Tuberculosis Diagnostic Delays and Treatment Outcomes among Patients with COVID-19, California, USA, 2020.

We assessed tuberculosis (TB) diagnostic delays among patients with TB and COVID-19 in California, USA. Among 58 persons, 43% experienced TB diagnostic delays, and a high proportion (83%) required hospitalization for TB. Even when viral respiratory pathogens circulate widely, timely TB diagnostic workup for at-risk persons remains critical for reducing TB-related illness.

Neural oscillations and speech processing at birth.

Are neural oscillations biologically endowed building blocks of the neural architecture for speech processing from birth, or do they require experience to emerge? In adults, delta, theta, and low-gamma oscillations support the simultaneous processing of phrasal, syllabic, and phonemic units in the speech signal, respectively. Using electroencephalography to investigate neural oscillations in the newborn brain we reveal that delta and theta oscillations differ for rhythmically different languages, suggesting that these bands underlie newborns' universal ability to discriminate languages on the basis of rhythm. Additionally, higher theta activity during post-stimulus as compared to pre-stimulus rest suggests that stimulation after-effects are present from birth.

Prenatal experience with language shapes the brain.

Human infants acquire language with notable ease compared to adults, but the neural basis of their remarkable brain plasticity for language remains little understood. Applying a scaling analysis of neural oscillations to address this question, we show that newborns' electrophysiological activity exhibits increased long-range temporal correlations after stimulation with speech, particularly in the prenatally heard language, indicating the early emergence of brain specialization for the native language.

Variation in Treatment of Pediatric Tuberculosis Infection in Different Provider Settings.

OBJECTIVES: To evaluate implementation of rifamycin-based regimens (RBR) for pediatric tuberculosis infection (TBI) treatment among 3 provider settings in a high-incidence county. STUDY DESIGN: A multicenter, retrospective observational study was performed across 3 sites in Los Angeles County: an academic center (AC), a general pediatrics federally qualified health center (FQHC), and department of public health (DPH) tuberculosis clinics. Patients initiated on TBI treatment age 1 months to 17 years between 2018 and 2020 were included. RBRs were defined as regimens: 3 months of weekly rifapentine and isoniazid, 4 months of daily rifampin, and 3 months of daily isoniazid and rifampin. RESULTS: We included 424 patients: 51 from AC, 327 from DPH, and 46 from FQHC. RBR use nearly doubled during the study period (from 43% in 2018 to 82% in 2020; P < .001). FQHC had the shortest time to chest radiograph and treatment initiation; however, AC and DPH were 4 times as likely to prescribe an RBR compared to FQHC (95% CI, 2.1-7.8). AC and DPH had similar completion rates (74%) and were 2.6 times as likely to complete treatment compared to FQHC (95% CI, 1.4-4.9). CONCLUSIONS: The use of RBRs for pediatric TBI varies significantly by clinical setting but is improving over time. Strategies are needed to improve RBR uptake, standardize care, and increase treatment completion, particularly among general pediatricians.

Is the tendency to maximise energy distribution an optimal collective activity for biological purposes? A proposal for a global principle of biological organization.

Our purpose is to address the biological problem of finding foundations of the organization in the collective activity among cell networks in the nervous system, at the meso/macroscale, giving rise to cognition and consciousness. But in doing so, we encounter another problem related to the interpretation of methods to assess the neural interactions and organization of the neurodynamics, because thermodynamic notions, which have precise meaning only under specific conditions, have been widely employed in these studies. The consequence is that apparently contradictory results appear in the literature, but these contradictions diminish upon the considerations of the specific circumstances of each experiment. After clarifying some of these controversial points and surveying some experimental results, we propose that a necessary condition for cognition/consciousness to emerge is to have available enough energy, or cellular activity; and a sufficient condition is the multiplicity of configurations in which cell networks can communicate, resulting in non-uniform energy distribution, the generation and dissipation of energy gradients due to the constant activity. The diversity of sensorimotor processing of higher animals needs a flexible, fluctuating web on neuronal connections, and we review results supporting such multiplicity of configurations among brain regions associated with conscious awareness and healthy brain states. These ideas may reveal possible fundamental principles of brain organization that could be extended to other natural phenomena and how healthy activity may derive to pathological states.

Qualia and Phenomenal Consciousness Arise From the Information Structure of an Electromagnetic Field in the Brain.

In this paper we address the following problems and provide realistic answers to them: (1) What could be the physical substrate for subjective, phenomenal, consciousness (P-consciousness)? Our answer: the electromagnetic (EM) field generated by the movement and changes of electrical charges in the brain. (2) Is this substrate generated in some particular part of the brains of conscious entities or does it comprise the entirety of the brain/body? Our answer: a part of the thalamus in mammals, and homologous parts of other brains generates the critical EM field. (3) From whence arise the qualia experienced in P-consciousness? Our answer, the relevant EM field is "structured" by emulating in the brain the information in EM fields arising from both external (the environment) and internal (the body) sources. (4) What differentiates the P-conscious EM field from other EM fields, e.g., the flux of photons scattered from object surfaces, the EM field of an electro-magnet, or the EM fields generated in the brain that do not enter P-consciousness, such as those generated in the retina or occipital cortex, or those generated in brain areas that guide behavior through visual information in persons exhibiting "blindsight"? Our answer: living systems express a boundary between themselves and the environment, requiring them to model (coarsely emulate) information from their environment in order to control through actions, to the extent possible, the vast sea of variety in which they are immersed. This model, expressed in an EM field, is P-consciousness. The model is the best possible representation of the moment-to-moment niche-relevant (action-relevant: affordance) information an organism can generate (a Gestalt). Information that is at a lower level than niche-relevant, such as the unanalyzed retinal vector-field, is not represented in P-consciousness because it is not niche-relevant. Living organisms have sensory and other systems that have evolved to supply such information, albeit in a coarse form.

Complexity of Brain Dynamics as a Correlate of Consciousness in Anaesthetized Monkeys.

The use of anaesthesia is a fundamental tool in the investigation of consciousness. Anesthesia procedures allow to investigate different states of consciousness from sedation to deep anesthesia within controlled scenarios. In this study we use information quantifiers to measure the complexity of electrocorticogram recordings in monkeys. We apply these metrics to compare different stages of general anesthesia for evaluating consciousness in several anesthesia protocols. We find that the complexity of brain activity can be used as a correlate of consciousness. For two of the anaesthetics used, propofol and medetomidine, we find that the anaesthetised state is accompanied by a reduction in the complexity of brain activity. On the other hand we observe that use of ketamine produces an increase in complexity measurements. We relate this observation with increase activity within certain brain regions associated with the ketamine used doses. Our measurements indicate that complexity of brain activity is a good indicator for a general evaluation of different levels of consciousness awareness, both in anesthetized and non anesthetizes states.

The origins and development of speech envelope tracking during the first months of life.

When humans listen to speech, their neural activity tracks the slow amplitude fluctuations of the speech signal over time, known as the speech envelope. Studies suggest that the quality of this tracking is related to the quality of speech comprehension. However, a critical unanswered question is how envelope tracking arises and what role it plays in language development. Relatedly, its causal role in comprehension remains unclear, as some studies have found it to be present even for unintelligible speech. Using electroencephalography, we investigated whether the neural activity of newborns and 6-month-olds is able to track the speech envelope of familiar and unfamiliar languages in order to explore the developmental origins and functional role of envelope tracking. Our results show that amplitude and phase tracking take place at birth for familiar and unfamiliar languages alike, i.e. independently of prenatal experience. However, by 6 months language familiarity modulates the ability to track the amplitude of the speech envelope, while phase tracking continues to be universal. Our findings support the hypothesis that amplitude and phase tracking could represent two different neural mechanisms of oscillatory synchronisation and may thus play different roles in speech perception.

Consciousness as an Emergent Phenomenon: A Tale of Different Levels of Description.

One of the biggest queries in cognitive sciences is the emergence of consciousness from matter. Modern neurobiological theories of consciousness propose that conscious experience is the result of interactions between large-scale neuronal networks in the brain, traditionally described within the realm of classical physics. Here, we propose a generalized connectionist framework in which the emergence of "conscious networks" is not exclusive of large brain areas, but can be identified in subcellular networks exhibiting nontrivial quantum phenomena. The essential feature of such networks is the existence of strong correlations in the system (classical or quantum coherence) and the presence of an optimal point at which the system's complexity and energy dissipation are maximized, whereas free-energy is minimized. This is expressed either by maximization of the information content in large scale functional networks or by achieving optimal efficiency through the quantum Goldilock effect.

Nanoparticles in Agroindustry: Applications, Toxicity, Challenges, and Trends.

Nanotechnology is a tool that in the last decade has demonstrated multiple applications in several sectors, including agroindustry. There has been an advance in the development of nanoparticulated systems to be used as fertilizers, pesticides, herbicides, sensors, and quality stimulants, among other applications. The nanoencapsulation process not only protects the active ingredient but also can affect the diffusion, interaction, and activity. It is important to evaluate the negative aspects of the use of nanoparticles (NPs) in agriculture. Given the high impact of the nanoparticulated systems in the agro-industrial field, this review aims to address the effects of various nanomaterials on the morphology, metabolomics, and genetic modification of several crops.

Large-Scale Land Development, Fugitive Dust, and Increased Coccidioidomycosis Incidence in the Antelope Valley of California, 1999-2014.

Ongoing large-scale land development for renewable energy projects in the Antelope Valley, located in the Western Mojave Desert, has been blamed for increased fugitive dust emissions and coccidioidomycosis incidence among the general public in recent years. Soil samples were collected at six sites that were destined for solar farm construction and were analyzed for the presence of the soil-borne fungal pathogen Coccidioides immitis which is endemic to many areas of central and southern California. We used a modified culture-independent nested PCR approach to identify the pathogen in all soil samples and also compared the sampling sites in regard to soil physical and chemical parameters, degree of disturbance, and vegetation. Our results indicated the presence of C. immitis at four of the six sites, predominantly in non-disturbed soils of the Pond-Oban complex, which are characterized by an elevated pH and salt bush communities, but also in grassland characterized by different soil parameters and covered with native and non-native annuals. Overall, we were able to detect the pathogen in 40% of the soil samples (n = 42). Incidence of coccidioidomycosis in the Antelope Valley was positively correlated with land use and particulate matter in the air (PM10) (Pearson correlation coefficient >0.5). With the predicted population growth and ongoing large-scale disturbance of soil in the Antelope Valley in coming years, incidence of coccidioidomycosis will likely further increase if policy makers and land developers continue to ignore the risk of grading land without implementing long-term dust mitigation plans in Environmental Impact Reports.

Effectiveness of 13-valent pneumococcal conjugate vaccine for prevention of invasive pneumococcal disease in children in the USA: a matched case-control study.

BACKGROUND: In 2010, 13-valent pneumococcal conjugate vaccine (PCV13) was licensed and recommended in the USA for prevention of invasive pneumococcal disease in children. Licensure was based on immunogenicity data comparing PCV13 with the earlier seven-valent formulation. Because clinical endpoints were not assessed for the new antigens, we did a postlicensure matched case-control study to assess vaccine effectiveness. METHODS: Cases in children aged 2-59 months were identified through active surveillance in 13 sites. Controls were identified via birth registries and matched to cases by age and postal (zip) code. The primary objective was the vaccine effectiveness of at least one dose against the 13 serotypes included in PCV13. Secondary objectives included vaccine effectiveness against all-cause invasive pneumococcal disease, against antibiotic non-susceptible invasive pneumococcal disease, and among children with and without underlying conditions. Vaccine effectiveness was calculated as (1 - matched odds ratio) × 100%. FINDINGS: We enrolled 722 children with invasive pneumococcal disease and 2991 controls; PCV13 serotype cases (217 [30%]) included most commonly serotypes 19A (128 [18%]), 7F (32 [4%]), and 3 (43 [6%]). Vaccine effectiveness against PCV13 serotypes was 86·0% (95% CI 75·5 to 92·3), driven by serotypes 19A and 7F, for which vaccine effectiveness was 85·6% (95% CI 70·6 to 93·5) and 96·5% (82·7 to 100), respectively. We also identified statistically significant effectiveness against serotype 3 (79·5%, 95% CI 30·3 to 94·8) and against antibiotic non-susceptible invasive pneumococcal disease (65·6%, 44·9 to 78·7). Vaccine effectiveness against all-cause invasive pneumococcal disease was 60·2% (95% CI 46·8 to 70·3). Vaccine effectiveness was similar among children with (81·4%, 95% CI 45·4 to 93·6) and without (85·8%, 74·9 to 91·9) underlying conditions. INTERPRETATION: PCV13 appears highly effective against invasive pneumococcal disease among children in the USA in the context of routine and catch-up schedules, although some new vaccine antigens could not be assessed. PCV13 immunisation provides a robust strategy for combating pneumococcal antimicrobial resistance. FUNDING: Centers for Disease Control and Prevention.

The Changing Epidemiology of Coccidioidomycosis in Los Angeles (LA) County, California, 1973-2011.

Coccidioidomycosis, also known as Valley Fever, is often thought of as an endemic disease of central California exclusive of Los Angeles County. The fungus that causes Valley Fever, Coccidioides spp., grows in previously undisturbed soil of semi-arid and arid environments of certain areas of the Americas. LA County has a few large areas with such environments, particularly the Antelope Valley which has been having substantial land development. Coccidioidomycosis that is both clinically- and laboratory-confirmed is a mandated reportable disease in LA County. Population surveillance data for 1973-2011 reveals an annual rate increase from 0.87 to 3.2 cases per 100,000 population (n = 61 to 306 annual cases). In 2004, case frequency started substantially increasing with notable epidemiologic changes such as a rising 2.1 to 5.7 male-to-female case ratio stabilizing to 1.4-2.2. Additionally, new building construction in Antelope Valley greatly rose in 2003 and displayed a strong correlation (R = 0.92, Pearson p<0.0001) with overall LA County incidence rates for 1996-2007. Of the 24 LA County health districts, 19 had a 100%-1500% increase in cases when comparing 2000-2003 to 2008-2011. Case residents of endemic areas had stronger odds of local exposures, but cases from areas not known to be endemic had greater mortality (14% versus 9%) with notably more deaths during 2008-2011. Compared to the 57 other California counties during 2001-2011, LA County had the third highest average annual number of cases and Antelope Valley had a higher incidence rate than all but six counties. With the large number of reported coccidioidomycosis cases, multi-agency and community partnering is recommended to develop effective education and prevention strategies to protect residents and travelers.

Classification of male lower urinary tract symptoms using mathematical modelling and a regression tree algorithm of noninvasive near-infrared spectroscopy parameters.

BACKGROUND: Assessment of bladder outlet obstruction (BOO) is standard clinical practice in patients with lower urinary tract symptoms (LUTS). This is currently achieved through pressure-flow studies. Research indicates that progressive functional impairment of the bladder due to BOO is associated with haemodynamic changes. Near-infrared spectroscopy (NIRS) is an optical method of monitoring tissue oxygenation and haemodynamics via changes in concentration of the chromophores oxyhaemoglobin (O(2)Hb) and deoxyhaemoglobin (HHb). OBJECTIVE: To report a noninvasive technique and mathematic method of analysis for assessment of BOO in male subjects using NIRS and to test the independent ability of NIRS data to distinguish between patients with and without obstruction using a classification and regression tree algorithm (CART). DESIGN, SETTING, AND PARTICIPANTS: A prospective cohort study to evaluate subjects presenting for urodynamic assessment of LUTS using standard urodynamic studies with simultaneous transcutaneous NIRS monitoring. The NIRS data (magnitude and pattern of changes in O(2)Hb and HHb) were analysed, and a CART algorithm was constructed. Sixty-four males referred for evaluation of LUTS were studied at a tertiary care, university-based research and clinical facility. MEASUREMENTS: Clinical symptoms were classified using the International Prostate Symptom Score (IPSS). Pressure-flow studies were done with simultaneous transcutaneous NIRS monitoring of the detrusor. Pressure-flow studies were classified according to the Abrams-Griffiths nomogram. NIRS data documented changes in the concentration of the chromophores O(2)Hb and HHb. RESULTS AND LIMITATIONS: IPSS scores ranged from 12 to 34, with a mean of 19. The pressure-flow nomogram found 30 patients with BOO, 16 patients without BOO, and 18 patients with equivocal results. The CART found a misclassification error of 4% with 88% specificity and 94% precision. The NIRS instrument and algorithm were new; no asymptomatic subjects were studied. CONCLUSION: Using a CART algorithm, noninvasive NIRS data during voiding had independent discriminatory ability related to classification of BOO.

Risk factors for mortality among patients with nonperinatal listeriosis in Los Angeles County, 1992-2004.

BACKGROUND: Listeriosis is a relatively rare foodborne disease with significant public health implications. The causative pathogen, Listeria monocytogenes, grows well in refrigeration, is associated with a case-fatality rate of 20%, and causes an estimated 28% of all foodborne disease-related deaths. Nevertheless, data on the risk factors for listeriosis mortality are limited. METHODS: Using the passive surveillance listeriosis database of the County of Los Angeles Department of Public Health, we conducted a 13-year retrospective cohort study to describe nonperinatal listeriosis mortality in Los Angeles County during the period 1992-2004. A nonperinatal listeriosis case was defined as one occurring in a nonpregnant person >42 days of age who resided in Los Angeles County and had a culture positive for L. monocytogenes. RESULTS: Unconditional multivariable logistic regression analysis of 281 nonperinatal listeriosis cases with 29 main effects variables resulted in finding nonhematological malignancy (odds ratio [OR], 5.92; 95% confidence interval [CI], 1.85-18.9), alcoholism (OR, 4.63; 95% CI, 1.36-15.8), age 70 years (OR, 3.44; 95% CI, 1.50-7.87), steroid medication (OR, 3.34; 95% CI, 1.38-8.08), and kidney disease (OR, 2.94; 95% CI, 1.18-7.31) to be statistically significant risk factors for mortality. Other listeriosis mortality risk factors with adjusted odds ratios >1.5 included blood transfusion, asthma, black race, Asian race, use of antibiotics, hypertension, receipt of chemotherapy, and Hispanic race. Patients admitted to the hospital with a diagnosis of sepsis alone had the highest mortality (23.7%), whereas patients with cases of meningitis alone had the lowest mortality (3.13%). CONCLUSIONS: The findings of this study should be used to help researchers and clinicians focus on specific risk factors to prevent nonperinatal listeriosis-related deaths.

Trabajo informal: motivos, bienestar subjetivo, salud, y felicidad en vendedores ambulantes / Trabalho informal: motivos, bem-estar subjetivo, saúde e felicidade de vendedores ambulantes / Informal work: motives, well being, health and happiness in street vendors

Las relaciones entre trabajo, bienestar subjetivo (B.S.), felicidad y salud son complejas y de alto interés teórico y empírico. Ellas son analizadas aquí en trabajadores informales de comercio ambulante. Mediante observación y fotografías en las cinco ciudades más pobladas de la región del Maule (Chile), se registra 1556 puestos de venta de los que aleatoriamente se selecciona 258 para encuestar. Resultados: presentan una satisfacción vital global moderada, estando menos satisfechos con sus amigos y ocio, que con su trabajo y su familia. Su mayor felicidad proviene de ésta (χ2Friedman=389,47; gl=3; p<0,001). Están enfermos M= 6 días mensualmente, aunque sólo dejan de trabajar un día al mes. Su B.S. correlaciona fuertemente con su satisfacción vital (r=0,45), ésta con su felicidad (r=0,44), y a su vez ésta con su salud (r=0,42). Se discute éstos y otros resultados obtenidos.(AU)

As relações entre trabalho, bem-estar subjetivo (B.S.), felicidade e saúde são complexas e de alto interesse teórico e empírico. Elas são analisadas aqui em trabalhadores informais do comércio ambulante. Mediante observação e fotografias nas cinco cidades mais populosas da região do Maule (Chile), registram-se 1556 postos de venda. Foram selecionados aleatoriamente 258 para interrogar. Resultados: os trabalhadores informais apresentam uma satisfação vital global moderada, estando menos satisfeitos com seus amigos e tempo de lazer do que com seu trabalho e sua família. Sua maior felicidade provém desta (χ2Friedman=389,47; gl=3; p<0,001). Encontram-se doentes M= 6 dias mensalmente, ainda que só deixem de trabalhar um dia ao mês. Seu B.S. correlaciona-se fortemente com sua satisfação vital (r=0,45), esta com sua felicidade (r=0,44) e esta última com sua saúde (r=0,42). Estes e outros resultados sãodiscutidos neste artigo.(AU)

Relationships among work, subjective well being (SWB), happiness and health are complex and have a high theoretical and empirical relevance. In this study, these relationships are analyzed in street vendors. Using observation and photographs in the five bigger cities Maule Region (Chile), 1556 sale points were found and 258 of them were randomly selected for this study. Results: vendors have a moderated life satisfaction, with lower satisfaction levels about their friends and leisure than about their work and family. The highest report of happiness comes from their family (χ2Friedman=389,47; gl=3; p<0,001). They report being sick M= 6 days per month, although they only miss work one day per month. Their SWB correlates with their life satisfaction (r=0, 45), happiness (r=0,44), and health level (r=0,42). These and others results are discussed in the study.(AU)

Trabajo informal: motivos, bienestar subjetivo, salud, y felicidad en vendedores ambulantes / Trabalho informal: motivos, bem-estar subjetivo, saúde e felicidade de vendedores ambulantes / Informal work: motives, well being, health and happiness in street vendors

Las relaciones entre trabajo, bienestar subjetivo (B.S.), felicidad y salud son complejas y de alto interés teórico y empírico. Ellas son analizadas aquí en trabajadores informales de comercio ambulante. Mediante observación y fotografías en las cinco ciudades más pobladas de la región del Maule (Chile), se registra 1556 puestos de venta de los que aleatoriamente se selecciona 258 para encuestar. Resultados: presentan una satisfacción vital global moderada, estando menos satisfechos con sus amigos y ocio, que con su trabajo y su familia. Su mayor felicidad proviene de ésta (χ2Friedman=389,47; gl=3; p<0,001). Están enfermos M= 6 días mensualmente, aunque sólo dejan de trabajar un día al mes. Su B.S. correlaciona fuertemente con su satisfacción vital (r=0,45), ésta con su felicidad (r=0,44), y a su vez ésta con su salud (r=0,42). Se discute éstos y otros resultados obtenidos.

As relações entre trabalho, bem-estar subjetivo (B.S.), felicidade e saúde são complexas e de alto interesse teórico e empírico. Elas são analisadas aqui em trabalhadores informais do comércio ambulante. Mediante observação e fotografias nas cinco cidades mais populosas da região do Maule (Chile), registram-se 1556 postos de venda. Foram selecionados aleatoriamente 258 para interrogar. Resultados: os trabalhadores informais apresentam uma satisfação vital global moderada, estando menos satisfeitos com seus amigos e tempo de lazer do que com seu trabalho e sua família. Sua maior felicidade provém desta (χ2Friedman=389,47; gl=3; p<0,001). Encontram-se doentes M= 6 dias mensalmente, ainda que só deixem de trabalhar um dia ao mês. Seu B.S. correlaciona-se fortemente com sua satisfação vital (r=0,45), esta com sua felicidade (r=0,44) e esta última com sua saúde (r=0,42). Estes e outros resultados sãodiscutidos neste artigo.

Relationships among work, subjective well being (SWB), happiness and health are complex and have a high theoretical and empirical relevance. In this study, these relationships are analyzed in street vendors. Using observation and photographs in the five bigger cities Maule Region (Chile), 1556 sale points were found and 258 of them were randomly selected for this study. Results: vendors have a moderated life satisfaction, with lower satisfaction levels about their friends and leisure than about their work and family. The highest report of happiness comes from their family (χ2Friedman=389,47; gl=3; p<0,001). They report being sick M= 6 days per month, although they only miss work one day per month. Their SWB correlates with their life satisfaction (r=0, 45), happiness (r=0,44), and health level (r=0,42). These and others results are discussed in the study.

[Nuchal translucency and ductus venosus as ultrasound markers of chromosomal abnormalities]. / Translucencia nucal fetal y ductus venosus como marcadores ecográficos de cromosomopatías.

Chromosomal abnormalities are frequent pathologies. We must find new methods for early prenatal diagnosis. Therefore we propose to assess the effectiveness of nuchal translucency thickness and abnormal Doppler of ductus venosus as ultrasound markers of aneuploidies. We evaluated 228 high risk pregnancies between 11 and 14 weeks. Later amniocentesis or newborn evaluation by a genetist was made. 28 patients were lost at follow up; the definitive sample was 200 pregnancies. Nuchal translucency thickness was increased in 5 fetuses, of these 4 presented abnormal Doppler of ductus venosus. Chromosomal anomalies were confirmed in 3 of these fetuses, for an incidence of 1.5%. Nuchal translucency thickness increased had: 100% sensitivity and 98.98% specificity. Abnormal Doppler of ductus venosus had: 100% sensitivity and 99.49% specificity. Nuchal translucency thickness and Doppler of ductus venosus are excellent markers of chromosomal abnormalities

Risk factors for neonatal methicillin-resistant Staphylococcus aureus infection in a well-infant nursery.

OBJECTIVE: To determine risk factors for neonatal methicillin-resistant Staphylococcus aureus (MRSA) skin and soft-tissue infection in a well-infant nursery. DESIGN: Case-control studies. SETTING: A well-infant nursery in a nonteaching, community hospital. METHODS: Case infants were newborns in the nursery who were born in the period November 2003 through June 2004 and had onset of MRSA skin and soft-tissue infection within 21 days after discharge from the nursery. Site inspections were conducted. Control infants were randomly selected male infants in the nursery during the outbreak periods. MRSA isolates were characterized with pulsed-field gel electrophoresis. RESULTS: Eleven case infants were identified in 2 outbreaks: outbreak 1 occurred from November 18 through December 24, 2003, and outbreak 2 occurred from May 26 through June 5, 2004. All were full-term male infants with pustular-vesicular lesions in the groin. Inspection revealed uncovered circumcision equipment, multiple-dose lidocaine vials, and inadequate hand hygiene practices. In outbreak 1, case infants (n=6) had a significantly higher mean length of stay than control infants (3.7 vs 2.5 days; P=.01). In outbreak 2, case infants (n=5) were more likely to have been circumcised in the nursery (OR, undefined [95% CI, 1.7 to undefined]) and to have received lidocaine injections (OR, undefined [95% CI, 2.6 to undefined]). Controlling for length of stay, case infants were more likely to have been circumcised in the nursery (OR, 12.2 [95% CI, 1.5 to undefined]). Pulsed-field gel electrophoresis showed that 7 available isolates were indistinguishable from a community-associated MRSA strain (USA300-0114). CONCLUSIONS: Newborns in well-infant nurseries are at risk for nosocomial infection with community-associated MRSA strains. Reducing length of stay, improving circumcision and hand hygiene practices, and eliminating use of multiple-dose lidocaine vials should decrease transmission of community-associated MRSA strains in nurseries.