Individuals with and acquired brain injury (ABI) often experience low motivation to engage in rehabilitation. However, measures of motivation and engagement in ABI populations are scarce. Currently, four such measures exist: the Brain Injury Rehabilitation Trust Motivation Questionnaire-Self (BMQ-S), the Motivation for Traumatic Brain Injury Rehabilitation Questionnaire (MOT-Q), the BMQ-Relative (BMQ-R), and the Rehabilitation Therapy Engagement Scale (RTES), but are without sufficient psychometric investigations and lack a theoretical framework. The purpose of this thesis was to evaluate the psychometric properties of the BMQ-S, MOT-Q, BMQ-R, and RTES in adults with an ABI, and to discuss how motivation theory can inform assessment of motivation in ABI. Thirty-nine adult ABI participants and 20 clinicians were recruited from an ABI rehabilitation program. Patient participants completed the BMQ-S, the MOT-Q, and self-rated measures of insight, apathy, depression, and anxiety. Clinician participants completed the BMQ-R, the RTES, and clinician-rated measures of insight and apathy. The MOT-Q and the BMQ-S had excellent internal consistency and test-retest reliability. The MOT-Q correlated with insight, while the BMQ-S correlated with apathy, depression, anxiety, and insight. The MOT-Q and the BMQ-S did not correlate with each other. The RTES and BMQ-R had excellent internal consistency and good inter-rater reliability. The RTES and the BMQ-R correlated with apathy and insight, and with each other. In light of the result that the BMQ-S and the MOT-Q did not correlate, it was determined that each measure may represent equally important but distinct aspects of motivation. By drawing upon Self-determination Theory, it was concluded that the BMQ-S and the MOT-Q may represent intrinsic and extrinsic motivation, respectively, and that utilizing both can provide a more comprehensive understanding of what factors are influencing a patient’s level of motivation to engage. / Thesis / Master of Science (MSc) / Low motivation to engage in rehabilitation is a common problem in acquired brain injury (ABI) populations. Four current measures of patient and clinician-rated motivation and engagement designed for ABI exist: the Brain Injury Rehabilitation Trust Motivation Questionnaire-Self (BMQ-S), the Motivation for Traumatic Brain Injury Rehabilitation Questionnaire (MOT-Q), the BMQ-Relative (BMQ-R), and the Rehabilitation Therapy Engagement Scale (RTES). However, these measures have insufficient investigations into whether they accurately measure motivation, and lack a theoretical framework as a basis of assessment. The goal of this thesis was to determine the reliability and validity of four motivation and engagement measures in an ABI population, and discuss the role of motivation theory in improving assessment of motivation in ABI. The results of this thesis suggest that all measures have good to excellent reliability and validity, and that the BMQ-S and the MOT-Q may represent distinct but equally important aspects of motivation in ABI.

Staphylococcus aureus is one of the most important pathogens both in community- or hospital-acquired infections. The first part of this study analyzed the similarity of molecular types of S. aureus isolates cultured from nares and blood in patients with S. aureus bacteremia (SAB) by pulse-fielded gel electrophoresis (PFGE) of digested chromosomal DNA by Sma I at Kaohsiung Veterans General Hospital from August 1, 2000 through July 31, 2001. The results showed that the PFGE types of 78 (82.1%) paired nare and blood isolates of the 95 SAB patients having nasal carriage of S. aureus were clonally identical; identical in 89.7% patients of nosocomial group and 62.9% in community-acquired group. This provides the powerful evidence in close relationship between nasal carriage of S. aureus and acquisition of it in bacteremia. The data also showed that the rate of methicillin resistance occurred in SAB patients with nasal carriage in isolates of nosocomial SAB was 85.3%, and 31.3% in community-acquired group. The second part of this study analyzed the distribution of PFGE types of 163 nosocomial SAB isolates. The most predominant type was type A and composed 51.5% (84 strains) of 163 nosocomial SAB isolates. They were further divided into 7 subtypes. The second prevailing type was type B, 6.1%(10 strains). The evidence that an endemic stain (type A) occurred in >50% of nosocomial bacteremic isolates demonstrates horizontal dissemination of a single endemic strain of S. aureus in the SAB patients was common in the hospital. These results provide support for strategies to endorse more intensive procedures in infection control and to prevent systemic S. aureus infections by eliminating S. aureus nasal carriage.

Staphylococcus aureus is a bacterial pathogen that is believed to be the most common agent of human infectious disease, causing conditions ranging from common skin lesions to life-threatening illnesses. S. aureus has also shown a remarkable ability to develop resistance to antimicrobial treatment, making infections difficult to treat. In the post-genomic era, proteomic studies analyzing the protein complement of a genome in a particular organism at any given time, have gained real significance. This result is largely due to dynamic changes in protein expression profiles which can lead wide alterations in physiology and behavior. For proteomics, it is necessary to maximize protein concentration and to devise a method that can be easily employed and provide reproducible results. Most proteomic studies of S. aureus involve 2D gel electrophoresis (2-DE); however, 2-DE has many drawbacks. Proteins that are too large, hydrophobic, acidic, or basic are poorly resolved. Multi-dimensional protein identification (MudPIT) allows complex protein samples to be analyzed in solution. As yet, there has not been a study involving solely 2D liquid chromatography followed by mass spectrometric analysis in S. aureus ; therefore we sought to catalogue the intracellular proteome and secretome of a commonly used and well-studied lab strain, SH1000. This was conducted during post-exponential and stationary phases of growth so as to understand its adaptation over time by utilizing differential protein synthesis. We found cytoplasmic proteins involved in glycolysis to be highly expressed in post-exponential phase while proteins involved in tricarboxylic acid cycle to be prevalent in stationary phase. We also found production of agr-regulated secreted toxins and proteases to be upregulated in stationary phase. In addition to this we employed proteomic approaches to quantitatively profile the secretomes of leading clinical isolates of S. aureus, as such a study is currently lacking. These included the two most common hospital-associated S. aureus strains (USA100 and USA200), and the two most common community-associated S. aureus strains (USA300 and USA400). We found agr-regulated proteins are generally upregulated in CA-MRSA strains USA300 and USA400 and surface-associated proteins to be upregulated in HA-MRSA strains USA100 and USA200. This finding concurs with literature regarding transcriptomic studies showing a hyperactive agr in CA-MRSA strains compared to HA-MRSA strains.

Lic. -avh. (sammanfattning) Stockholm : Karolinska institutet, 2007. / Härtill 2 uppsatser.

Thesis (M.A.)--Deakin University, 1992. / Includes bibliographical references (leaves 122-133).

The purpose of this thesis is to explore the changes to family dynamics that result from invisible symptoms of acquired brain injury The perspective put forth is that of individuals living with invisible symptoms of acquired brain injury. This study is based on a thematic analysis of the findings from nine semi-structured interviews with individuals (aged 24-64 yrs.; 6 men, 3 women) who have been formally diagnosed with an acquired brain injury. The data is interpreted and discussed using a critical framework, specifically, Critical Disability Theory. The findings from this analysis illustrate how invisible symptoms such as cognitive impairments, memory loss, mood changes etc., of acquired brain injury affect family dynamics in relation to emotional roles, domestic roles, financial roles, and perception and treatment of the affected individual. These changes were either exacerbated or minimized by the assumptions, misconceptions and knowledge level of the individual’s family in relation to understanding brain injury and the ways in which disability can manifest. Also important to family relations are the perceptions of participants that they must prove that they do have a disability; the roles healthcare professionals play in the validation of the injuries, both to the individual and the family; and how powerfully dominant constructions of disability – and invisible acquired brain injury in particular – are ingrained in social discourse and impact upon family dynamics for people living with invisible acquired brain injury. Lastly, an important part of this research is a compilation of recommendations put forth by the participants for healthcare professionals to keep in mind when working with individuals who either are suspected of having or have an acquired brain injury. / Thesis / Master of Social Work (MSW)

Problem detection is a critical component in nursing, such that superior detection could lead to quicker intervention, even if the nature of the problem is not yet clear. A critical problem intensive care nurses typically engage in is detecting the threat of an impending hospital-acquired infection. The purpose of this study was to investigate the effects of the presence of risk factors, expertise, and time pressure on problem detection. The results suggested that time pressure seemed to have a detrimental effect on problem detection, and nurses benefitted from the presence of more risk factors. When not under time pressure, nurses were more sensitive in their problem detection judgments, and only needed one risk factor to trigger problem detection. Experienced nurses were more sensitive to the type of infection at detection, and were more likely to identify the problem correctly after information had been accumulated. These results suggest that problem detection was differentially affected by risk factors based on the presence or absence of time pressure. In addition, experienced nurses took a different approach to problem detection when compared to novices. Finally, problem detection and problem identification can in some situations occur simultaneously, but are distinct processes.

Clostridium difficile infection (CDI) has proven to be a constantly evolving disease periodically posing new diagnostic and clinical dilemmas. Different regions of the world have reported specific local genomic characteristics of the infecting strains, which may be related to variation in disease presentation and outcome. This study was performed to determine the clinical and molecular features of severe, recurrent and community-associated disease in the Lothian region of Scotland, UK among patients diagnosed from August 2010-July 2011. Three hundred and thirty-five patients with laboratory confirmed CDI were studied for epidemiological features, clinical presentation, and laboratory markers. They were followed up for one year to determine recurrence and mortality. Four hundred and thirty-two episodes were recorded. Ribotypes, presence of toxin genes and MLVA subtypes of isolates from these episodes were determined. During the course of the study, PCR ribotype 078 was identified as an important emerging type and concerns of “hypervirulence” were raised when an outbreak was recorded in 2012. This ribotype was studied to compare its clinical and molecular characteristics with other endemic ribotypes and between its own outbreak-related and endemic subtypes. Asymptomatic children were also sampled to determine their role as pools of potential pathogens. Severe episodes accounted for 40.4% of total and 29.3% patients had multiple episodes on record. One-year mortality was 32.8% of which CDI was listed on 25.5% death certificates. Ribotype 078 was confirmed in 6.8% episodes. Community-associated disease was identified in 25.3% patients, which differed significantly from hospital-associated disease in the number of antibiotics and gastrointestinal manipulation prior to CDI. Endemic PCR ribotype 078 caused significantly less recurrent disease and more community- associated disease when compared to the most prevalent ribotype 001. Patients who died from ribotype 078 within 30d had a lower Charlson comorbidity index than ribotype 001 counterparts suggesting that the former may infect healthier patients. MLVA subtyping of ribotype 078 proved useful in identifying epidemiological relationships during the outbreak. CDI had contributed to the death of 50% of all patients infected with the outbreak related ribotype 078 strain compared to 14.3% of those infected with the endemic strains. This study documents the changing epidemiology of CDI in the region and demonstrates differences in epidemic and endemic disease.

Ever since the seminal Marienthal studies during the Great Depression of the 1930s, studies have linked employment to health and well-being of individuals. However, employment participation for people living with HIV (PLHIV) may not necessarily provide positive health outcomes given negative social responses to HIV infection, particularly stigma and discrimination. Using causal steps approach, the study examines the extent to which the linkage between formal employment status and health-related quality of life is affected by both social capital and HIV-related stigma among PLHIV. Quantitative data were obtained from 554 male and female adults on HIV treatment for at least two years in South Africa. Health-related quality of life (HRQoL) was measured using the validated Medical Outcomes Short Form (SF-36) (Quality Metric, USA) and is represented by physical and mental component summary scores. Formally employed study participants experienced superior HRQoL in comparison to those not formally employed. Both employment status and physical and mental component summary scores were unrelated to objective measures of HIV disease status – CD4 count and viral load. Levels of social capital did not vary significantly by formal employment status. Perceived HIV-related stigma was significantly lower among formally employed study participants than those who were not formally employed, but only in the dimension of personalised stigma, after controlling for potential confounders. Social capital indicators were significantly positively associated with mental but were unrelated to physical component summary scores. All HIV-related stigma scale scores were inversely associated with social capital indicators and with physical and mental component summary scores, after controlling for potential confounders. These results provide little support for mediation of the relationship between formal employment status and HRQoL among PLHIV by social capital and HIV-related stigma. Both social capital and HIV-related stigma have independent relevance to, but formal employment accounts for the largest effect on the health and well-being of PLHIV.

It is important to realize that guidelines cannot always account for individual variation among patients. They are not intended to supplant physician judgment with respect to particular patients or special clinical situations. Infectious Diseases Society of America considers adherence to these guidelines to be voluntary, with the ultimate determination regarding their application to be made by the physician in the light of each patient's individual circumstances. Coccidioidomycosis, also known as San Joaquin Valley fever, is a systemic infection endemic to parts of the southwestern United States and elsewhere in the Western Hemisphere. Residence in and recent travel to these areas are critical elements for the accurate recognition of patients who develop this infection. In this practice guideline, we have organized our recommendations to address actionable questions concerning the entire spectrum of clinical syndromes. These can range from initial pulmonary infection, which eventually resolves whether or not antifungal therapy is administered, to a variety of pulmonary and extrapulmonary complications. Additional recommendations address management of coccidioidomycosis occurring for special at-risk populations. Finally, preemptive management strategies are outlined in certain at-risk populations and after unintentional laboratory exposure.