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In 2018, the Clostridium difficile LabID event methodology changed so that hospitals doing 2-step tests, nucleic acid amplification test (NAAT) plus enzyme immunofluorescence assay (EIA), had their adjustment modified to EIA-based tests, and only positive final tests (eg, EIA) were counted in the numerator. We report the immediate impact of this methodological change at 3 Milwaukee hospitals.
Objectives: The worldwide spread of Parkinson’s disease (PD) calls for sensitive and specific measures enabling its early (or, ideally, preclinical) detection. Here, we use language measures revealing deficits in PD to explore whether similar disturbances are present in asymptomatic individuals at risk for the disease. Methods: We administered executive, semantic, verb-production, and syntactic tasks to sporadic PD patients, genetic PD patients with PARK2 (parkin) or LRRK2 (dardarin) mutation, asymptomatic first-degree relatives of the latter with similar mutations, and socio-demographically matched controls. Moreover, to detect sui generis language disturbances, we ran analysis of covariance tests using executive functions as covariate. Results: The two clinical groups showed impairments in all measures, most of which survived covariation with executive functions. However, the key finding concerned asymptomatic mutation carriers. While these subjects showed intact executive, semantic, and action-verb production skills, they evinced deficits in a syntactic test with minimal working memory load. Conclusions: We propose that this sui generis disturbance may constitute a prodromal sign anticipating eventual development of PD. Moreover, our results suggest that mutations on specific genes (PARK2 and LRRK2) compromising basal ganglia functioning may be subtly related to language-processing mechanisms. (JINS, 2017, 23, 150–158)
Because individuals develop dementia as a manifestation of neurodegenerative or neurovascular disorder, there is a need to develop reliable approaches to their identification. We are undertaking an observational study (Ontario Neurodegenerative Disease Research Initiative [ONDRI]) that includes genomics, neuroimaging, and assessments of cognition as well as language, speech, gait, retinal imaging, and eye tracking. Disorders studied include Alzheimer’s disease, amyotrophic lateral sclerosis, frontotemporal dementia, Parkinson’s disease, and vascular cognitive impairment. Data from ONDRI will be collected into the Brain-CODE database to facilitate correlative analysis. ONDRI will provide a repertoire of endophenotyped individuals that will be a unique, publicly available resource.
Many studies have reported that cannabis use increases the risk of a first episode of psychosis (FEP). However, only a few studies have investigated the nature of cannabis-related experiences in FEP patients, and none has examined whether these experiences are similar in FEP and general populations. The aim of this study was to explore differences in self-reported cannabis experiences between FEP and non-psychotic populations.
A total of 252 subjects, who met International Classification of Diseases (ICD)-10 criteria for FEP, and 217 controls who reported cannabis use were selected from the Genetics and Psychosis (GAP) study. The Medical Research Council Social Schedule and the Cannabis Experience Questionnaire were used to collect sociodemographic data and cannabis use information, respectively.
Both ‘bad’ and ‘enjoyable’ experiences were more commonly reported by FEP subjects than controls. Principal components factor analysis identified four components which explained 62.3% of the variance. Linear regression analysis on the whole sample showed that the type of cannabis used and beliefs about the effect of cannabis on health all contributed to determining the intensity and frequency of experiences. Linear regression analysis on FEP subjects showed that the duration of cannabis use and amount of money spent on cannabis were strongly related to the intensity and frequency of enjoyable experiences in this population.
These results suggest a higher sensitivity to cannabis effects among people who have suffered their first psychotic episode; this hypersensitivity results in them reporting both more ‘bad’ and ‘enjoyable’ experiences. The greater enjoyment experienced may provide an explanation of why FEP patients are more likely to use cannabis and to continue to use it despite experiencing an exacerbation of their psychotic symptoms.
Structural brain magnetic resonance imaging (MRI) traits share part of their genetic variance with cognitive traits. Here, we use genetic association results from large meta-analytic studies of genome-wide association (GWA) for brain infarcts (BI), white matter hyperintensities, intracranial, hippocampal, and total brain volumes to estimate polygenic scores for these traits in three Scottish samples: Generation Scotland: Scottish Family Health Study (GS:SFHS), and the Lothian Birth Cohorts of 1936 (LBC1936) and 1921 (LBC1921). These five brain MRI trait polygenic scores were then used to: (1) predict corresponding MRI traits in the LBC1936 (numbers ranged 573 to 630 across traits), and (2) predict cognitive traits in all three cohorts (in 8,115–8,250 persons). In the LBC1936, all MRI phenotypic traits were correlated with at least one cognitive measure, and polygenic prediction of MRI traits was observed for intracranial volume. Meta-analysis of the correlations between MRI polygenic scores and cognitive traits revealed a significant negative correlation (maximal r = 0.08) between the HV polygenic score and measures of global cognitive ability collected in childhood and in old age in the Lothian Birth Cohorts. The lack of association to a related general cognitive measure when including the GS:SFHS points to either type 1 error or the importance of using prediction samples that closely match the demographics of the GWA samples from which prediction is based. Ideally, these analyses should be repeated in larger samples with data on both MRI and cognition, and using MRI GWA results from even larger meta-analysis studies.
The Balearic Shearwater Puffinus mauretanicus is considered one of the most threatened seabirds in the world, with the breeding population thought to be in the range of 2,000–3,200 breeding pairs, from which global population has been inferred as 10,000 to 15,000 birds. To test whether the actual population of Balearic Shearwaters is larger than presently thought, we analysed the data from four land-based census campaigns of Balearic Shearwater post-breeding migration through the Strait of Gibraltar (mid-May to mid-July 2007–2010). The raw results of the counts, covering from 37% to 67% of the daylight time throughout the migratory period, all revealed figures in excess of 12,000 birds, and went up to almost 18,000 in two years. Generalised Additive Models were used to estimate the numbers of birds passing during the time periods in which counts were not undertaken (count gaps), and their associated error. The addition of both counted and estimated birds reveals figures of between 23,780 and 26,535 Balearic Shearwaters migrating along the north coast of the Strait of Gibraltar in each of the four years of our study. The effects of several sources of bias suggest a slight potential underestimation in our results. These figures reveal the urgent need to reformulate the population viability analysis for the species, and then if necessary reconsider its conservation status.
We evaluated the behaviors of anesthesiologists during induction and maintenance of anesthesia. Contacts with surfaces occurred a mean (±standard error) of 154.8 ± 7.7 and 60 ± 3.1 times per hour during induction and maintenance, respectively (P < .0001). Hand hygiene events were 1.8 ± 0.27 per hour during induction versus 1.19 ± 0.27 during maintenance (P = .018).
Infect Control Hosp Epidemiol 2014;35(8):1056–1059
Forty anesthesia providers were evaluated with and without hand sanitizer dispensers present on the anesthesia machine. Having a dispenser increased the frequency of hand hygiene only from 0.5 to 0.8 events per hour (P = .01). Other concomitant interventions are needed to further increase hand hygiene frequency among anesthesia providers.
The objective of the study was to design and evaluate a pilot programme aimed at promoting the active ageing of older adults at the Mexican Institute of Social Security. The study was conducted in three stages: (a) design; (b) implementation; and (c) before–after evaluation through analysis of changes in functional status, occupational functioning and health-related quality of life. To overcome the limitations of the study design, we evaluated the effect of 80 per cent adherence to the programme on the outcome variables using the generalised linear regression models (GLM). Two hundred and thirty-nine older adults agreed to participate, of whom 65 per cent completed the programme. Most were women; the average age was 77 years. Adherence to the programme was higher than 75 per cent for the group who completed active ageing services and less than 60 per cent for the drop-out group. Overall, 46 per cent of older adults reached an adherence level of 80 per cent or higher. Adherence was significantly associated with improved quality of life total score (coefficient 2.7, p<0.0001) and occupational functioning total score (coefficient 2.2, p<0.0001). Participation of older adults in an active ageing programme may improve their health-related quality of life and occupational functioning. It is necessary to identify the potential barriers and to implement strategies to improve the recruitment and retention rates during the intervention.
The risk of stroke in patients with asymptomatic carotid stenosis (ACS) is now so low that it is important to have methods to identify those patients most likely to benefit from intervention, or who may require special consideration in choice of medical therapy. We studied the prediction of stroke, death or transient ischemic attacks (stroke/death/TIA) in patients with ACS by intracranial arterial stenosis, and microemboli on transcranial Doppler (TCD), and the effect of diabetes mellitus on microemboli, intracranial stenosis and risk of events.
Patients with ACS > 60% by Doppler ultrasound were recruited from the Stroke Prevention Clinic of University Hospital, London, Canada. All 339 participants underwent TCD for detection of intracranial stenosis and detection of microemboli, and carotid ultrasound to measure extracranial stenosis and total carotid plaque area. Participants were followed for three years, to determine the risk of stroke/death/TIA.
Stroke/death/TIA occurred in 38% of patients with microemboli versus 10% without (p=0.0001), and in 18% of patients with intracranial stenosis, versus 10% without (p=0.042). Diabetics were significantly more likely to have intracranial stenosis (45% vs. 29%, p =0.014), microemboli (38% vs. 10%, p <0.0001), and had significantly higher risk of stroke/death/TIA over three years (21% vs. 11% without; p=0.024). Survival free of stroke, TIA or death was significantly better without microemboli or intracranial stenosis (p<0.0001).
Diabetes, microemboli and intracranial stenosis predicted higher risk of stroke, death or TIA than did extracranial stenosis or total plaque area; diabetics may need more intensive therapy.
Potential transmission of organisms from the environment to patients is a concern, especially in enclosed settings, such as operating rooms, in which there are multiple and frequent contacts between patients, provider's hands, and environmental surfaces. Therefore, adequate disinfection of operating rooms is essential. We aimed to determine the change in both the thoroughness of environmental cleaning and the proportion of environmental surfaces within operating rooms from which pathogenic organisms were recovered.
Prospective environmental study using feedback with UV markers and environmental cultures.
A 1,500-bed county teaching hospital.
Environmental service personnel, hospital administration, and medical and nursing leadership
The proportion of UV markers removed (cleaned) increased from 0.47 (284 of 600 markers; 95% confidence interval [CI], 0.42-0.53) at baseline to 0.82 (634 of 777 markers; 95% CI, 0.77-0.85) during the last month of observations (P < .0001). Nevertheless, the percentage of samples from which pathogenic organisms (gram-negative bacilli, Staphylococcus aureus, and Enterococcus species) were recovered did not change throughout our study. Pathogens were identified on 16.6% of surfaces at baseline and 12.5% of surfaces during the follow-up period (P = .998). However, the percentage of surfaces from which gram-negative bacilli were recovered decreased from 10.7% at baseline to 2.3% during the follow-up period (P = .015).
Feedback using Gram staining of environmental cultures and UV markers was successful at improving the degree of cleaning in our operating rooms.
Phonons and crystalline structures of Hg1−xCdxSe alloys (0 ≤ x ≤ 0.5) were studied by Raman spectroscopy and X-ray powder diffraction patterns at 298K. The crystalline alloys were prepared by a special combination of synthesis and the Bridgman method. Experimental data showed a face-centered cubic structure, (No. 216), for all samples, exhibiting a linear dependence for Cd molar fraction, x, for cell parameters, a, and the mass densities, ρ. Phonon frequencies were analyzed using the Romevi-Romevi model for phonons in multicomponent alloys, obtaining a fair agreement with experimental data. Furthermore, an algorithm to implement the Romevi-Romevi model is proposed.
The psycho-social needs of patients with advanced chronic illness and their families include emotional, spiritual, and bereavement care. With a funding initiative by the La Caixa Foundation and design by the WHO Collaborating Center, we developed and implemented a program for the comprehensive care of terminally-ill individuals and their families, in Spain. The intent was to improve the psycho-social and spiritual dimensions of care, to generate experience and evidence, to explore models, and to act as catalyst in the Spanish National Strategy for Palliative Care.
We reviewed the process of design, implementation, and initial evaluation of the program at 18 months.
Thirty psycho-social teams’ (PST) acting as support teams projects were initiated. There were 120 full-time healthcare professionals appointed (58% clinical psychologists). These professionals received training through a comprehensive postgraduate course, and all used the same documentation. Some results were collated 18 months post-implementation. The total number of patients attended to was 10,954, and the number of relatives was 17,715. The preliminary clinical outcomes show a significant improvement in well-being, and a decrease in anxiety and insomnia, although there was a smaller impact on alleviating depression. Healthcare professionals collated results on satisfaction with palliative care (PC) services.
Significance of results:
Based on these preliminary results, we suggest that the PST can be a model of organization that is effective and efficient in improving the psycho-social and spiritual aspects of care of terminally ill patients. Further follow-up and evaluation with validated tools are the main goals for the immediate future.
Some seaweeds exert antioxidant and hypocholesterolaemic properties. The effects of diets including restructured meats (RM) containing Wakame (W) or Nori (N) algae on arylesterase (AE) activity and lipoprotein concentration and composition were tested. In the present study, six groups of ten male growing Wistar rats each were fed a mix of 85 % AIN-93M diet and 15 % freeze-dried RM for 35 d. The control group (C) consumed control RM, the W and N groups consumed RM with 5 % W and 5 % N, respectively. The cholesterol-enriched C (CC), W (CW) and N (CN) groups consumed their corresponding basal diets with supplementary cholesterol (2·43 %) and cholic acid (0·49 %). Cholesterol in the diet induced lower (P < 0·001) growth ratios. Both W and N diets significantly increased AE activity. VLDL-cholesterol values were lower in N rats than in W rats. AE activity increased (P < 0·001) in CC and CW rats but not in CN rats compared with their corresponding counterparts. AE was lower (P < 0·05) in the CN group than in the CC and CW groups. The CN diet partially blocked (P < 0·001) the hypercholesterolaemic induction observed in CC and CW diets and reduced TAG levels (at least P < 0·05) with respect to those of CC rats. Although dietary cholesterol supplementation increased total cholesterol, VLDL-cholesterol and (intermediate-density lipoprotein+LDL)-cholesterol (all P < 0·001) in all rats, the CN diet moderately improved the lipoprotein profile of hypercholesterolaemic rats. Changes in AE activity and plasma cholesterol in CN rats but not in CW rats suggest a possible relationship between the two parameters. It is concluded that inclusion of RM enriched with N may be used in hypercholesterolaemic diets to improve lipoprotein metabolism.
Despite decades of intensive research iron aluminides remain characterised by relatively poor ductility at room temperature and low strength at high temperatures, especially under slow strain rate or creep conditions. A variety of strengthening particles has been tested for improving high temperature strength, but each has serious limitations: typical carbide precipitates are unable to resist dissolution or coarsening at high temperatures; as-solidified iron aluminides with sufficient amounts of transition elements such as Nb or Mo show heavy solidification segregation and are embrittled by a network of Laves phase; mechanical milling with stable oxides appears an excessively expensive processing route. A new iron-aluminium alloy has been developed with Zr and Cr additions that forms fine coherent precipitates even after extended annealing at temperatures as high as 900ºC. These precipitates have a complex Fe3Zr structure and form in a cube-on-cube orientation relationship in the bcc matrix. The low solubility and diffusivity of the solute, as well as the low energy, near-coherent interface ensures excellent stability of these intermetallic precipitates. Interesting strengthening is possible for this material under the relevant high temperature creep conditions.
As the critical design requirements decrease, we need to understand how confinement affects the performance of the materials we use. One example of this occurs with the lubricant used on magnetic recording disks to reduce wear between the disk and head reader during unexpected intermittent contact. Lubricants for use in hard drives need to have sufficient reflow and redistribution properties which are stable in a wide range of temperatures experienced in today's hard drive. Since the material properties of the confined system often differ from the bulk properties, the tools needed to properly investigate these systems need to be developed and understood. In this study, we utilized atomic force microscopy (AFM) techniques, to study the confinement effects on lubricant stability with temperature. Our studies have demonstrated distinct changes in adhesion force with changes in the thickness of the confining substrate layer. As adhesion is a component of friction, these changes in adhesion are directly related to lubricant performance and its ability to reduce wear between disk and reader.