Methicillin resistant Staphylococcus aureus - importance of appropriate empirical therapy in serious infections

India has been titled the capital of antimicrobial resistance in the world with the centre for disease dynamics, economics and policy (CDDEP) predicting two million deaths in India by 2050. As per the World Health Organisation’s global priority pathogen list of 2017, methicillin resistant Staphylococcus aureus (MRSA) has been classified as a ‘high priority’ pathogen due to its association with increased mortality rate, rising prevalence of resistance and increased burden on healthcare settings. A recent report by Indian Council of Medical Research signifies the exponential rise in the prevalence of MRSA in India, from 29% in 2009 to 39% in 2018. Serious MRSA infections are commonly associated with poor clinical outcomes coupled with increased hospitalisation stay and cost. Therefore, early identification and appropriate empiric treatment of MRSA plays a crucial role in healthcare settings. However, the constant rise in multi-drug resistance to the currently available anti-MRSA agents as well as their compromised safety profile limits its clinical use to manage severe MRSA infections. This review article explores the implications of severe MRSA infections and inappropriate empirical therapy on the clinical as well as economic outcomes. In addition, it also highlights limitations of the currently available anti-MRSA agents and the need for newer agents to manage multi drug resistant (MDR) gram positive infections.

Investigating the OXA Variants of ESKAPE Pathogens

ESKAPE pathogens are the leading cause of nosocomial infections. The Global Priority List of WHO has categorized ESKAPE as priority 1 and 2 pathogens. Even though several mechanisms contribute to antimicrobial resistance, OXA β-lactamase has emerged as a new threat in combating nosocomial infections. In the present study we have investigated the presence of OXA and their variants, copy number, distribution on chromosomes/plasmids, subfamilies, phylogenetic relationships, amino acid identities and variabilities in ESKAPE pathogens. Our results revealed that a total of 929 OXA were present in 2258 completely assembled genomes, which could be further subdivided into 16 sub-families. Among all the ESKAPE pathogens, OXA were highly prevalent in A. baumannii, followed by P. aeruginosa and K. pneumoniae but completely absent in E. faecium and S. aureus while, only a few copies were found in Enterobacter spp. Most of the OXA variants belonged to the OXA-51-like subfamily (200 proteins), followed by OXA-50-like subfamily (189 proteins), OXA-23-like subfamily (156 proteins) and OXA-1-like subfamily (154 proteins). OXA-51-like, OXA-213-like, OXA-134-like, OXA-58-like, OXA-24-like and OXA-20-like subfamilies were present exclusively in A. baumannii. Phylogenetic tree of the subfamilies revealed that OXA-1-like and OXA-33-like, OXA-51-like and OXA-213-like and, OXA-5-like and OXA-10-like belonged to the same branches with amino acid identities as 100%, 97.10% and 80.90% respectively. This indicates that the members of these subfamily-pairs might have evolved from the same ancestor or have recently diverged. Thus, a judicious use of carbapenems is warranted to curtail the rise of new OXA enzymes and preserve them. This is the first detailed report about the OXA of ESKAPE pathogens.

Understanding the market drivers behind the reduced demand for ivory products in Japan

1.Reducing demand for wildlife products has been recognised as an important global priority, especially with fears that there are expanding markets for certain taxa. However, consumer demand is a complicated phenomenon and as with many conservation issues, it can involve numerous interacting biological, social, political and socio-economic factors, operating at a range of scales and time periods (Margoluis et al., 2009; Knight et al., 2019). 2.The demand for elephant ivory is an excellent illustration of the gaps in our current knowledge. Although it is well-documented that Japan is no longer a significant destination consumer market for ivory products, as it was in the 1980’s, we have limited insights into how consumer behaviour and attitudes influenced ivory sales. This is partly because post-hoc evaluations of such complex systems are difficult when relying on traditional quantitative methods. We used General Elimination Methodology and semi-structured interviews with key stakeholders to provide a richer understanding of consumer behavioural change in Japan. 3.We identified the two biggest market drivers, the CITES international trade ban and economic recession, as well as a range of minor drivers and enabling conditions. These included respect for government authority, the passive nature of demand for ivory, and a general cultural shift away from conspicuous consumption. We also ruled out purported influences that are unlikely to have had an impact, such as pressure from eminent people. 4.This case study highlights the potentially important role of theory-based qualitative evaluations in conservation. Adopting this new approach will help us move away from debates about whether a single intervention caused a particular outcome, instead recognising that there are likely to be multiple contributing factors driven by interactions between different actors. In doing so, we can challenge current simplistic narratives and gain a more nuanced understanding of conservation interventions.

Delayed Tuberculosis Diagnosis in a Low Incidence Country and its Effect on Cost of Care

Background Tuberculosis elimination (TB) is a global priority that requires high-quality timely care to be achieved. In low TB incidence countries such as Ireland, delayed diagnosis is common. Despite cost being central to policy making, it is not known if delayed care affects care cost among TB patients in a low-incidence setting. Methods Health care records of patients with signs and symptoms of TB evaluated by a tertiary service in Ireland between July 1st 2018 and December 31st 2019 were reviewed to measure and determine predictors of patient-related delays, health care-provider related delay and the cost of TB care. Benchmarks against which the outcomes were compared were derived from the literature. Results Thirty-seven patients were diagnosed with TB and 51% (19/37) had pulmonary TB (PTB). The median patient-related delay was 60 days among those with PTB, greater than the benchmark derived from the literature (38 days). The median health care provider-related delay among patients with PTB was 16 days and, although similar to the benchmark (median 22 days, minimum 11 days, maximum 36 days) could be improved. The health care-provider related delay among patients with EPTB was 66 days, greater than the benchmark (42 days). The cost of care was €8298, and while similar to that reported in the literature (median €9,319, minimum €6,486, maximum €14,750) could be improved. Patient-related delay among those with PTB predicted care costs. Conclusion Patient-related and health care-related delays in TB diagnosis in Ireland must be reduced. Initiatives to do so should be resourced.

Mitigating social-ecological risks from the surge in China’s overseas investment: an Indonesian profile

Rapid development has become a global priority as countries strive to meet the UN Sustainable Development Goals by 2030. Sustainable development is crucial for increasing human well-being in emerging economies while avoiding perverse outcomes on livelihoods, biodiversity, and ecosystem services. China’s Belt and Road Initiative (BRI) promises to help countries reach their national goals for economic growth, trade, and development, but there remain widespread concerns over how this boom in Chinese foreign direct investment (FDI) will impact social-ecological systems. Here, we discuss the risks implicit in BRI-related FDI projects to ecosystems and local communities, and how these risks can be mitigated or exacerbated by national governance of BRI projects and national development policies. We frame our discussion around Indonesia, where convoluted governance of some of the largest Chinese FDI projects may reduce accountability, and a recent job creation law brings risks of rapid unsustainable development practices across this biodiversity hotspot.

Understanding factors impacting global priority of emergency care: a qualitative policy analysis

IntroductionThe high burden of emergency medical conditions has not been met with adequate financial and political prioritisation especially in low and middle-income countries. We examined the factors that have shaped the priority of global emergency care and highlight potential responses by emergency care advocates.MethodsWe conducted semistructured interviews with key experts in global emergency care practice, public health, health policy and advocacy. We then applied a policy framework based on political ethnography and content analysis to code for underlying themes.ResultsWe identified problem definition, coalition building, paucity of data and positioning, as the main challenges faced by emergency care advocates. Problem definition remains the key issue, with divergent ideas on what emergency care is, should be and what solutions are to be prioritised. Proponents have struggled to portray the urgency of the issue in a way that commands action from decision-makers. The lack of data further limits their effectiveness. However, there is much reason for optimism given the network’s commitment to the issue, the emerging leadership and the existence of policy windows.ConclusionTo improve global priority for emergency care, proponents should take advantage of the emerging governance structure and build consensus on definitions, generate data-driven solutions, find strategic framings and engage with non-traditional allies.

Subtidal Natural Hard Substrate Quantitative Habitat Mapping: Interlinking Underwater Acoustics and Optical Imagery with Machine Learning

Subtidal natural hard substrates (SNHS) promote occupancy by rich benthic communities that provide irreplaceable and fundamental ecosystem functions, representing a global priority target for nature conservation and recognised in most European environmental legislation. However, scientifically validated methodologies for their quantitative spatial demarcation, including information on species occupancy and fine-scale environmental drivers (e.g., the effect of stone size on colonisation) are rare. This is, however, crucial information for sound ecological management. In this investigation, high-resolution (1 m) multibeam echosounder (MBES) depth and backscatter data and derivates, underwater imagery (UI) by video drop-frame, and grab sediment samples, all acquired within 32 km2 of seafloor in offshore Belgian waters, were integrated to produce a random forest (RF) spatial model, predicting the continuous distribution of the seafloor areal cover/m2 of the stones’ grain sizes promoting colonisation by sessile epilithic organisms. A semi-automated UI acquisition, processing, and analytical workflow was set up to quantitatively study the colonisation proportion of different grain sizes, identifying the colonisation potential to begin at stones with grain sizes Ø ≥ 2 cm. This parameter (i.e., % areal cover of stones Ø ≥ 2 cm/m2) was selected as the response variable for spatial predictive modelling. The model output is presented along with a protocol of error and uncertainty estimation. RF is confirmed as an accurate, versatile, and transferable mapping methodology, applicable to area-wide mapping of SNHS. UI is confirmed as an essential aid to acoustic seafloor classification, providing spatially representative numerical observations needed to carry out quantitative seafloor modelling of ecologically relevant parameters. This contribution sheds innovative insights into the ecologically relevant delineation of subtidal natural reef habitat, exploiting state-of-the-art underwater remote sensing and acoustic seafloor classification approaches.

Debt for nature swaps – which nature, how much and who pays?

Financially viable means to conserve biodiversity are urgently needed. We analyze how debt-for-nature swaps could conserve currently unprotected biodiversity priority-areas for six biomes in 67 countries under the debt service suspension initiative related to COVID19. Using novel methods and data, we find that the 67 countries hold over 22% of global priority-areas, yet 82.96% is unprotected. For 35 of the 67 countries, swapping 0.1% of public debt could conserve 100% of unprotected priority-areas. By swapping 5.09% of these countries’ total public debt (USD26.5 billion) in a pooled swap, 100% of priority-areas could be protected across the countries. Management costs could partly be covered through re-routed interest payments within the countries, with further annual funding of USD0.5-3.5 billion required. One-Sentence Summary: We develop a framework for efficient application of debt-for-nature swaps to maximize biodiversity conservation.

To the problem of using an automated workplace by people with disabilities

Introduction. Employees of the banking sector with health restrictions have negative experience of using internal software to interact with customers and perform their official duties. Many employees, for example, with hearing problems, would like to work in call centers, but do not have this opportunity due to the outdated software. The research objective is to analyze the priority tasks for the further development of software products, taking into account the existing health problems of employees.Materials and Methods. One of the subsystems of the automated workplace (hereinafter referred to as the AWP) was selected the software, which allows the employee to interact directly with the clients of the given organization. The analysis used the method of expert evaluation by T. L. Saati with the assistance of one of the experts in the development of software for people with disabilities.Results. Using the fundamental preference scale and expert opinion in the field of software development for people with disabilities, a priority matrix was built for each of the criteria (subtitles, simplified fonts, voice guidance, simplified and remote management) and platforms (IOS, Android, Windows OS), as well as a global priority matrix for all criteria and platforms.Discussions and Conclusions. An expert assessment of several characteristics of the software of a commercial banking organization of the Russian Federation was carried out to identify the disadvantages of using the software by employees with disabilities. During the analysis, intermediate conclusions were made: the most demanded criterion for people with hearing problems is “Subtitle”; for people without the ability to leave the house — “Remote control”; for people with amputations or irreversible limb injuries — “Simplified control”. The other parameters are not recommended for implementation.

Empowering Women in the Face of Body Ideals: A Scoping Review of Health Promotion Programs

Achieving women’s health equity and empowerment is a global priority. In a Western context, women are often disempowered by the value society places on body size, shape or weight, which can create a barrier to health. Health promotion programs can exacerbate women’s preoccupations with their bodies by focusing outcomes toward achieving an “ideal” body size. Women’s health promotion activities should be empowering if the desired outcomes are to improve their health and well-being long-term. This review sought to identify key elements from health promotion programs that aimed to empower women. A search was conducted in PubMed, MEDLINE, Web of Science, Scopus, CINAHL complete, and Academic Search Premiere databases. The search yielded 27 articles that collectively reported on 10 different programs. Through thematic synthesis, each article was analyzed for (1) key program features employed to empower women and (2) how such programs evaluated women’s health. Seven themes resulted, of which five describe key empowering features ( active participation, social support, sustainable change, holistic health perspective, strength-based approach) and two evaluation characteristics ( assessment across multiple health domains and a mixed-method design). The findings from this review can assist health promoters to design and improve initiatives that aim to empower women.