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Search Results: 1 - 10 of 205317 matches for " Christine P. Muganda "
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Outpatient Healthcare Settings and Transmission of Clostridium difficile
Lucy A. Jury, Brett Sitzlar, Sirisha Kundrapu, Jennifer L. Cadnum, Kim M. Summers, Christine P. Muganda, Abhishek Deshpande, Ajay K. Sethi, Curtis J. Donskey
PLOS ONE , 2013, DOI: 10.1371/journal.pone.0070175
Abstract: Background Recent reports suggest that community-associated Clostridium difficile infection (CDI) (i.e., no healthcare facility admission within 90 days) may be increasing in frequency. We hypothesized that outpatient clinics could be an important source for acquisition of community-associated CDI. Methods We performed a 6-month prospective study of CDI patients to determine frequency of and risk factors for skin and environmental shedding during outpatient visits and to derive a prediction rule for positive cultures. We performed a point–prevalence culture survey to assess the frequency of C. difficile contamination in outpatient settings and evaluated the frequency of prior outpatient visits in patients with community-associated CDI. Results Of 67 CDI patients studied, 54 (81%) had 1 or more outpatient visits within 12 weeks after diagnosis. Of 44 patients cultured during outpatient visits, 14 (32%) had skin contamination and 12 (27%) contaminated environmental surfaces. Decreased mobility, fecal incontinence, and treatment with non-CDI antibiotics were associated with positive cultures, whereas vancomycin taper therapy was protective. In patients not on CDI therapy, a prediction rule including incontinence or decreased mobility was 90% sensitive and 79% specific for detection of spore shedding. Of 84 clinic and emergency department rooms cultured, 12 (14%) had 1 or more contaminated environmental sites. For 33 community-associated CDI cases, 31 (94%) had an outpatient visit during the 12 weeks prior to onset of diarrhea. Conclusions Patients with recent CDI present a significant risk for transmission of spores during outpatient visits. The outpatient setting may be an underappreciated source of community-associated CDI cases.
Effect of a Stewardship Intervention on Adherence to Uncomplicated Cystitis and Pyelonephritis Guidelines in an Emergency Department Setting
Michelle T. Hecker, Clinton J. Fox, Andrea H. Son, Rita K. Cydulka, Jonathan E. Siff, Charles L. Emerman, Ajay K. Sethi, Christine P. Muganda, Curtis J. Donskey
PLOS ONE , 2014, DOI: 10.1371/journal.pone.0087899
Abstract: Objective To evaluate adherence to uncomplicated urinary tract infections (UTI) guidelines and UTI diagnostic accuracy in an emergency department (ED) setting before and after implementation of an antimicrobial stewardship intervention. Methods The intervention included implementation of an electronic UTI order set followed by a 2 month period of audit and feedback. For women age 18 – 65 with a UTI diagnosis seen in the ED with no structural or functional abnormalities of the urinary system, we evaluated adherence to guidelines, antimicrobial use, and diagnostic accuracy at baseline, after implementation of the order set (period 1), and after audit and feedback (period 2). Results Adherence to UTI guidelines increased from 44% (baseline) to 68% (period 1) to 82% (period 2) (P≤.015 for each successive period). Prescription of fluoroquinolones for uncomplicated cystitis decreased from 44% (baseline) to 14% (period 1) to 13% (period 2) (P<.001 and P = .7 for each successive period). Unnecessary antibiotic days for the 200 patients evaluated in each period decreased from 250 days to 119 days to 52 days (P<.001 for each successive period). For 40% to 42% of cases diagnosed as UTI by clinicians, the diagnosis was deemed unlikely or rejected with no difference between the baseline and intervention periods. Conclusions A stewardship intervention including an electronic order set and audit and feedback was associated with increased adherence to uncomplicated UTI guidelines and reductions in unnecessary antibiotic therapy and fluoroquinolone therapy for cystitis. Many diagnoses were rejected or deemed unlikely, suggesting a need for studies to improve diagnostic accuracy for UTI.
Sharing Tourism Benefits with the Local Community: A Business Perspective from the Grassroots in Tanzania
M Muganda, A Sirima, B Moshy, P Mkumbo
Ethiopian Journal of Environmental Studies and Management , 2012,
Abstract: Local communities’ participation in tourism benefit-sharing is central to tourism development. While there is a well-established literature on benefit-sharing from the perspective of wildlife protected areas and adjacent local communities, there is little emphasis on how other tourism businesses do this. Using a case study of Barabarani village, Tanzania, this paper examines how other tourism businesses share benefits with the neighbouring communities. It explores this using: in-depth semi-structured interviews with tourism businesses, NGOs, and key decisionmakers within the community; a two-month period of field observations coupled with the researcher’s experience with the wider community; informal discussions with some members of the local community; and document analysis. The findings show that tourism businesses in Barabarani village have schemes that favourably benefit local people, but the extent to which a particular business has developed its schemes differed from one business to another depending on the nature of business, ownership, and objectives. In some businesses such schemes were automatically created as a ‘by-product’ of particular decisions they make. Overall, public businesses had more systematic benefit sharing schemes than private businesses. Thus, there was no guarantee local communities would receive benefits from private businesses, and if any, they were executed on an ad hoc basis.
Etiology of the bifid (double) femoral head, with prior history of developmental dysplasia of the hip  [PDF]
Leonard P. Seimon, Christine Kohler-Ekstrand, Howard D. Dorfman
Case Reports in Clinical Medicine (CRCM) , 2013, DOI: 10.4236/crcm.2013.25085
Abstract: Our patient presented with a double femoral head, that is, two separate heads with individual epiphyses, but a single contiguous metaphysis. Two similar cases had been described in the literature. The only common feature in these three cases is that they had open reduction for Developmental Dysplasia of the Hip (DDH) through an anterior approach. No other pathology was detected in these patients. A rabbit model was created in which the cartilaginous anlage of the rabbit femoral head was surgically split. After 2-4 weeks a bifid femoral head developed, mimicking that described in the literature. We suggest that inadvertent damage to the femoral head during surgery for DDH may in fact lead to the development of a bifid femoral head. Prior history of DDH should be considered when the isolated bifid femoral head is identified.
Direct Regulation of CLOCK Expression by REV-ERB
Christine Crumbley,Thomas P. Burris
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0017290
Abstract: Circadian rhythms are regulated at the cellular level by transcriptional feedback loops leading to oscillations in expression of key proteins including CLOCK, BMAL1, PERIOD (PER), and CRYPTOCHROME (CRY). The CLOCK and BMAL1 proteins are members of the bHLH class of transcription factors and form a heterodimer that regulates the expression of the PER and CRY genes. The nuclear receptor REV-ERBα plays a key role in regulation of oscillations in BMAL1 expression by directly binding to the BMAL1 promoter and suppressing its expression at certain times of day when REV-ERBα expression levels are elevated. We recently demonstrated that REV-ERBα also regulates the expression of NPAS2, a heterodimer partner of BMAL1. Here, we show that REV-ERBα also regulates the expression another heterodimer partner of BMAL1, CLOCK. We identified a REV-ERBα binding site within the 1st intron of the CLOCK gene using a chromatin immunoprecipitation – microarray screen. Suppression of REV-ERBα expression resulted in elevated CLOCK mRNA expression consistent with REV-ERBα's role as a transcriptional repressor. A REV-ERB response element (RevRE) was identified within this region of the CLOCK gene and was conserved between humans and mice. Additionally, the CLOCK RevRE conferred REV-ERB responsiveness to a heterologous reporter gene. Our data suggests that REV-ERBα plays a dual role in regulation of the activity of the BMAL1/CLOCK heterodimer by regulation of expression of both the BMAL1 and CLOCK genes.
2-Hydroxy-4-n-propoxy-5-bromoacetophenone oxime as an Analytical Reagent for Gravimetric Determination of V(V)
Ambily P. Nair,J. Christine
Journal of Chemistry , 2009, DOI: 10.1155/2009/129832
Crohn's Disease-Associated Adherent-Invasive Escherichia coli Adhesion Is Enhanced by Exposure to the Ubiquitous Dietary Polysaccharide Maltodextrin
Kourtney P. Nickerson, Christine McDonald
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0052132
Abstract: Crohn's disease (CD) is associated with intestinal dysbiosis evidenced by an altered microbiome forming thick biofilms on the epithelium. Additionally, adherent-invasive E. coli (AIEC) strains are frequently isolated from ileal lesions of CD patients indicating a potential role for these strains in disease pathogenesis. The composition and characteristics of the host microbiome are influenced by environmental factors, particularly diet. Polysaccharides added to food as emulsifiers, stabilizers or bulking agents have been linked to bacteria-associated intestinal disorders. The escalating consumption of polysaccharides in Western diets parallels an increased incidence of CD during the latter 20th century. In this study, the effect of a polysaccharide panel on adhesiveness of the CD-associated AIEC strain LF82 was analyzed to determine if these food additives promote disease-associated bacterial phenotypes. Maltodextrin (MDX), a polysaccharide derived from starch hydrolysis, markedly enhanced LF82 specific biofilm formation. Biofilm formation of multiple other E. coli strains was also promoted by MDX. MDX-induced E. coli biofilm formation was independent of polysaccharide chain length indicating a requirement for MDX metabolism. MDX exposure induced type I pili expression, which was required for MDX-enhanced biofilm formation. MDX also increased bacterial adhesion to human intestinal epithelial cell monolayers in a mechanism dependent on type 1 pili and independent of the cellular receptor CEACAM6, suggesting a novel mechanism of epithelial cell adhesion. Analysis of mucosa-associated bacteria from individuals with and without CD showed increased prevalence of malX, a gene essential for MDX metabolism, uniquely in the ileum of CD patients. These findings demonstrate that the ubiquitous dietary component MDX enhances E. coli adhesion and suggests a mechanism by which Western diets rich in specific polysaccharides may promote dysbiosis of gut microbes and contribute to disease susceptibility.
Stochastic Methodology for the Study of an Epidemic Decay Phase, Based on a Branching Model
Sophie Pénisson,Christine Jacob
International Journal of Stochastic Analysis , 2012, DOI: 10.1155/2012/598701
Abstract: We present a stochastic methodology to study the decay phase of an epidemic. It is based on a general stochastic epidemic process with memory, suitable to model the spread in a large open population with births of any rare transmissible disease with a random incubation period and a Reed-Frost type infection. This model, which belongs to the class of multitype branching processes in discrete time, enables us to predict the incidences of cases and to derive the probability distributions of the extinction time and of the future epidemic size. We also study the epidemic evolution in the worst-case scenario of a very late extinction time, making use of the Q-process. We provide in addition an estimator of the key parameter of the epidemic model quantifying the infection and finally illustrate this methodology with the study of the Bovine Spongiform Encephalopathy epidemic in Great Britain after the 1988 feed ban law. 1. Introduction Outbreaks of infectious diseases of animals or humans are subject, when possible, to control measures aiming at curbing their spread. Effective measures should force the epidemic to enter its decay phase and to reach extinction. The decay phase can then be simply detected by a decrease of the number of cases, when this decrease is obvious. However this is not always the case, and this rough qualitative information might not be sufficient to evaluate accurately the effectiveness of the proposed measures to reduce the final size and duration of the outbreak. The goal of this paper is to present a stochastic methodology in discrete time to study more accurately the decay phase of an epidemic. Our framework is the spread, in a large open population, of a rare transmissible disease such that the infection process may be assumed to follow a Reed-Frost type model, with a probability for a susceptible to become infected by a given dose of pathogens inversely proportional to the total population size. Moreover the latent period (during which an individual is infected but not yet infectious) may be random and long compared to the generation time. Questions about the decay phase include the following: which quantitative criteria can ensure that the disease has entered an extinction phase? What is the probability distribution of the epidemic extinction time, of the epidemic final size, and of the incidence of infected individuals? Finally, what would be the evolution of the epidemic in the event of a very late extinction of the disease? From a practical point of view, it is generally impossible to observe all infections. Susceptible and
Smith Normal Form of a Multivariate Matrix Associated with Partitions
Christine Bessenrodt,Richard P. Stanley
Mathematics , 2013,
Abstract: Consideration of a question of E. R. Berlekamp led Carlitz, Roselle, and Scoville to give a combinatorial interpretation of the entries of certain matrices of determinant~1 in terms of lattice paths. Here we generalize this result by refining the matrix entries to be multivariate polynomials, and by determining not only the determinant but also the Smith normal form of these matrices. A priori the Smith form need not exist but its existence follows from the explicit computation. It will be more convenient for us to state our results in terms of partitions rather than lattice paths.
Continuing Education for Teachers in the Teaching Residency Program at Colégio Pedro II in Brazil  [PDF]
Neide F. P. Sant’Anna, Francisco R. P. Mattos, Christine S. Costa
Creative Education (CE) , 2017, DOI: 10.4236/ce.2017.88084
Abstract: This article discusses the Teaching Residency Program of Colégio Pedro II, which features as a realization of Third Space in the qualification of teachers. The program is a reality of interaction between academic research and teaching practice, employing the experience in a public school to enhance the quality of teaching actions in the school realities of the participants, contributing to both to improve the quality of professional training of residents and to provide a discussion of the educational context. Four basic classes of conflicts experienced by recently graduated teachers, and such conflicts are analyzed with support on concept of Third Space.
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