Can severity of a humanitarian crisis be quantified? Assessment of the INFORM severity index.

BACKGROUND: Those responding to humanitarian crises have an ethical imperative to respond most where the need is greatest. Metrics are used to estimate the severity of a given crisis. The INFORM Severity Index, one such metric, has become widely used to guide policy makers in humanitarian response decision making. The index, however, has not undergone critical statistical review. If imprecise or incorrect, the quality of decision making for humanitarian response will be affected. This analysis asks, how precise and how well does this index reflect the severity of conditions for people affected by disaster or war? RESULTS: The INFORM Severity Index is calculated from 35 publicly available indicators, which conceptually reflect the severity of each crisis. We used 172 unique global crises from the INFORM Severity Index database that occurred January 1 to November 30, 2019 or were ongoing by this date. We applied exploratory factor analysis (EFA) to determine common factors within the dataset. We then applied a second-order confirmatory factor analysis (CFA) to predict crisis severity as a latent construct. Model fit was assessed via chi-square goodness-of-fit statistic, Comparative Fit Index (CFI), Tucker-Lewis Index (TLI), and Root Mean Square Error of Approximation (RMSEA). The EFA models suggested a 3- or 4- factor solution, with 46 and 53% variance explained in each model, respectively. The final CFA was parsimonious, containing three factors comprised of 11 indicators, with reasonable model fit (Chi-squared = 107, with 40 degrees of freedom, CFI = 0.94, TLI = 0.92, RMSEA = 0.10). In the second-order CFA, the magnitude of standardized factor-loading on the 'societal governance' latent construct had the strongest association with the latent construct of 'crisis severity' (0.73), followed by the 'humanitarian access/safety' construct (0.56). CONCLUSIONS: A metric of crisis-severity is a critical step towards improving humanitarian response, but only when it reflects real life conditions. Our work is a first step in refining an existing framework to better quantify crisis severity.

Methicillin-resistant Staphylococcus aureus transmission and hospital-acquired bacteremia in a neonatal intensive care unit in Greece.

BACKGROUND: Staphylococcus aureus is a common pathogen causing hospital acquired infections (HAIs) in neonates. In this study, the epidemiology of methicillin-resistant S. aureus (MRSA) colonization and infections in a 30-bed, level III university-affiliated neonatal intensive care unit (NICU) located in a children's hospital was retrospectively investigated for the period 2014-2018. METHODS: Genes encoding Panton-Valentine Leukocidin (lukS/lukF-PV, PVL), toxic shock syndrome toxin (tst), exfoliative toxins (eta, etb), and the resistance genes mecA, mecC and fusB, were defined in 46 representative strains by PCRs. Relatedness of strains was assessed by MLST. RESULTS: Of 1538 neonates, 77 (5%) had a positive culture for MRSA (23/77 were NICU-acquired and 54/77 imported cases). Four MRSA bacteremias occurred. Most isolates were multi-resistant. One major clone was identified, ST225, among 40 tested neonatal strains (23/40, 58%). Of these, 14/23 were imported from the same maternity hospital (MH). Another clone, ST217, was predominant (4/6) among health care workers (HCWs), found colonized. Four isolates classified as ST80 were PVL-positive. Additional four strains carried tst (10%), belonging to ST30 and ST225 (two strains each), and two etb. The implicated MH was notified for the problem, decolonization treatment was successfully performed in HCWs and neonates. Strengthening of infection control measures with emphasis on hand hygiene was applied. CONCLUSIONS: Uncovering reservoirs for on-going MRSA transmission in NICUs has proved challenging. Well known nosocomial MRSA clones are being constantly introduced and transmitted via MHs and HCWs. Effective infection prevention and control requires constant vigilance.

Spontaneous perforation of the tympanic membrane in the first 10 days of life.

Twelve cases of neonates admitted to the neonatal unit of our hospital, between January 1, 2000, and December 31, 2005, because of otorrhea due to spontaneous perforation of the tympanic membrane within the first 10 days of life are presented. Data were collected retrospectively from medical records. Cultures of the middle ear exudate grew PSEUDOMONAS AERUGINOSA in 10, SERRATIA MARCENSCENS in 1, and STAPHYLOCOCCUS AUREUS in 1 neonate. Cultures of nasopharyngeal secretions grew P. AERUGINOSA in nine, S. MARCENSCENS in one, S. AUREUS in one, and STREPTOCOCCUS VIRIDANS in one neonate. Middle ear versus nasopharyngeal secretions cultures grew the same organism in 11 neonates. A 10-day course of parenteral antibiotics was administered (ampicillin-ceftazidime for all neonates except for the one neonate with the S. AUREUS otitis who received netilmicin-cloxacillin). All neonates had uneventful course and were discharged home in good clinical condition. Our findings suggest that neonates with eardrum perforation should receive antibiotics parenterally, as the most common pathogens is P. AERUGINOSA, for which there are no satisfactory antibiotics for oral use.

A rare type of double aortic arch diagnosed by echocardiography in an asymptomatic 9-year-old patient.

A case of double aortic arch with an atretic left arch distal to the origin of the left subclavian artery was suspected by echocardiography (ECHO) in an asymptomatic 9-year-old girl and confirmed by magnetic resonance imaging (MRI). The authors report their ECHO findings, which could be an important diagnostic tool for symptomatic patients because confusion exists in the literature regarding the differentiation of the aforementioned rare malformation from a right arch with mirror image branching. The authors support their ECHO proposal with an explanation based on the hypothetical double aortic arch plan set by Edwards.

A unique case of reversible myocardial ischemia in a hyperthyroid neonate.

A case of an 8-day-old preterm neonate with heart failure, pulmonary hypertension, and myocardial ischemia due to hyperthyroidism is reported. Treatment of the disease initially with b-blockers and, upon establishment of hyperthyroidism, with propylthiouracil reversed all cardiac abnormalities. Contrary to the rule, diagnosis of hyperthyroidism in the mother was established following the diagnosis of the condition in her baby. On long-term follow-up (10 years), the child has developed normally, remains euthyroid with normal electrocardiogram. To our knowledge, diagnosis and reversal of the above-mentioned ischemic abnormalities have not been previously reported in neonates.