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To determine the burden of skin and soft tissue infections (SSTI), the nature of antimicrobial prescribing and factors contributing to inappropriate prescribing for SSTIs in Australian aged care facilities, SSTI and antimicrobial prescribing data were collected via a standardised national survey. The proportion of residents prescribed ⩾1 antimicrobial for presumed SSTI and the proportion whose infections met McGeer et al. surveillance definitions were determined. Antimicrobial choice was compared to national prescribing guidelines and prescription duration analysed using a negative binomial mixed-effects regression model. Of 12 319 surveyed residents, 452 (3.7%) were prescribed an antimicrobial for a SSTI and 29% of these residents had confirmed infection. Topical clotrimazole was most frequently prescribed, often for unspecified indications. Where an indication was documented, antimicrobial choice was generally aligned with recommendations. Duration of prescribing (in days) was associated with use of an agent for prophylaxis (rate ratio (RR) 1.63, 95% confidence interval (CI) 1.08–2.52), PRN orders (RR 2.10, 95% CI 1.42–3.11) and prescription of a topical agent (RR 1.47, 95% CI 1.08–2.02), while documentation of a review or stop date was associated with reduced duration of prescribing (RR 0.33, 95% CI 0.25–0.43). Antimicrobial prescribing for SSTI is frequent in aged care facilities in Australia. Methods to enhance appropriate prescribing, including clinician documentation, are required.
Tonsillectomy is a common procedure with significant post-operative pain. This study was designed to compare post-operative pain, returns to a normal diet and normal activity, and duration of regular analgesic use in Coblation and bipolar tonsillectomy patients.
A total of 137 patients, aged 2–50 years, presenting to a single institution for tonsillectomy or adenotonsillectomy were recruited. Pain level, diet, analgesic use, return to normal activity and haemorrhage data were collected.
Coblation tonsillectomy was associated with significantly less pain than bipolar tonsillectomy on post-operative days 1 (p = 0.005), 2 (p = 0.006) and 3 (p = 0.010). Mean pain scores were also significantly lower in the Coblation group (p = 0.039). Coblation patients had a significantly faster return to normal activity than bipolar tonsillectomy patients (p < 0.001).
Coblation tonsillectomy is a less painful technique compared to bipolar tonsillectomy in the immediate post-operative period and in the overall post-operative period. This allows a faster return to normal activity and decreased analgesic requirements.
Worldwide 350 million people suffer from major depression, with the majority of cases occurring in low- and middle-income countries. We examined the patterns, correlates and care-seeking behaviour of adults suffering from major depressive episode (MDE) in China.
A nationwide study recruited 512 891 adults aged 30–79 years from 10 provinces across China during 2004–2008. The 12-month prevalence of MDE was assessed by the Modified Composite International Diagnostic Interview-short form. Logistic regression yielded adjusted odds ratios (ORs) of MDE associated with socio-economic, lifestyle and health-related factors and major stressful life events.
Overall, 0.7% of participants had MDE and a further 2.4% had major depressive symptoms. Stressful life events were strongly associated with MDE [adjusted OR 14.7, 95% confidence interval (CI) 13.7–15.7], with a dose–response relationship with the number of such events experienced. Family conflict had the highest OR for MDE (18.9, 95% CI 16.8–21.2) among the 10 stressful life events. The risk of MDE was also positively associated with rural residency (OR 1.5, 95% CI 1.4–1.7), low income (OR 2.3, 95% CI 2.1–2.4), living alone (OR 2.6, 95% CI 2.3–3.0), smoking (OR 1.4, 95% CI 1.3–1.6) and certain other mental disorders (e.g. anxiety, phobia). Similar, albeit weaker, associations were observed with depressive symptoms. Among those with MDE, about 15% sought medical help or took psychiatric medication, 15% reported having suicidal ideation and 6% reported attempting suicide.
Among Chinese adults, the patterns and correlates of MDE were generally consistent with those observed in the West. The low rates of seeking professional help and treatment highlight the great gap in mental health services in China.
Major depressive disorder (MDD) is moderately heritable, however genome-wide association studies (GWAS) for MDD, as well as for related continuous outcomes, have not shown consistent results. Attempts to elucidate the genetic basis of MDD may be hindered by heterogeneity in diagnosis. The Center for Epidemiological Studies Depression (CES-D) scale provides a widely used tool for measuring depressive symptoms clustered in four different domains which can be combined together into a total score but also can be analysed as separate symptom domains.
We performed a meta-analysis of GWAS of the CES-D symptom clusters. We recruited 12 cohorts with the 20- or 10-item CES-D scale (32 528 persons).
One single nucleotide polymorphism (SNP), rs713224, located near the brain-expressed melatonin receptor (MTNR1A) gene, was associated with the somatic complaints domain of depression symptoms, with borderline genome-wide significance (pdiscovery = 3.82 × 10−8). The SNP was analysed in an additional five cohorts comprising the replication sample (6813 persons). However, the association was not consistent among the replication sample (pdiscovery+replication = 1.10 × 10−6) with evidence of heterogeneity.
Despite the effort to harmonize the phenotypes across cohorts and participants, our study is still underpowered to detect consistent association for depression, even by means of symptom classification. On the contrary, the SNP-based heritability and co-heritability estimation results suggest that a very minor part of the variation could be captured by GWAS, explaining the reason of sparse findings.
Nosocomial outbreaks of Legionnaires disease have been linked to contaminated water in hospitals. Immunocompromised patients are particularly vulnerable and, when infected, have a high mortality rate. We report the investigation of a cluster of cases of nosocomial pneumonia attributable to Legionella pneumophila serogroup 1 that occurred among patients on our stem cell transplantation unit.
We conducted a record review to identify common points of potential exposure, followed by environmental and water sampling for Legionella species from those sources. We used an air sampler to in an attempt to detect aerosolized Legionella and pulsed-field gel electrophoresis to compare clinical and environmental isolates.
The most likely sources identified were the water supply in the patients' rooms and a decorative fountain in the radiation oncology suite. Samples from the patients' rooms did not grow Legionella species. Cultures of the fountain, which had been restarted 4 months earlier after being shut off for 5 months, yielded L. pneumophila serogroup 1. The isolates from both patients and the fountain were identical by pulsed-field gel electrophoresis. Both patients developed pneumonia within 10 days of completing radiation therapy, and each reported having observed the fountain at close range. Both patients' infections were identified early and treated promptly, and both recovered.
This cluster was caused by contamination of a decorative fountain despite its being equipped with a filter and ozone generator. Fountains are a potential source of nosocomial Legionnaires disease despite standard maintenance and sanitizing measures. In our opinion, fountains present unacceptable risk in hospitals serving immunocompromised patients.
Shiga toxin-producing Escherichia coli (STEC) can cause serious disease in human beings. Ruminants are considered to be the main reservoir of human STEC infections. However, STEC have also been isolated from other domestic animals, wild mammals and birds. We describe a cross-sectional study of wild birds in northern England to determine the prevalence of E. coli-containing genes that encode Shiga toxins (stx1 and stx2) and intimin (eae), important virulence determinants of STEC associated with human disease. Multivariable logistic regression analysis identified unique risk factors for the occurrence of each virulence gene in wild bird populations. The results of our study indicate that while wild birds are unlikely to be direct sources of STEC infections, they do represent a potential reservoir of virulence genes. This, coupled with their ability to act as long-distance vectors of STEC, means that wild birds have the potential to influence the spread and evolution of STEC.
In 1990, Fontan, Kirklin, and colleagues published equations for survival after the so-called “Perfect Fontan” operation. After 1988, we evolved a protocol using an internal or external polytetraflouroethylene tube of 16 to 19 millimetres diameter placed from the inferior caval vein to either the right or left pulmonary artery along with a bidirectional cava-pulmonary connection. The objective of this study was to test the hypothesis that a “perfect” outcome is routinely achievable in the current era when using a standardized surgical procedure.
Between 1 January, 1988, and 12 December, 2005, 112 patients underwent the Fontan procedure using an internal or external polytetraflouroethylene tube plus a bidirectional cava-pulmonary connection, the latter usually having been constructed as a previous procedure. This constituted 45% of our overall experience in constructing the Fontan circulation between 1988 and 1996, and 96% of the experience between 1996 and 2005. Among all surviving patients, the median follow-up was 7.3 years. We calculated the expected survival for an optimal candidate, given from the initial equations, and compared this to our entire experience in constructing the Fontan circulation.
An internal tube was utilized in 61 patients, 97% of whom were operated prior to 1998, and an external tube in 51 patients, the latter accounting for 95% of all operations since 1999. At 1, 5, 10 and 15 years, survival of the entire cohort receiving polytetraflouroethylene tubes is superimposable on the curve calculated for a “perfect” outcome. Freedom from replacement or revision of the tube was 97% at 10 years.
Using a standardized operative procedure, combining a bidirectional cavopulmonary connection with a polytetraflouroethylene tube placed from the inferior caval vein to the pulmonary arteries for nearly all patients with functionally univentricular hearts, early and late survival within the “perfect” outcome as predicted by the initial equations of Fontan and Kirklin is routinely achievable in the current era. The need for late revision or replacement of the tube is rare.
During the 2004–2005 influenza season two independent influenza surveillance systems operated simultaneously in three United States counties. The New Vaccine Surveillance Network (NVSN) prospectively enrolled children hospitalized for respiratory symptoms/fever and tested them using culture and RT–PCR. The Emerging Infections Program (EIP) and a similar clinical-laboratory surveillance system identified hospitalized children who had positive influenza tests obtained as part of their usual medical care. Using data from these systems, we applied capture–recapture analyses to estimate the burden of influenza related-hospitalizations in children aged <5 years. During the 2004–2005 influenza season the influenza-related hospitalization rate estimated by capture–recapture analysis was 8·6/10 000 children aged <5 years. When compared to this estimate, the sensitivity of the prospective surveillance system was 69% and the sensitivity of the clinical-laboratory based system was 39%. In the face of limited resources and an increasing need for influenza surveillance, capture–recapture analysis provides better estimates than either system alone.
We show that if $k$ is a positive integer, then there are, under certain technical hypotheses, only finitely many coprime positive $k$-term arithmetic progressions whose product is a perfect power. If $4 \leq k \leq 11$, we obtain the more precise conclusion that there are, in fact, no such progressions. Our proofs exploit the modularity of Galois representations corresponding to certain Frey curves, together with a variety of results, classical and modern, on solvability of ternary Diophantine equations. As a straightforward corollary of our work, we sharpen and generalize a theorem of Sander on rational points on superelliptic curves.
The AS/AGU rat provides an alternative to experimentally produced laboratory models of basal ganglia
disorders. This mutant is characterised by disturbances of movement including clumsy gait, whole body
tremor, rigidity and difficulty in initiating movement. From an early age, there is a profound depletion of
extracellular dopamine in the dorsal caudate-putamen as measured via in vivo microdialysis; levels are only
10–20% of those found in the parent Albino Swiss (AS) strain. Subsequently a depletion of whole tissue
dopamine levels occurs and, later still, loss of dopaminergic cells in the substantia nigra pars compacta. The
dysfunction in movement and the nigrostriatal dopaminergic system are clearly linked, since movement can
be ameliorated by L-DOPA administration. Furthermore, there are depletions in glucose utilisation in several
regions of the basal ganglia circuitry, including the substantia nigra pars compacta, the subthalamic nucleus
and the ventrolateral thalamus. The AS/AGU rat represents a unique opportunity to investigate the
intrinsic factors controlling the integrity of dopaminergic systems and the recent successful positional cloning
of the agu gene will allow the molecular mechanisms underlying this interesting phenotype to be analysed.
The relationship between reproductive status and reproductive physiology was investigated in male Damaraland mole-rats Cryptomys damarensis, an eusocial rodent that exhibits a marked reproductive division of labour. Testicular anatomical and histological morphometrics, selected sperm motion parameters and measurements of circulating plasma testosterone were studied in 44 males (17 reproductive and 27 non-reproductive). Reproductive males were significantly larger than non-reproductive males. Testicular mass of reproductive males, corrected for body mass, was significantly larger than in non-reproductives. However, corrected testicular volume did not vary significantly between the two groups. Circulating plasma testosterone concentrations of reproductives and non-reproductives were not significantly different (reproductive males 201.5 ± 56.5 pg/l vs 187.5 + 91 pg/l for non-reproductive males). The quality of sperm was measured by the percentage of spermatozoa produced and the amount of immature sperm, and differed between the two groups. Reproductive males produced a greater proportion of motile sperm (77.8%) than non-reproductives (56.3%). Non-reproductive males were characterized by a greater proportion of immature sperm in the epididymis (79%) than the reproductives (25%). Interestingly, the spermatozoa of reproductive males were characterized by a greater percentage of head and tail defects. Oligospermia may be the result of a reduction in circulating follicle stimulating hormone, which acts upon the Sertoli cells of the seminiferous tubules, that in turn may be due to a lack of an opportunity to mate while in the confines of the colony in this obligate outbreeder.
We develop a rigorous theory of piezoacoustic phonon limited electron transport in bulk GaN and GaN-based heterostructures. Within the Boltzmann equation approach we derive a new expression for the momentum relaxation rate and show that the Pauli principle restrictions are comparable in importance to a screening effect at temperatures up to 150 K provided that the electron density is large. This is of particular importance for electrons in GaN/AlN-based quantum wells where very high electron densities initiated by the piezoelectric effect have recently been reported. Variations of the piezoacoustic phonon limited electron mobility with the lattice temperature and with the electron density for a zinc-blende and wurtzite GaN are presented.
Exposure of male Albino Swiss rats to the nonsteroidal antiandrogen
flutamide during the period from
gestational day (d) 10 to birth resulted in feminisation of the external
genitalia and the suppression of
growth of the male reproductive tract. In adulthood, testes were found to be
located in diverse positions.
True cryptorchidism occurred in 10% of cases, whereas 50% of testes descended
to the scrotum and 40%
were located in a suprainguinal ectopic region. Varying degrees of tubule
abnormality were seen in the testes
of flutamide-treated animals, ranging from completely normal tubules with full
spermatogenesis (and the
expected frequency of the stages of spermatogenesis) to severely abnormal
tubules lined with Sertoli cells
only. For each individual testis, the overall severity of tubule damage was
strongly correlated with its adult
location, with intra-abdominal testes worst affected and scrotally-located
testes least; only the latter
contained normal tubules. Similarly, intra-abdominal testes were the smallest
in weight and contained the
least testosterone. By contrast, postnatal treatment of male rats with flutamide
from birth to postnatal d 14
did not impair development of the external genitalia, the process of
testicular descent or adult
spermatogenesis. These findings confirm that androgen blockade during embryonic
with testicular descent but also demonstrate that (1) prenatal flutamide treatment
per se has a detrimental
effect on adult testis morphology but (2) the degree of abnormality of the
testes is strongly influenced by location.
Pulsed γ radiation from the Geminga pulsar was recorded by the COS B satellite from 50 MeV to 5 GeV between 1975 and 1982. It has been analysed to derive the source spectral properties as a function of time and phase. The two main peaks are separated by 0.50 ± 0.01 in phase. Significant pulsed emission has also been detected in both phase regions between the two main peaks. Significant spectral differences with phase have been found; the emission from the first peak is slightly softer than from the second one and the Interpeak 2 radiation is extremely soft. The first peak emission remained stable within the statistics over 7 years while the flux from the other phase intervals changed significantly with time. The phase dependence of the variability implies that all the observed source emission should be pulsed and that it consists of four discrete beams with different apertures and spectra. The beams characteristics are strikingly similar to those of four γ-ray beams generated by the Vela pulsar.
In Niger, uranium occurs in upper Palaeozoic and lower Mesozoic continental sedimentary basins west of the Aïr mountains, but the source of the uranium had not been identified. Geochemical studies and fissiontrack observations on alkaline ignimbrites preserved in two Palaeozoic anorogenic centres in Aïr show that uranium is concentrated in the matrix and on secondary iron-oxide coatings surrounding lithic and crystal fragments. Based on variable Th/U ratios and degree of oxidation, it is concluded that the original ignimbrite field was enriched in uranium, but that a considerable proportion was leached during the weathering of the volcanic pile. Tectonic uplift, anorogenic magmatism, followed by weathering and erosion of the volcanic cover, with sedimentation in nearby continental basins, have all contributed to the development of uranium mineralization in Niger. The petrological and geochemical similarities between the Palaeozoic ring complexes in Niger and the Nigerian Mesozoic ring structures suggest that sedimentary uranium deposits may also be found in Nigeria if the tectonic and sedimentological controls were favourable.
Enriched concentrations of uranium have been discovered in the exposed granitic roof zones of the Nigerian subvolcanic centres, with Th/U ratios approaching unity. Thus local vein deposits of uraninite, as well as dispersed uranium in recent sedimentary horizons, could be discovered particularly in the drainage systems entering the Chad Basin.
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