Global burden of Clostridium difficile infections::a systematic review and meta-analysis

Background: Clostridium difficile is a leading cause of morbidity and mortality in several countries. However, there are limited evidence characterizing its role as a global public health problem. We conducted a systematic review to provide a comprehensive overview of C. difficile infections (CDI) rates.Methods: Seven databases were searched (January 2016) to identify studies and surveillance reports published between 2005 and 2015 reporting CDI incidence rates. CDI incidence rates for health care facility-associated (HCF), hospital onset-health care facility-associated, medical or general intensive care unit (ICU), internal medicine (IM), long-term care facility (LTCF), and community-associated (CA) were extracted and standardized. Meta-analysis was conducted using a random effects model.Results: 229 publications, with data from 41 countries, were included. The overall rate of HCF-CDI was 2.24 (95% confidence interval CI = 1.66- 3.03) per 1000 admissions/y and 3.54 (95%CI = 3.19-3.92) per 10 000 patient- days/y. Estimated rates for CDI with onset in ICU or IM wards were 11.08 (95%CI = 7.19-17.08) and 10.80 (95%CI = 3.15-37.06) per 1000 admission/ y, respectively. Rates for CA-CDI were lower: 0.55 (95%CI = 0.13- 2.37) per 1000 admissions/y. CDI rates were generally higher in North America and among the elderly but similar rates were identified in other regions and age groups.Conclusions: Our review highlights the widespread burden of disease of C. difficile, evidence gaps, and the need for sustainable surveillance of CDI in the health care setting and the community.</p

Underwritten Voices: Resonant Spaces and Unsound Silences in Dani Zelko, Soraya Maico&ntilde;o, and Daniela Catrileo

ABSTRACT: This article reflects on how twenty-first century Mapuche writers Daniela Catrileo and Soraya Maicoño upend notions of “silence” as corresponding to emptiness or absence through their experiments with poetic form. I begin by examining patterns and forms of silence and silencing in Mapuche poetry, mainly in dialogue with the poet Liliana Ancalao, as well as Mapudungun’s polyphonous conception of a “language” or “poetics” of the land that destabilizes colonial modes of listening, voicing, and sense-making. I then analyze the poetics of the line break, as well as the notion of poetic “white space,” as contesting narratives that attempt to silence and make invisible Mapuche communities through settler colonial frameworks. I finally evaluate the relationship between form, the caesura or the line break, and silencing or absence in two recent works: Pewma Ull: El sueño del sonido by Soraya Maicoño and Dani Zelko, and Río herido by Daniela Catrileo. Through a notion I term “underwriting,” I posit that these poets politicize form and blankness in order to not only make resonant Mapuche voices that have been previously construed as silent and absent by the settler state, but to propose alternative and active conceptualizations of “silence” as poetic modes of theorizing notions of mourning, restitution, and justice under settler colonialism. Keywords: Mapuche poetry, comparative Indigenous poetics, voice, silence, Daniela Catrileo, Soraya Maicoño, Dani Zelko   RESUMEN: Este artículo reflexiona sobre cómo las escritoras mapuches del siglo XXI Daniela Catrileo y Soraya Maicoño cuestionan la noción de “silencio” como sinónimo de vacío o ausencia a través de sus experimentos con la forma poética. En primer lugar, reviso patrones y formas de silencio y silenciamiento en la poesía mapuche, especialmente en diálogo con la poetisa Liliana Ancalao, así como la concepción polifónica del mapudungun de una “lengua” o “poética” de la tierra que desestabiliza los modos coloniales de escucha, voz y creación de sentido. A continuación, analizo la poética de la cesura y la noción de “espacio poético en blanco”, como narrativas contestatarias a procesos y sistemas coloniales que intentan silenciar e invisibilizar a las comunidades mapuches. Por último, evalúo la relación entre la forma, la cesura o el salto de línea y el silenciamiento o la ausencia en dos obras recientes: Pewma Ull: El sueño del sonido, de Soraya Maicoño y Dani Zelko, y Río herido, de Daniela Catrileo. A través de un concepto que llamo “sub-scripción” (underwriting), propongo que estos poetas politizan la forma y la opacidad no sólo para hacer que resuenen las voces mapuches que han sido previamente interpretadas como silenciosas y ausentes por el Estado colonizador, sino también para proponer conceptualizaciones alternativas y activas del “silencio” como modos poéticos de teorizar las nociones de duelo, restitución, y justicia bajo el colonialismo del asentamiento. Palabras clave: Poesía mapuche, poéticas Indígenas comparadas, voz, silencio, Daniela Catrileo, Soraya Maicoño, Dani Zelko

The Transition to IVUS-Guided IVC Filter Deployment in the Nontrauma Patient

While prior reports have demonstrated intravascular ultrasound (IVUS)-guided inferior vena cava filter (IVCF) deployment to be feasible, larger reviews using the latest generation of filters in the nontrauma setting are absent. We review our experience with the deployment of 104 IVCFs using IVUS, whereby we transition from a combined use of IVUS with traditional road mapping techniques (venography and/or renal vein cannulation) to the sole use of the IVUS as the road mapping tool for IVCF insertion. The use of IVUS for IVCF deployment minimizes radiation exposure to patients and staff, minimizes patient contrast exposure, and minimizes dependency on auxiliary staff for fluoroscopy. Intravascular ultrasound IVCF deployments can be performed without increasing morbidity and mortality, case duration, or overall costs when compared to standard deployments. The learning curve for transitioning into the use of the IVUS as the primary road mapping tool for IVCF deployments is approximately 20 cases. </jats:p

Initial systolic blood pressure and ongoing internal bleeding following torso trauma

<b>Objective</b> : Recent studies have suggested that an initial systolic blood pressure (SBP) in the range of 90-110 mmHg in a trauma patient may be indicative of hypoperfusion and is associated with poor patient outcome. However, the use of initial SBP as a surrogate for predicting internal bleeding is yet to be validated. The purpose of this study was to assess the presenting SBPs in patients with torso trauma and evidence of ongoing internal hemorrhage. <b>Setting and Design</b> : This was a retrospective chart review conducted at the Level II Trauma Center. <b>Materials and Methods</b> : Adult patients who sustained trauma and underwent chest and/or abdominal computed tomography (CT) scans and angiography were included in the study. Demographic and clinical information was extracted from patients who had CT scan and angiography. Extravasation of contrast material on CT scan and angiography was considered positive for ongoing internal bleeding. <b>Results</b> : From January 2002 through July 2007, a total of 113 consecutive patients were included in this study. Forty-seven patients had evidence of ongoing internal bleeding (41.6&#x0025;; 95&#x0025; confidence interval: 32.4&#x0025;, 51.2&#x0025;). When comparing patients with and without ongoing bleeding, these two groups were similar in their gender, race, pulse, injury severity score and shock index. However, bleeding patients were typically older [mean (standard deviation): 44.5 (20.5) <i>vs</i> 37.3 (19.1) years; <i>P</i> = 0.051], had a lower initial SBP [116.2 (36.0) <i>vs</i> 130.0 (30.4) mmHg; <i>P</i> = 0.006] and had a higher Glasgow coma scale (GCS) [13.1 (4.0) <i>vs</i> 12.1 (4.4); <i>P</i> = 0.09]. From a multivariate logistic regression analysis, older age (<i>P</i> = 0.046) and lower SBP (<i>P</i> = 0.01) were significantly associated with bleeding, when controlled for gender, race and GCS. Among the 47 patients with ongoing bleeding, only seven patients (15&#x0025;) had a SBP lower than 90 mmHg and 25 patients (53&#x0025;) had a SBP higher than or equal to 120 mmHg. The spleen was the most frequently injured organ identified with active bleeding. <b>Conclusions</b> : Initial SBP cannot predict the ongoing internal bleeding