping advanced practice nursing roles in oncology nursing. DATA SOURCES: Review and research articles, text-books, and organization documents. CONCLUSIONS: The current managed care environment provides many opportunities and challenges for oncology advanced practice nurses. Advanced practice nurses have both clinical and organization competencies that enable them to mediate the clinical needs of patients and organization goals within the health care system. IMPLICATIONS FOR NURSING PRACTICE: Advanced practice nurses can help shape their roles and practice by active participation in the development of systems to support access to clinical and financial information for effective decision making, collaboration among disciplines, and incorporating evidence-based care in their clinical practices.