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To evaluate a computer-assisted point-prevalence survey (CAPPS) for hospital-acquired infections (HAIs).
A 754-bed teaching hospital in the Netherlands.
For the internal validation of a CAPPS for HAIs, 2,526 patients were included. All patient records were retrospectively reviewed in depth by 2 infection control practitioners (ICPs) to determine which patients had suffered an HAI. Preventie van Ziekenhuisinfecties door Surveillance (PREZIES) criteria were used. Following this internal validation, 13 consecutive CAPPS were performed in a prospective study from January to March 2013 to determine weekly, monthly, and quarterly HAI point prevalence. Finally, a CAPPS was externally validated by PREZIES (Rijksinstituut voor Volksgezondheid en Milieu [RIVM], Bilthoven, Netherlands). In all evaluations, discrepancies were resolved by consensus.
In our series of CAPPS, 83% of the patients were automatically excluded from detailed review by the ICP. The sensitivity of the method was 91%. The time spent per hospital-wide CAPPS was ~3 hours. External validation showed a negative predictive value of 99.1% for CAPPS.
CAPPS proved to be a sensitive, accurate, and efficient method to determine serial weekly point-prevalence HAI rates in our hospital.
Both peer groups and genetics have been associated with adolescent smoking behavior. Recently, Loehlin (Loehlin, J. C. (2010). Is there an active gene–environment correlation in adolescent drinking behavior? Behavior Genetics, 40, 447–451) reported that twin differences in alcohol use were associated with differences in the number of common friends. Twins with more common friends were more similar in drinking, but only for dizygotic pairs. Using the same sample as Loehlin's (the National Merit twins), we replicated all of these findings for a composite cigarette smoking measure and for smoking initiation, but not persistence. The pattern of results is most consistent with homophily, or the tendency to associate with individuals that are like oneself. If peer influence occurs in the presence of homophily, then active genotype–environment correlation will be induced.
The newer cyanide antidote, hydroxocobalamin, due to its pigmentation, has been found to cause interferences in some laboratory assays. Co-oximetry may also be affected by hydroxocobalamin, leading to false elevations in hemoglobin concentration, methemoglobin, carboxyhemoglobin, and false decreases in oxyhemoglobin. The Masimo Radical-7 is a medical device that performs noninvasive oximetry and estimates hemoglobin (Hb) concentration and percent carboxyhemoglobin (COHb), methemoglobin (MetHb), and oxyhemoglobin saturation (O2Hb).
The study sought to determine the effect of hydroxocobalamin on noninvasive measurement of hemoglobin indices using the Masimo Radical-7 monitor.
Seven asymptomatic volunteers who were unexposed to cyanide had baseline heart rate (HR), blood pressure (BP), and oximeter measurements recorded followed by an infusion of five grams of hydroxocobalamin over 15 minutes. The above parameters were subsequently recorded at: 5, 10, 15, 30 and 60 minutes post infusion. Data were analyzed by calculating the area under the curve (AUC) for each variable and comparing the results to expected values by paired t tests. Expected AUC values were calculated by extrapolating baseline values across the entire time period.
The mean differences from baseline values with 95% confidence intervals and t tests of mean difference were: SBP: 11 mm Hg (95% CI, 0-22; P = .051); HR: -9 (95% CI, -15 to -3; P = .01); Hb: -0.1 (95% CI, -0.7 to 0.4; P = .57); O2Hb: 0 g/dL (95% CI, -1 to 1; P = .41); COHb: -1 (95% CI, -3 to 1; P = .25); MetHb: -0.2 (95% CI, -0.3 to 0; P = .03).
After infusion of hydroxocobalamin there was a significant elevation of systolic blood pressure and decrease in heart rate. There were no significant differences in Hb, O2Hb, and COHb. Although percent methemoglobin concentrations were statistically lower, the authors feel this difference is of trivial clinical significance.
The administration of hydroxocobalamin does not significantly impact noninvasive oximetry.
CashinB, MatlockA, KangC, ReynoldsP, WillsB. Effect of Hydroxocobalamin on Surface Oximetry in Nonexposed Humans. Prehosp Disaster Med. 2013;28(4):1-3.
Health claims on food products are often used as a means to highlight scientifically proven health benefits associated with consuming those foods. But do consumers understand and trust health claims? This paper provides an overview of recent research on consumers and health claims including attitudes, understanding and purchasing behaviour. A majority of studies investigated selective product–claim combinations, with ambiguous findings apart from consumers’ self-reported generic interest in health claims. There are clear indications that consumer responses differ substantially according to the nature of carrier product, the type of health claim, functional ingredient used or a combination of these components. Health claims tend to be perceived more positively when linked to a product with an overall positive health image, whereas some studies demonstrate higher perceived credibility of products with general health claims (e.g. omega-3 and brain development) compared to disease risk reduction claims (e.g. bioactive peptides to reduce risk of heart disease), others report the opposite. Inconsistent evidence also exists on the correlation between having a positive attitude towards products with health claims and purchase intentions. Familiarity with the functional ingredient and/or its claimed health effect seems to result in a more favourable evaluation. Better nutritional knowledge, however, does not automatically lead to a positive attitude towards products carrying health messages. Legislation in the European Union requires that the claim is understood by the average consumer. As most studies on consumers’ understanding of health claims are based on subjective understanding, this remains an area for more investigation.
Four new species of Thraulodes Ulmer (Ephemeroptera: Leptophlebiidae), Thraulodes amanda sp. n., Thraulodes pelicanus sp. n., Thraulodes xavantinensis sp. n. and Thraulodes sinuosus sp. n are described based on imagos. A new synonymy (Thraulodes lepidus [Ulmer]=Thraulodes cryptodrilus Nieto & Domínguez) is proposed and the distribution of Thraulodes schlingeri is expanded based on a new record from western Brazil.
Lower birthweight, and rapid childhood weight gain predict elevated cardiovascular risk factors in children. We examined associations between serial, detailed, anthropometric measurements from birth to 9.5 years of age and cardiovascular risk markers in Indian children. Children (n = 663) born at the Holdsworth Memorial Hospital, Mysore, India were measured at birth and 6–12 monthly thereafter. At 9.5 years, 539 (255 boys) underwent a 2-h oral glucose tolerance test, and blood pressure (BP) and fasting lipid concentrations were measured. Insulin resistance was calculated using the HOMA equation. These outcomes were examined in relation to birth measurements and changes in measurements (growth) during infancy (0–2 years), 2–5 years and 5–9.5 years using conditional s.d. scores. Larger current weight, height and skinfold thickness were associated with higher risk markers at 9.5 years (P < 0.05). Lower weight, smaller length and mid-arm circumference at birth were associated with higher fasting glucose concentrations at 9.5 years (P ⩽ 0.01). After adjusting for current weight/height, there were inverse associations between birthweight and/or length and insulin concentrations, HOMA, systolic and diastolic BP and plasma triglycerides (P < 0.05). Increases in conditional weight and height between 0–2, 2–5 and 5–9.5 years were associated with higher insulin concentrations, HOMA and systolic BP. In conclusion, in 9–10-year-old Indian children, as in other studies, cardiovascular risk factors were highest in children who were light or short at birth but heavy or tall at 9 years. Greater infant and childhood weight and height gain were associated with higher risk markers.
Foetal development may permanently affect muscle function. Indian newborns have a low mean birthweight, predominantly due to low lean tissue and muscle mass. We aimed to examine the relationship of birthweight, and arm muscle area (AMA) at birth and post-natal growth to handgrip strength in Indian children. Grip strength was measured in 574 children aged 9 years, who had detailed anthropometry at birth and every 6–12 months post-natally. Mean (standard deviation (s.d.)) birthweight was 2863 (446) g. At 9 years, the children were short (mean height s.d. −0.6) and light (mean weight s.d. −1.1) compared with the World Health Organization growth reference. Mean (s.d.) grip strength was 12.7 (2.2) kg (boys) and 11.0 (2.0) kg (girls). Weight, length and AMA at birth, but not skinfold measurements at birth, were positively related to 9-year grip strength (β = 0.40 kg/s.d. increase in birthweight, P < 0.001; and β = 0.41 kg/s.d. increase in AMA, P < 0.001). Grip strength was positively related to 9-year height, body mass index and AMA and to gains in these measurements from birth to 2 years, 2–5 years and 5–9 years (P < 0.001 for all). The associations between birth size and grip strength were attenuated but remained statistically significant for AMA after adjusting for 9-year size. We conclude that larger overall size and muscle mass at birth are associated with greater muscle strength in childhood, and that this is mediated mainly through greater post-natal size. Poorer muscle development in utero is associated with reduced childhood muscle strength.
This chapter discusses the relation of social support to health outcomes. We consider approaches to the conceptualization of social support and discuss findings on the relation of social support to onset, progression or recovery from chronic illnesses which are major sources of mortality. An emphasis is on understanding physiological and behavioural mechanisms through which social support is related to health status. In a final section we summarize developments in this area, note current debates and suggest directions for clinical research.
Conceptualization and measurement of social support
There are two major approaches to conceptualizing social variables related to health. The structural approach focuses on assessing the structure of a person's network of social connections. In a typical network assessment the respondent is asked to name persons with whom he/she has a connection, typically including questions about spouse, family, friends, neighbours and workmates. Network assessments may also include questions about membership of community organizations (e.g. churches, professional or service organizations, fraternal organizations) and participation in sports, cultural activities and leisure/recreational activities. A score for network size is based on the total number of connections a person has; a score for social integration is based on the total number of different roles a person has in the community; and a score termed ‘social participation’ is based on the total amount of participation in activities that involve other people. These indices are taken to represent the extent of a person's integration in the community (Cohen, Underwood & Gottlieb, 2000).
Pathogenesis, clinical disease, host response, and epidemiology: HCMV
Mark R. Wills, Department of Medicine, School of Clinical Medicine, University of Cambridge, UK,
Andrew J. Carmichael, Department of Medicine, School of Clinical Medicine, University of Cambridge, UK,
J. H. Sinclair, Department of Medicine, School of Clinical Medicine, University of Cambridge, UK,
J. G. Patrick Sissons, Department of Medicine, School of Clinical Medicine, University of Cambridge, UK
HCMV, as all persistent viruses, has to survive in the host in the face of an immune response. Antibody, and probably T-cells in particular, contain the infection in the normal host but impaired T-cell immunity is associated with HCMV disease. The virus encodes functions which can counter this immune response and may also use immune cells as sites of latency. Although our knowledge of many aspects of the virus/host relationship is still incomplete, studies on HCMV over the past 20 years have given insight into how a large DNA virus achieves this coexistence with the normal immune response. Other chapters also contain relevant material.
Cells of the immune system as sites of latency and reactivation for HCMV
Consideration of the immune response to HCMV has to take account of the fact that some cells of the immune system are strong candidates for being sites of latency (see elsewhere in this volume). It is a longstanding clinical observation that HCMV can be transmitted by blood transfusion, but the most sensitive PCR based techniques do not detect HCMV DNA in plasma or serum of healthy virus carriers (although they do in patients with active HCMV disease), implying HCMV is most likely transmitted by cells in peripheral blood. Evidence from several laboratories suggests that HCMV is latent in myeloid lineage cells (Sinclair and Sissons, 2006).
X-Ray Absorption Spectroscopy (XAS) and Photoelectron Spectroscopy (PES) have been performed upon highly radioactive samples, particularly Plutonium, at the Advanced Light Source in Berkeley, CA, USA. First results from alpha and delta Plutonium are reported as well as a detailed analysis of sample quality.
We have observed the recovery of the performance of amorphous silicon (a-Si:H) based solar cell (especially the fill factor) at temperatures between 25°C and 170°C after ∼600 hours of light soaking under 1 sun illumination at ∼40°C. We find that there is some recovery of the fill factor of the cells even at temperatures below the temperature of light soaking. The recovery is significantly greater in cells of poor quality. There is also some evidence of enhancement of the recovery rate due to an external electric field. Above the light soaking temperature, a sort of thermally activated recovery of the fill factor is observed.
Pulsed laser deposition (PLD) was used to grow microcrystalline thin films of germanium (Ge) and Ge-carbon (Ge,C) alloys on fused quartz and silicon substrates at substrate temperatures 25°C ≤ Ts ≤ 325°C. The films were analyzed structurally with x-ray diffraction (XRD), optically, electrically with four-point probe measurements, and chemically with x-ray photoelectron spectroscopy (XPS). XRD results displayed a varying degree of crystallinity, with the most crystalline films obtained at Ts > 150°C. The resistivity of the Ge films decreased with increasing temperature, displaying a significant decrease for the films deposited at Ts ≥ 230°C. The growth conditions for Ge films served as a starting point for low-temperature deposition of Ge,C alloys with up to 5% C. The effects of Ts and carbon concentration on film properties are discussed.
Empirical Total Energy Tight Binding (TETB) has proven to be a fast and accurate method for calculating materials properties for various system, including bulk, surface and amorphous structures. The determination of the tight binding parameters from first-principles results is a multivariate, non-linear optimization problem with multiple local minima. Simulated annealing is an optimization method which is flexible and “guaranteed” to find a global minimum, opposed to classical methods like non-linear least squares algorithms. As an example results are presented for a nonorthogonal s,p parameterization for Silicon based on the NRL tight binding formalism.