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"Whiting, Sarah"
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Nocardiosis in the Tropical Northern Territory of Australia, 1997–2014
Background
Nocardia is an opportunistic pathogen that can cause life-threatening disease. We aimed to characterize the epidemiological, microbiological, and clinical features of nocardiosis in the tropical north of Australia.MethodsWe conducted a retrospective cohort study of nocardiosis diagnosed between 1997 and 2014. Population-based incidences were calculated using district population data.ResultsClinically significant nocardiosis was identified in 61 patients. The unadjusted population-based annual incidence of nocardiosis was 2.02 (95% confidence interval [CI], 1.55–2.60) per 100000 people and was 1.7 (95% CI, .96–2.90) fold higher in Indigenous compared with non-Indigenous persons (P = .027). Of 61 patients, 47 (77%) had chronic lung disease, diabetes, and/or hazardous alcohol consumption; 22 (36%) were immunocompromised; and 8 (13%) had no identified comorbidities. Disease presentations included pulmonary (69%; 42 of 61), cutaneous (13%; 8 of 61), and disseminated nocardiosis (15%; 9 of 61). The most commonly identified species were Nocardia asteroides and Nocardia cyriacigeorgica (each 11%). Linezolid was the only antimicrobial to which isolates were universally susceptible; 89% (48 of 54), 60% (32 of 53), and 48% (26 of 54) of isolates were susceptible to trimethoprim-sulfamethoxazole, ceftriaxone, and imipenem, respectively. Eighteen patients (30%) required intensive care unit (ICU) admission, and 1-year mortality was 31%.ConclusionsThe incidence of nocardiosis in tropical Australia is amongst the highest reported globally. Nocardiosis occurs in both immunocompromised and immunocompetent hosts, and it is associated with high rates of ICU admission, 1-year mortality, and resistance to commonly recommended antimicrobials. Diagnosis should be considered in patients with consistent clinical features, particularly if they are Indigenous or have chronic lung disease.
Journal Article
“Even the Birds Got More Out of Her Than I Did”: Wrecking and Constructive Memory in Key West, Florida
This thesis investigates the creative nature of memory at work in coastal city of Key West, Florida. Using the commemoration of the wreckers as a medium, I argue that the memory of wreckers is based on fictional maritime literature from the nineteenth century. The basis of the collective memory of wreckers in Key West from maritime fiction affects the way that the residents define themselves. Through embracing the fictional wrecker past that the monument to the wreckers represents, the residents of Key West embody their Conch identity. Thus, collective memory in this city works as a creative vehicle and shows that storytelling is what makes us.The thesis begins by giving an overview of the monument called The Wreckers, by sculptor James Mastin and its location. Next, it discusses the historiography of commemoration to situate the monument and this essay within the discussion of the meaning and purpose of monuments in public spaces. The second aspect of this thesis investigates nineteenth-century wreckers and the secondary scholarship that investigates them. Finally, the last section looks into nineteenth-century maritime fiction about wreckers and pirates. Through looking more closely at such fiction, specifically Richard Meade Bache’s The Young Wrecker of the Florida Reef, I argue that the symbolic imagery employed by Mastin in his 1997 monument found inspiration in Bache’s fictional novel.
Dissertation
The spread of coronavirus disease 2019 (COVID-19) via staff work and household networks in residential aged-care services in Victoria, Australia, May–October 2020
Objective:Morbidity and mortality from coronavirus disease 2019 (COVID-19) have been significant among elderly residents of residential aged-care services (RACS). To prevent incursions of COVID-19 in RACS in Australia, visitors were banned and aged-care workers were encouraged to work at a single site. We conducted a review of case notes and a social network analysis to understand how workplace and social networks enabled the spread of severe acute respiratory coronavirus virus 2 (SARS-CoV-2) among RACS.Design:Retrospective outbreak review.Setting and participants:Staff involved in COVID-19 outbreaks in RACS in Victoria, Australia, May–October 2020.Methods:The Victorian Department of Health COVID-19 case and contact data were reviewed to construct 2 social networks: (1) a work network connecting RACS through workers and (2) a household network connecting to RACS through households. Probable index cases were reviewed to estimate the number and size (number of resident cases and deaths) of outbreaks likely initiated by multisite work versus transmission via households.Results:Among 2,033 cases linked to an outbreak as staff, 91 (4.5%) were multisite staff cases. Forty-three outbreaks were attributed to multisite work and 35 were deemed potentially preventable had staff worked at a single site. In addition, 99 staff cases were linked to another RACS outbreak through their household contacts, and 21 outbreaks were attributed to staff–household transmission.Conclusions:Limiting worker mobility through single-site policies could reduce the chances of SARS-CoV-2 spreading from one RACS to another. However, initiatives that reduce the chance of transmission via household networks would also be needed.
Journal Article
