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dreaminginthedeepsouth · 6 months

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LETTERS FROM AN AMERICAN

October 16, 2023

HEATHER COX RICHARDSON

This morning, the Justice Department announced that the United States has reached a settlement with the plaintiffs in the case of Ms. L. v. U.S. Immigration and Customs Enforcement, a class action lawsuit filed in 2018 over the Trump administration's policy of separating parents and children at the southwest border to deter migrants. That policy, implemented in 2017 and 2018, resulted in more than 5,500 children being separated from their parents.

In 2018 a judge ordered the families reunited, but it turned out the Trump administration had not kept records of the family members. As soon as he took office, President Joe Biden appointed a task force to accomplish the reunifications, but 85 children are still separated from their families. The task force also found that 290 of the children removed from their parents were U.S. citizens.

The lawsuit charged that the policy broke a number of U.S. laws—seeking asylum is legal, and taking children away from their parents without cause is not—and the settlement seeks both to heal the victims of the policy and to make sure it never happens again. The affected families will have a different process for applying for asylum than other migrants and will have access to benefits such as work authorization, possible housing assistance, immigration lawyers, and mental health care to address the trauma of the separations, and the government will agree not to turn back to such a policy in the future.

“The separation of families at our southern border was a betrayal of our nation’s values,” said Associate Attorney General Vanita Gupta. “By providing services to these families and implementing policies to prevent future separations, today’s agreement addresses the impacts of those separations and helps ensure that nothing like this happens again.”

The judge will need to approve the settlement.

MAGA Republicans seem unconcerned with what the law says. Indeed, they have been working hard to discredit the law in order to protect former president Trump, attacking the Department of Justice and the Federal Bureau of Investigation. After Trump has publicly attacked prosecutors and witnesses in the case over his attempt to overturn the results of the 2020 election, Judge Tanya Chutkan today prohibited him from such attacks on the court’s staff, witnesses, testimony, and prosecutors.

Last week, Representative Jim Jordan (R-OH) called for shutting down the government in November unless Democrats agree to cutting all spending for processing or releasing into the country any new migrants. He says the demand is “non-negotiable.” But U.S. and international law require the U.S. to process asylum requests, even if a migrant arrives in between legal points of entry.

Former senior Department of Homeland Security lawyer Tom Jawetz told Greg Sargent of the Washington Post that Jordan’s plan “would be both illegal and a practical impossibility.” Administration officials “are legally obligated to process people for asylum on request,” he said. “It’s not a choice.”

But therein lies the heart of today’s Republican Party: its extremist leaders no longer believe that rules apply to them. Jordan, a staunch ally of Trump, was key to the former president’s efforts to steal the 2020 presidential election. He is now gathering votes for a bid to become the speaker of the House of Representatives after the MAGA extremists threw former House speaker Kevin McCarthy out.

In 2017, former Republican House speaker John Boehner told journalist Tim Alberta: “Jordan was a terrorist as a legislator going back to his days in the Ohio House and Senate…. A terrorist. A legislative terrorist.” In 2021, he clarified: “I just never saw a guy who spent more time tearing things apart—never building anything, never putting anything together.”

After a secret ballot showed that 55 of his colleagues would not support him in a floor vote, Jordan has insisted on a public vote, putting his colleagues under pressure to support him and thus to support Trump. They are caving, one at a time.

But Representative Don Bacon (R-NE) called out the MAGA group that revolted repeatedly against the Republican conference and now is demanding Republican unity for the unpopular Jordan, forcing the party to fully embrace Trump. “I can’t abide by the fact a small group violated the rules to get what they wanted [and] now I’m supposed to play by the rules,” Bacon said. “I think we’ve got to have consequences, and you’ve got to stand up for this. That’s what Americans do.”

We used to be able to assume that Americans did, in fact, play by the rules, accepting the principle of the rule of law. That principle is now openly challenged here in the U.S.

That principle is also at stake around the world. In a piece in The Atlantic on October 9, foreign policy journalist Anne Applebaum noted the fragility of the rules-based international order, a system of norms and values established after World War II in an attempt to create a system for resolving international disputes, preventing territorial wars, and ending no-holds-barred slaughter.

A series of agreements, including the United Nations Charter, the Universal Declaration of Human Rights, the U.N. Genocide Convention, and the Geneva Conventions on the laws of war established those rules, and while they have often been flouted, they offered grounds for challenging those nations and military personnel who broke them.

Applebaum pointed out that Russia’s invasion of Ukraine and the attack by Hamas on Israeli civilians “are both blatant rejections of that rules-based world order, and they herald something new. Both aggressors have deployed a sophisticated, militarized, modern form of terrorism, and they do not feel apologetic or embarrassed about this at all.” They feel justified in ignoring the rules-based international order and sowing terror and chaos among civilians.

Their “goal is to undo whatever remains of the rules-based world order, and to put anarchy in its place. They did not hide their war crimes. Instead, they filmed them and circulated the videos online.” Applebaum suggests “we might miss the Geneva Conventions when they are gone.”

Biden, Vice President Kamala Harris, and Secretary of State Antony Blinken have made no secret of their determination to strengthen the rules-based international order, and tonight the White House announced that Biden will travel on Wednesday to the Middle East, where he will visit Israel before traveling to Jordan, where he will meet with the country’s leader King Abdullah II, Egyptian president Abdel Fattah El-Sisi, and Palestinian Authority president Mahmoud Abbas.

We might miss the idea of the rule of law here at home if we continue to empower MAGA Republicans. Voters in Poland missed it, and yesterday 73% of them turned out to oust from power the nationalist-conservative party that, Anne Applebaum notes in a different Atlantic article, “turned state television into a propaganda tube, used state companies to fund its political campaigns,… politicized state administration[,]… altered electoral laws and even leaked top-secret military documents, manipulating their contents for electoral gain.”

Opponents of the ruling party, which took power in 2015, came together in a coalition that rejected angry nationalism in favor of civic patriotism, met in demonstrations around the country, featured women prominently in their campaigns, promised to end Poland’s strong abortion restrictions, and offered closer cooperation with Europe.

Rebuilding democracy will be neither fast nor easy, Applebaum notes, but “Poland shows that autocracy is not inevitable.”

—

LETTERS FROM AN AMERICAN

HEATHER COX RICHARDSON

#Letters From An American #Heather Cox Richardson #Poland #Israel #rule of law #US House of Representatives

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10minus6cosm · 2 months

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RCPA microbiology training – resources and notes (Part 1)

Our trainee Shireen recently passed her Royal College of Pathologists of Australasia Examination. She was invited to share her exam preparation strategy for the benefit of our other trainees.

Disclaimer

This document is based on my personal experience and what worked well for me to get me through the exams. Everyone’s experience will be different and what worked for me may not work so well for someone else (and vice versa)!

This is also not comprehensive and is just my attempt to cobble together a list of the resources that I used or found particularly helpful. There are also many other resources beyond the ones listed here!

Where possible I have tried to include links to various websites but please use the links at your own discretion.

It is also important to know your lab protocols well and know how the lab works.

Lastly don’t forget to go through the RCPA microbiology trainee handbook and the administrative requirements handbook!

General notes on exam preparation

Study tools

Anki flash cards – I am happy to share my Anki deck (with disclaimers)

I created my own Anki deck and slowly added to it over the course of about 3 years – had approximately 2400 cards by the time I took my Part II exam.

Every time I came across a new fact or something that I felt I needed to remember I would put the information into a flash card.

Anki has the advantage of being easily searchable, so the flash cards I made doubled as my study notes.

Anki syncs across all of my devices, so I created flash cards on my laptop and went through flash cards on my phone whenever I had a pocket of time (walking to/from the MRT, walking in the park, waiting for people).

Overall I found this an excellent tool to get my brain to remember microbiology trivia.

Study group

Having a study group made a massive difference to exam prep for me – I cannot overemphasise how helpful having one was!

Probably a good time to find a study group would be around a year before the Part I exam.

Question banks (not RCPA exam specific)

ID/micro MCQ book https://www.amazon.co.uk/Infectious-Diseases-Microbiology-Virology-Specialist/dp/1316609715/ - I went through this book before FRCPath I.

Jawetz has nice end of chapter MCQs.

Past year questions and question banks (RCPA exam specific)

RCPA question banks – RCPA publishes Part I Paper A questions for the last few years on the RCPA website

Ask your seniors if they have more questions – for example my study group made up practice questions for each other and therefore we have an additional self-generated question bank.

If I were to go back in time to about 1-1.5 years before my Part I, my approach would be to look through past year questions early to get a good idea of what sort of questions are being asked. Do as many practice questions as possible. Then see if can answer the questions for other similar organisms/illnesses too…

Start of training

I went through these books cover to cover. This is the approximate order in which I’d read these books, and I’d probably aim to finish these books in the first year or so of training

Book reviews

Clinical microbiology made ridiculously simple https://www.amazon.sg/Clinical-Microbiology-Made-Ridiculously-Simple-dp-1935660500/dp/1935660500/ This is a book targeted as medical students (I think) but I found this a great read at the start of training to get an overview and learn some mnemonics and ways to remember things that have stuck with me. Can get through this book fairly quickly!

Comprehensive review of infectious diseases https://www.amazon.com/Comprehensive-Review-Infectious-Diseases-Andrej/dp/0323568661/ Great introduction to ID and microbiology, but use with caution and some things may be different for our local setting/Australia

Murray (I used the 8th edition, updated edition is https://www.amazon.sg/Medical-Microbiology-Patrick-R-Murray/dp/) and/or Jawetz https://www.amazon.sg/Jawetz-Melnick-Adelbergs-Medical-Microbiology/dp/1260012026/ Both are undergraduate microbiology textbooks that cover fairly similar content at a fairly similar level. I read through both and preferred Murray for reading/learning, but liked the end of chapter MCQs in Jawetz.

Color Atlas of Medical Bacteriology (review is for third edition, updated edition is https://www.amazon.sg/Color-Atlas-Medical-Bacteriology-Luis/dp/1683670353/) Lots of nice pictures that show a lot of the bacterial isolates and biochemical reactions you need to become familiar with in the lab. Text also quite helpful as an introduction to each group of bacteria Fast facts bacteria chapter at the back is also very nice for quick reference/learning.

Part I preparation

Book reviews

Oxford handbook of Infectious Diseases and Microbiology https://www.amazon.sg/Oxford-Handbook-Infectious-Diseases-Microbiology/dp/019967132X/ This is unfortunately getting a bit dated now (2016), and is UK-based so some guidelines/methods are different from what we do here/in Australia. Can be a little dry (as it contains a lot of facts), but it has very nice chapters covering antimicrobials (sadly a bit outdated now) and infection control that can be read as introductions to these topics. Part 3 systematic microbiology contains many of the important organisms you need to know about by the time you take RCPA Part I. (Note this is not a comprehensive list, see the section on “list of organisms/infections to know” below.) The "smaller print" organisms that have come out before in Paper A include leishmaniasis and BK virus, which are both covered in this section Part 4 clinical syndromes is useful to put microbiology in context, and is also useful for the RCPA Part I/II vivas which I found more clinical than the written/practical.

Koneman https://www.amazon.sg/Konemans-Color-Textbook-Diagnostic-Microbiology/dp/1284322378/ Unfortunately, this edition is also getting a bit dated (2016). Extremely intimidating the first time I saw this book. Gets better once you read a bit through it and realise what are the important things you need to know (mostly at the start/end of chapters that talk about introductions to the various groups of organisms and microbiology techniques) and what are the less important stuff that is OK to read and forget. Definitely read through the introduction chapters as these are basics of microbiology! Chapter 3/4 on immunological and molecular methods - good to read through, but I preferred the chapters in MCM. Bacteriology - a lot of information, including a lot of organisms that you do not need to remember for exams (e.g. one of my favourite organisms I came across in this book was Staphylococcus condimenti which is found in soy sauce - but not really an organism you need to remember for exams!). It is however useful to know that the lists of endless corynebacteria and identification tables exist to be able to easily refer to them when you need to in daily practice. Mycology - this is less comprehensive than Larone, but I really liked reading through the section here as I found it gave me a very good introduction/overview to the topic. Essentially the fungi here are mostly "important" so it is good to know about what is mentioned here. Parasitology - same as mycology, I liked this section as it had a very good introduction/overview to the topic, and again the parasites here are mostly "important" Virology - afraid I can't comment on this as I don't remember much about the virology chapter here.

Larone's Medically Important Fungi https://www.amazon.sg/Larones-Medically-Important-Fungi-Identification/dp/1683674405/ Good textbook for mycology When reading through need to differentiate between important fungi and small print fungi Methods chapters are useful

Clinical Microbiology Procedures Handbook (I used the 4th edition, updated edition is https://www.amazon.sg/Clinical-Microbiology-Procedures-Handbook-Multi/dp/1683673980/) I read through sections of this book as I rotated through the labs (e.g. read the TB section when was in TB lab). Start and end of each section is particularly useful as gives introduction and interpretation information. Some parts of the 4th edition were a bit outdated by the time I read it - but there is a brand new 5th edition out now. I did read through quite a lot of this, and if time had permitted I would have liked to read through more of it before my Part I. Is also useful to be familiar with this as it's useful to easily reference it in practice.

Manual of clinical microbiology (I used the 11th edition, updated edition is https://www.amazon.sg/Manual-Clinical-Microbiology-Multi-Carroll/dp/1683674294/) I did not read the whole of this book! I used this book mostly for techniques (particularly liked the chapters on molecular and immunoassays) and as a reference when needed.

(Please note I am missing a good virology textbook here - this is because I already did a good amount of virology in my past and that together with other resources and guidelines was more than sufficient to get me through my exams. The virology textbook I used as a final year undergraduate >10 years ago was Flint's (updated version is https://www.amazon.sg/Principles-Virology-Multi-Jane-Flint/dp/1683670329/ which looks rather different from the version I used which was only a single volume) but this may be overly a basic science textbook. If you're not confident with basic virology it might be advisable to also find a good virology textbook.)

Websites and guidelines (Australian)

RCPA website

RCPA webinar series Watch all of these! Can be quite topical to current issues Quite a few topics covered in the series came out in my exams There are also a few webinars that are specifically for exam prep

Exam specific prep

Meet the examiner session from RCPA Path update – should be updated yearly https://www.rcpa.edu.au/Education/Disciplines/Microbiology/Exams/Examination-Advice

Past year exam questions

Optimise oral examination handbook (2022)

Additional quality management questions: https://www.rcpa.edu.au/Education/Laboratory-Management/Quality-Management/Docs/Quality-management-exam-questions-(1).aspx

Position statements, policies, guidelines I read most of these for Part I/II Some of these cover topics that came out in my exam Selective reporting of antimicrobials in Australia Modules - Ethics, Bullying/Harassment, Quality, etc Workshop slides Molecular Microbiology – the slides are uploaded every year, not too long after the workshop

Australia Department of Health and Aged Care website - www.health.gov.au

List of diseases that are notifiable or have vaccines https://www.health.gov.au/diseases

Links to PHLN laboratory case definitions and CDNA SONGS Communicable disease https://www.health.gov.au/health-topics/communicable-diseases

Can check for updates: Australian health documents https://www.health.gov.au/resources/publications Use filter: topics --> communicable diseases Can also use filters: Publication type --> case definition Publication type --> guideline CDNA guidelines https://www.health.gov.au/resources/collections/cdna-guidance-documents

State health departments Each state has information about specific diseases/infections that are of importance there, plus information about health alerts (links below under “list of organisms/infections to know”)

There are also some very nice guidelines on certain state websites

NSW department of health NSW disease control guidelines (a bit similar to the SoNGs, has things that are not in the SoNGs) https://www.health.nsw.gov.au/Infectious/controlguideline/Pages/default.aspx

Northern Territory department of health Quite a lot of specific disease guidelines including invasive group A streptococcus (and acute post strep glomerulonephritis), diphtheria, leprosy, malaria, NTM, syphilis)

Queensland department of health Really nice infection control guidelines Exposure to blood and body fluids Foodborne illness outbreak Healthcare worker vaccination MDRO Outbreak management

Perinatal infections Really important to know about perinatal infections and it came up quite a bit in my exams

ASID management of perinatal infections guidelines https://anzasid.sharepoint.com/sites/E-Knowledge/Shared%20Documents/Forms/AllItems.aspx?id=%2Fsites%2FE%2DKnowledge%2FShared%20Documents%2FANZPID%2FASID%20Management%20of%20Perinatal%20Infections%203rd%20Edition%2Epdf&parent=%2Fsites%2FE%2DKnowledge%2FShared%20Documents%2FANZPID&p=true&ga=1

Pregnancy care guidelines https://www.health.gov.au/resources/pregnancy-care-guidelines/table-of-contents Includes information on pregnancy and infections and screening https://www.health.gov.au/resources/pregnancy-care-guidelines/part-f-routine-maternal-health-tests/

ASHM - bloodborne viruses and sexually transmissible infections in antenatal care https://www.ashm.org.au/wp-content/uploads/2023/08/ASHM-BBVs-STIs-in-Antenatal-Care-Resource-2022.pdf

Immunisation

Immunisation handbook: https://immunisationhandbook.health.gov.au/vaccine-preventable-diseases

National immunisation programme schedule: https://www.health.gov.au/health-topics/immunisation/when-to-get-vaccinated/national-immunisation-program-schedule

More immunisation guidelines and info from NCIRS https://ncirs.org.au/health-professionals/ncirs-fact-sheets-faqs

National vaccine storage guidelines - Strive for 5 https://www.health.gov.au/resources/publications/national-vaccine-storage-guidelines-strive-for-5?language=en

National guidelines for yellow fever vaccination centres and providers (Australian Department of Health) https://www.health.gov.au/sites/default/files/2022-12/national-guidelines-for-yellow-fever-vaccination-centres-and-providers.pdf

NPAAC and NATA

May be useful to read through once before Part I. Definitely read through all the microbiology-relevant ones and know well before Part II

NPAAC standards https://www.safetyandquality.gov.au/our-work/accreditation/pathology-accreditation-standards NATA/RCPA accreditation https://nata.com.au/accreditation/medical-laboratory-accreditation-iso-15189/

HIV/HepB/HepC

Healthcare workers with blood borne viruses https://www.health.gov.au/resources/collections/cdna-national-guidelines-for-healthcare-workers-on-managing-bloodborne-viruses

Exposure prone and non-exposure prone procedures in Australia https://www.health.gov.au/sites/default/files/documents/2020/03/cdna-guidance-on-classification-of-exposure-prone-and-non-exposure-prone-procedures-in-australia-2017.pdf

NSW management of healthcare workers potentially exposed to HIV/HepB/HepC https://www1.health.nsw.gov.au/pds/Pages/doc.aspx?dn=PD2017_010

HIV

Australasian society for HIV, viral hepatitis and sexual health medicine (ASHM) and guidelines/resources: https://ashm.org.au/resources/

Testing Portal: https://testingportal.ashm.org.au

Antiretroviral guideline https://arv.ashm.org.au HIV care guide PrEP and PEP guidelines for HIV U=U guidance https://ashm.org.au/hiv/ https://www.ashm.org.au/hiv/hiv-management/ https://hivlegal.ashm.org.au/ (And there are probably many other guidelines!)

National HIV testing policy https://testingportal.ashm.org.au/files/ASHM_National%20HIVTestingPolicy_2020_HIV_.pdf

Hepatitis B

https://www.hepatitisb.org.au

https://www.gesa.org.au/public/13/files/Education%20%26%20Resources/Clinical%20Practice%20Resources/Hep%20B/HBV%20consensus%20Mar%202022%20Updated.pdf

National Hepatitis B testing policy https://testingportal.ashm.org.au/files/ASHM_TestingPolicy_2020_HepatitisB_07_2.pdf

Hepatitis C

https://www.hepcguidelines.org.au

National Hepatitis C testing policy https://testingportal.ashm.org.au/wp-content/uploads/2023/03/National_HepatitisC_Testing_Policy_v1-4_March_2023-v2.pdf

STI guidelines

Australian STI management guidelines for use in primary care:

https://sti.guidelines.org.au This has links to other guidelines

ASHM also has a lot of microsites https://contacttracing.ashm.org.au https://testingportal.ashm.org.au/ https://syphilisoutbreaktraining.com.au

Lifeblood (blood donation Australia) was an unexpectedly good resource for various infectious diseases

https://www.lifeblood.com.au/health-professionals/learn/resource-library

Filter for "factsheet" or search for "infectious" or search for "infections"

Should get a list of "transfusion focused infectious disease fact sheets" for a number of infections e.g. SARS-CoV-2, H5N1, Murray Valley Encephalitis Virus

These fact sheets are really nice as they summarise each infection including epidemiology in Australia, treatment, diagnosis, prevention Also useful for reading about transfusion associated infections!

Infection control and outbreak management

Australian guidelines for prevention and control of infection in healthcare https://www.safetyandquality.gov.au/sites/default/files/2023-09/australian_guidelines_for_the_prevention_and_control_of_infection_in_healthcare_current_version_v11.19_24_august_20232.pdf32.pdf

Outbreak management (Queensland guide) https://www.health.qld.gov.au/__data/assets/pdf_file/0025/444508/management-outbreaks.pdf

Infection control (Queensland) https://education.qld.gov.au/initiativesstrategies/Documents/infection-control-guideline.pdf

PHLN lab procedures and precautions for samples from patients with viral haemorrhagic fevers https://www.health.gov.au/resources/publications/phln-laboratory-procedures-and-precautions-for-samples-collected-from-patients-with-viral-haemorrhagic-fevers

Guidelines for legionella control https://www.health.gov.au/sites/default/files/documents/2022/07/enhealth-guidance-guidelines-for-legionella-control.pdf

Infectious diseases requiring additional precautions (NSW) https://aci.health.nsw.gov.au/__data/assets/pdf_file/0008/286838/ID_requiring_additional_control_precautions.pdf

GENCA/GESA guidelines on endoscope reprocessing https://www.genca.org/public/5/files/Nurses%20info/IPCE%202021_Feb2022update.pdf

RACGP infection prevention and control standards https://www.racgp.org.au/FSDEDEV/media/documents/Running%20a%20practice/Practice%20standards/Infection-prevention-and-control.pdf

Mycology

Mycology Adelaide https://www.adelaide.edu.au/mycology/ This was somewhat similar to Larone but is a good resource and is Australian

Additional useful guidelines and documents

Uptodate list of health hazards in travellers to Australia and NZ: https://www.uptodate.com/contents/potential-health-hazards-in-travelers-to-australia-new-zealand-and-the-southwestern-pacific-oceania

CARAlert organisms (critical antimicrobial resistances) https://www.safetyandquality.gov.au/our-work/antimicrobial-resistance/antimicrobial-use-and-resistance-australia-surveillance-system/national-alert-system-critical-antimicrobial-resistances-caralert

Australian Society for Microbiology - Guidelines for QC of microbiological culture media https://static1.squarespace.com/static/5c184125b98a781241e53ab6/t/5db2996892f5c03a7ff21a0f/1571985772520/Guidelines+for+the+Quality+Assurance+of+Medical+Microbiological+culture+media+2nd+edition+July+2012.pdf

Australian risk group organisms - I couldn't find a good resource for this! Some partial ones at https://cdn.csu.edu.au/__data/assets/pdf_file/0019/3283012/Biosafety-Manual-Booklet-3.pdf

Packaging and transport of infectious substances https://apps.who.int/iris/rest/bitstreams/1333766/retrieve#page17

Australian Refugee Health guide https://refugeehealthguide.org.au

List of Australian tests and diseases https://pathologytestsexplained.org.au

Infections disease transmission in solid organ transplantation https://tsanz.com.au/storage/documents/TSANZ-Infectious-Disease-review_Final_collated_edit.pdf

CDS https://cdstest.net – I found the resistance mechanisms explanations here very good

Websites and guidelines (non-Australian)

CLSI

M100 - I read this from cover to cover

Other CLSI documents that might be helpful include M35 abbrieviated identification of bacteria and yeast

M39 cumulative antibiogram

M45 ST of infrequently isolated or fastidious bacteria

M47 blood cultures - overlaps with the UK SMI and CMPH on blood cultures

M48 lab detection and ID of mycobacteria

M56 anaerobes

M58 MALDI

M62 ST of mycobacteria, Nocardia, other aerobic actinomycetes

MM03 molecular diagnostic methods for infectious diseases

MM09 nucleic acid sequencing methods

MM18 identification of bacteria and fungi by targeted DNA sequencing - basically 16S/ITS (And also other documents…)

EUCAST

Bacteria susceptibility testing document - useful to get some familiarity with this.

There are also a lot of helpful documents on the website that are good to read.

CDC

Infection control https://www.cdc.gov/infectioncontrol/index.html

CDC DPDx - lots of nice photos for parasites

CDC Yellow book https://wwwnc.cdc.gov/travel/yellowbook/2020/table-of-contents

Disinfection and sterilisation https://www.cdc.gov/infectioncontrol/guidelines/disinfection/index.html

CDC lab biosafety - biosafety in microbiological and biomedical laboratories (6th ed 2020)

Other useful resources

UK SMI

Cystic fibrosis lab guidelines https://www.cysticfibrosis.org.uk/sites/default/files/2020-12/Laboratory%20standards.pdf

European CDC website https://www.ecdc.europa.eu/en

IDSA guidelines https://www.idsociety.org/practice-guideline/alphabetical-guidelines/

APHL/ASM clinical lab preparedness and response guide https://www.aphl.org/aboutAPHL/publications/documents/WORK_BlueBook.pdf

Keeping up with current topics

Good to know about current topics in microbiology – this includes JCM etc for things like new methods, issues with testing, etc

Also look specifically for topics that are important in Australia Browse Australian news and see if there is anything that sounds important/likely E.g. Japanese encephalitis, mpox, flooding, black mould… If it has been reported in mainstream news and is related to infection it would be good to know about it!

National Notifiable Diseases Surveillance System (NNDSS) reports https://www.health.gov.au/resources/collections/nndss-fortnightly-reports - useful to get an idea of what is happening in Australia Each Australian state has their own site with health alerts – good to have a browse through to see if there is anything of particular interest.

NSW https://www.health.nsw.gov.au/Infectious/alerts/Pages/default.aspx

SA https://www.sahealth.sa.gov.au/wps/wcm/connect/public+content/sa+health+internet/public+health/alerts/health+alerts/

Queensland https://www.qld.gov.au/health/conditions/health-alerts WA https://www.health.wa.gov.au/Articles/F_I/Health-alerts-infectious-diseases

List of organisms/infections to know

When I first started microbiology training, the endless lists of organisms and infections seemed endless and extremely daunting.

I eventually settled on a "minimum" list of organisms/infections I need to know:

Anything that is mentioned in Part 3 of the Oxford Handbook of ID and Microbiology

Anything that is in the Australian guidelines (PHLN, CDNA SONGS, ACSQHC)

Anything that is in the Australian vaccination handbook

Anything that is listed in the infectious diseases lists of the individual Australian states

Victoria https://www.health.vic.gov.au/infectious-diseases/disease-information-and-advice

NSW https://www.health.nsw.gov.au/Infectious/factsheets/Pages/default.aspx

Queensland https://www.health.qld.gov.au/disease-control and https://www.qld.gov.au/health/condition/infections-and-parasites

NT https://health.nt.gov.au/public-health-notifiable-diseases

WA https://www.health.wa.gov.au/Articles/N_R/Notification-of-infectious-diseases-and-related-conditions

Alternative way of thinking about the organisms/infections are: Need to know well

Common and important, e.g. MSSA/MRSA, Enterobacterales, VZV, CMV

Common but unlikely (or less likely) to be clinically significant e.g. Staphylococcus epidermidis

Rare but important or with important associations, e.g. coccidioides, Mycobacterium ulcerans, Corynebacterium diphtheriae/ulcerans/pseudotuberculosis

Don’t really need to know well Rare and unlikely to be clinically significant e.g. Staphylococcus condimenti

For each organism/infection, I learned

Type/category of infection

Epidemiology – especially if there is anything specifically important to Australia, e.g. certain groups/regions/activities that have higher risk for infection

Transmission

Clinical presentation

Diagnosis

Non-laboratory diagnosis

Laboratory diagnosis

Sample type and collection

Sample transport

Microbiological diagnosis methods

Typing methods

Any particular issues with testing?

Treatment

Prevention

Anything special I needed to know

Specific additional things to look up for Part I

Not comprehensive!

Sensitivity, specificity, PPV, NPV - be able to calculate this - how this is affected by prevalence of disease

Receiver-operating characteristic curves

HEPA filters and how they work

Requirements of a PC2/3/4? laboratory

How is immunoglobulin avidity testing done (this is done for CMV in Australia?)

Sterilisation and disinfection

Types of autoclave and controls needed

Audit cycle

Outbreak management and epidemiological investigation

Cumulative antibiogram

Validation vs verification

Infection control - standard, contact, droplet, aerosol precautions

Measurement of uncertainty

R0 and R

Clinical trials and phases

PCR targets used for organisms

PK/PD

Australian infectious diseases screening programmes

Quality control and quality assurance

Levy-Jennings chart

Methods of diagnosis and specifics about how they work

Isothermal amplification

Sequencing by Sanger

Whole Genome Sequencing - Illumina, Nanopore

Different serological assays and how they work - ELISA, capture assays, haemagglutination-inhibition, CFT, virus neutralisation assays

Immunochromatographic tests

Transport and handling of infectious substances, how are they categorised (A/B)

Types of biosafety cabinets and how they work

Risk groups, definition of risk groups

Australian groups and organisations and regulations - NPAAC, NATA, TGA…

Organ/blood donation and microbiological testing

I also had definitions for

Quality control, quality assurance

Measurement uncertainty

MIC, ECOFF, breakpoints, susceptible, resistant, intermediate, SDD, wild type, non-WT

Critical concentration (MTB)

Sterilisation, disinfection, cleaning

R0, R

Validation, verification

Antibody titre

Universal and standard precautions

Prozone/hook effects

Notes about each part of the Part I exam

Disclaimer This is based on my own experience with the exam and there is always a possibility that the exam format or emphasis may change from year to year!

Paper A

RCPA publishes the previous papers for the past few years, and your seniors may have papers going back even longer.

Some of the questions repeat, so it is useful going through the past questions and preparing answers.

Keep in mind time limitations in the exam - there is a limit to how much you can write in 9 minutes! May be worth doing some of the questions "timed" to get a realistic idea of how much you can write. I think I wrote around a page for most questions.

A lot of basic microbiology here – e.g. “lab diagnosis of X” and technical questions.

Paper B

Short answer questions that cover a lot of various aspects of microbiology

Quite a few of the questions were "spot diagnosis" - photo provided, what is the likely organism, question related to this. Test ability to recognise fungi, parasites, etc.

Questions and topics were very random and were pulled from everything and everywhere.

Practical

Practice working up samples (including EQA samples) in the lab in parallel with routine work up done by lab staff

Make sure you are able to do all the tests that are known to be tested - e.g. I had to learn how to do urine microscopy as this isn't done by microbiology here. Double check what you need to be able to do for your year (my year included Gram stain, AFB stain, urine microscopy)

Go through past EQA reports

Go through lab manual and SOPs

A couple of months before I generated a list of media/reagents/etc I thought I might need to use during the practical. I went through this list with the lab to ensure that I would have these available for use when I need and “reserved” a stock of agar plates/etc for my use during the practical.

Before the practical I generated my own list of media/conditions to use for each sample type - and followed this list (with some additions depending on question stem) on day 1 of the exam to plate things out.

Viva

Practice questions with study group - we tried to do this similar to the exam when we would read the question, make short notes, and answer the question over zoom. Once done you might get additional questions to answer, such as in the viva.

I thought the Part I viva was more clinical and more guideline based than the rest of the Part I exam.

I found that knowing the Australian guidelines helped a lot with the viva.

Caveat. When I set Shireen the task of writing up her RCPA exam prep experience I certainly was not expecting an 18 page thesis. If you have sustained your interest all the way through this post you may have surmised that she is from one of the elite schools in Singapore. Rest assured her experience represents a counsel of perfection, and it may well be possible to pass the RCPA exams with less exhaustive preparation...

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reddancer1 · 6 months

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Heather Cox Richardson

October 16, 2023 (Monday)

The judge will need to approve the settlement.

We used to be able to assume that Americans did, in fact, play by the rules, accepting the principle of the rule of law. That principle is now openly challenged here in the U.S.

Rebuilding democracy will be neither fast nor easy, Applebaum notes, but “Poland shows that autocracy is not inevitable.”

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univpdf · 1 year

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Jawetz Melnick & Adelbergs Medical Microbiology (28th Edition) – eBook

Jawetz Melnick and Adelbergs Medical Microbiology (28th Edition) – eBook PDF Since 1954, Jawetz, Melnick & Adelberg’s Medical Microbiology, 28th edition, (PDF) has been hailed by instructors, students, and clinicians as the single-best resource for understanding the roles microorganisms play in human illness and health. Fully up to date and concise, this trusted classic links fundamental…

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kiquqemudus · 2 years

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detohasije · 2 years

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watson14y · 2 years

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digitalebookpdf · 2 years

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Jawetz Melnick & Adelbergs Medical Microbiology (28th Edition) – eBook PDF

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etextpdf · 2 years

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Jawetz Melnick & Adelbergs Medical Microbiology (28th Edition) – PDF

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sheyla-c · 4 years

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Time to learn some bacterias...

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rightsinexile · 3 years

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TPS can promote stability and recovery for Central American countries hit by recent hurricanes

The following opinion piece was written by Silva Mathema associate policy director, and Tom Jawetz vice president immigration policy of the Center for American Progress. It was published by the Center for American Progress on 21 December 2020.

In November, two deadly hurricanes, Eta and Iota, hit several Central American countries back to back, causing widespread devastation from high winds, landslides, mudslides, and flooding across Nicaragua, Guatemala, El Salvador, Honduras, and other countries. While it will take time to know the full extent of the damage, Oxfam reports that so far 11 million people have been affected throughout the region, with 800,000 evacuated from their communities.

The United States has responded by offering humanitarian assistance and financial and logistical support to aid in recovery and rebuilding efforts, including allocating $48 million in humanitarian assistance through the U.S. Agency for International Development (USAID) to help Guatemala, Honduras, Nicaragua, and Colombia and providing rescue services and delivering aid through the US Southern Command. However, the United States can do more. Specifically, the US Department of Homeland Security (DHS), in consultation with the State Department, should use its authority to designate Guatemala for Temporary Protected Status (TPS) and redesignate El Salvador, Honduras, and Nicaragua. [Read more here.]

#Silva Mathema #Tom Jawetz #Center for American Progress #Central America #US #TPS #hurricane

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mfi-miami · 5 years

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Career Insurance Fraudster Scott Jawetz Finally Going To Prison

Career Insurance Fraudster Scott Jawetz Is Finally Facing Prison Time But Not For Insurance Fraud But Tax Fraud

Career insurance fraudster pleaded guilty today in federal court in Michigan. Scott Jawetz pleaded guilty today to conspiring to impede the functions of the IRS. He also pleaded guilty to conspiring to steal from the Detroit Police Department.

Court documents show the Boca…

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medcury · 3 years

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Oi! Você pode dizer quais livros utiliza para estudar microbiologia, por favor? ☺️

Microbiologia Médica e Imunologia - Levinson & Jawetz

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socialjusticeartshare · 3 years

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Immigrant advocates urge Biden to quickly rectify the trauma of family separation

Immigrant advocacy groups, who for years scrambled to identify and reunite families separated at the US-Mexico border, are now preparing for the incoming administration and steps to rectify the trauma experienced by parents and children.

Last week, immigrant advocacy groups met with the Joe Biden transition team on family separation and next steps as part of a series of ongoing listening sessions, according to a source familiar with the meeting. Alejandro Mayorkas, Biden's pick to lead the Department of Homeland Security, has also met with immigration leaders, among other groups, according to another source familiar with the discussions.

Immigrant advocacy groups hope Biden's administration can work toward restoring trust with the families who've grown increasingly skeptical of the US since having their kids taken from them.

"It's going to take a long time for families to trust the government if they're not seeing action," said Cathleen Caron, executive director at Justice in Motion, which is leading the on-the-ground efforts to locate the deported parents who were separated from their children.

Advocates have been putting together a list of recommendations on how the government can work to rectify the consequences of family separation and address the situation in a thoughtful and holistic manner, according to Conchita Cruz, a co-executive director of the Asylum Seeker Advocacy Project, which represents separated families.

The so-called "zero tolerance" policy -- which called for the criminal prosecutions of every adult illegally crossing the border and, as a result, the separation of thousands of families -- became a flashpoint during the Trump administration. The policy came to encapsulate the lengths President Donald Trump was willing to go to in order to deter migrants from coming to the US, regardless of their circumstances, and it revealed the disarray that ensues when agencies are unprepared.

Biden has condemned the policy, calling it "criminal" during a presidential debate in October. "Their kids were ripped from their arms and separated. And now they cannot find over 500 sets of those parents and those kids are alone. Nowhere to go. Nowhere to go. It's criminal. It's criminal," he said.

Since 2018, when the "zero tolerance" policy was implemented, court filings and watchdog reports have continued to shed light on the consequences of family separation, revealing the information withheld by the US government and the hundreds of parents who have yet to be reunited with their children.

"We're starting from the premise that this is one of the low points of the last four years, one of the worst ongoing atrocities that needs to be rectified," said Tom Jawetz, the vice president of immigration policy at Center for American Progress.

Finding parents

One of the first expectations of the incoming administration, Caron said, is scrubbing agencies to ensure there's no information or data that's been held back that could be helpful to identifying and locating families.

A recent court filing in an ongoing family separation case also revealed that the Trump administration would hand over information from the Executive Office for Immigration Review, an agency under the Justice Department that oversees the US immigration court system. That database will provide needed phone numbers and addresses to locate additional families.

But beyond assuring that all family details have been provided, groups stressed that a Biden administration should focus on rectifying the damage done, leaving the process of locating families up to the groups that have worked on the issue.

The American Civil Liberties Union, which has led litigation against the Trump administration over family separation, outlined five steps the incoming administration should consider taking when tackling the issue.

Those steps include allowing the parents and children who were separated and then deported to return to the United States, as well as giving some type of legal status to those families that were separated and creating a victims fund to help families with trauma and medical needs.

"Finally and importantly, while we of course welcome any help the Biden administration can give us to find the remaining families (now the parents of 628 children), that is not where we would like to see the new administration concentrate its efforts," said Lee Gelernt,an attorney at the ACLU. "I am confident that we will ultimately find the families, but only the government can reunite the families and provide them with legal status in the United States."

Gelernt said that through the litigation they've learned of nearly 5,500 separations since July 2017.

Task force

Advocate groups have also called for accountability and transparency to fully account for the "zero tolerance" policy and its ramifications, as well as factoring in the input of parents who were separated from their children.

Biden has pledged to sign an executive order to form a task force that will focus on reuniting separated families. While the creation of a task force has been welcomed, immigrant advocate groups caution that it shouldn't supplant the efforts of the last two years.

"We need to make sure we're using all our resources to support those efforts, rather than thinking the task force can itself serve as search and rescue," Jawetz said, adding that the task force could play a useful role in providing a "single focus for inter-agency efforts that will have White House involvement."

"Task force is great, but we don't want it to be a stall tactic or take too long," Caron echoed. "We need a focal point in the government to be able to have the conversations with."

Speaking virtually at an American Business Immigration Coalition summit this month, Mayorkas nodded to the restrictionist policies of the Trump administration, saying that "we must stop vilifying these communities," and he cited the family separation policy.

"There is no more powerful and heartbreaking example of that inhumanity than the separation of children from their parents," he said.

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#immigrant children #families separate #trauma #biden

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