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To describe the investigation and control of a cluster of Serratia marcescens bacteremia in a 505-bed tertiary-care center.
Cluster cases were defined as all patients with S. marcescens bacteremia between March 2 and April 7, 2014, who were found to have identical or related blood isolates determined by molecular typing with pulsed-field gel electrophoresis. Cases were compared using bivariate analysis with controls admitted at the same time and to the same service as the cases, in a 4:1 ratio.
In total, 6 patients developed S. marcescens bacteremia within 48 hours after admission within the above period. Of these, 5 patients had identical Serratia isolates determined by molecular typing, and were included in a case-control study. Exposure to the post-anesthesia care unit was a risk factor identified in bivariate analysis. Evidence of tampered opioid-containing syringes on several hospital units was discovered soon after the initial cluster case presented, and a full narcotic diversion investigation was conducted. A nurse working in the post-anesthesia care unit was identified as the employee responsible for the drug diversion and was epidemiologically linked to all 5 patients in the cluster. No further cases were identified once the implicated employee’s job was terminated.
Illicit drug use by healthcare workers remains an important mechanism for the development of bloodstream infections in hospitalized patients. Active mechanisms and systems should remain in place to prevent, detect, and control narcotic drug diversions and associated patient harm in the healthcare setting.
Subjective reports of insomnia and hypersomnia are common in bipolar disorder (BD). It is unclear to what extent these relate to underlying circadian rhythm disturbance (CRD). In this study we aimed to objectively assess sleep and circadian rhythm in a cohort of patients with BD compared to matched controls.
Forty-six patients with BD and 42 controls had comprehensive sleep/circadian rhythm assessment with respiratory sleep studies, prolonged accelerometry over 3 weeks, sleep questionnaires and diaries, melatonin levels, alongside mood, psychosocial functioning and quality of life (QoL) questionnaires.
Twenty-three (50%) patients with BD had abnormal sleep, of whom 12 (52%) had CRD and 29% had obstructive sleep apnoea. Patients with abnormal sleep had lower 24-h melatonin secretion compared to controls and patients with normal sleep. Abnormal sleep/CRD in BD was associated with impaired functioning and worse QoL.
BD is associated with high rates of abnormal sleep and CRD. The association between these disorders, mood and functioning, and the direction of causality, warrants further investigation.
In the coastal mountain chain of southern Victoria Land approximately 4,000 km.2 of glacier-cut valleys and dividing ranges are almost completely ice-free, while the surrounding areas are fully glacierized.
In the ice-free Wright Valley and Victoria Valley systems evidence of four glaciations is recognized. The earliest two glaciations were the most extensive; glaciers flowed eastwards from the ice plateau through the coastal ranges and cut broad valleys extending to McMurdo Sound and the Ross Sea. The moraines of these glaciations are thin and highly weathered. The third glaciation was less extensive, consisting of advances by smaller glaciers derived from the inland ice plateau, the Wilson Piedmont Glacier and névé fields in the dividing ranges. The surfaces of moraines of this glaciation are now partly covered by saline lakes, evaporite deposits and extensive areas of desert pavements strewn with ventifacts. The fourth and youngest glaciation comprised small advances by remnants of the plateau-fed valley glaciers. Thick boulder moraines of this glaciation overlie earlier deposits.
During each glaciation the greatest volume of ice was derived from the inland ice plateau. The volume of ice entering the valleys was dependent on the difference in altitude between the plateau surface and subglacial rock thresholds at the valley heads. Decrease in the surface level of the inland ice plateau caused the rock thresholds to increasingly hinder the eastward flow of plateau ice until practically no ice could flow down into the valleys, thereby terminating the glaciation. Such a condition exists at the present time.
Accurate and complete reporting of study methods, results and interpretation are essential components for any scientific process, allowing end-users to evaluate the internal and external validity of a study. When animals are used in research, excellence in reporting is expected as a matter of continued ethical acceptability of animal use in the sciences. Our primary objective was to assess completeness of reporting for a series of studies relevant to mitigation of pain in neonatal piglets undergoing routine management procedures. Our second objective was to illustrate how authors can report the items in the Reporting guidElines For randomized controLled trials for livEstoCk and food safety (REFLECT) statement using examples from the animal welfare science literature. A total of 52 studies from 40 articles were evaluated using a modified REFLECT statement. No single study reported all REFLECT checklist items. Seven studies reported specific objectives with testable hypotheses. Six studies identified primary or secondary outcomes. Randomization and blinding were considered to be partially reported in 21 and 18 studies, respectively. No studies reported the rationale for sample sizes. Several studies failed to report key design features such as units for measurement, means, standard deviations, standard errors for continuous outcomes or comparative characteristics for categorical outcomes expressed as either rates or proportions. In the discipline of animal welfare science, authors, reviewers and editors are encouraged to use available reporting guidelines to ensure that scientific methods and results are adequately described and free of misrepresentations and inaccuracies. Complete and accurate reporting increases the ability to apply the results of studies to the decision-making process and prevent wastage of financial and animal resources.
The UK has seen a significant transition from Defined Benefit (“DB”) to Defined Contribution (“DC”) for occupational pension saving. The planned automatic enrolment program starting in 2012 is expected to increase the use of DC. The main features of DC are that investment risk falls onto the individual during the pre-retirement phase and that there are no guarantees as to investment returns or the level of pension. In July 2012, Steve Webb, the Pensions Minister, challenged industry to think hard about meeting the need for more certainty about pension savings in DC plans and to consider providing an affordable ‘Money Safe’ guarantee where the member would get back at least the nominal value of their contributions (individual, employer and tax relief). This paper explores whether this is viable for the mass market.
Positron annihilation spectroscopy has been used to profile the distribution of defects following implantation of 120keV Ge+ into (100) Si in the dose range l x 1010 - lx104 cm−2 . The openvolume defect profiles can be adequately fitted assuming a simple rectangular block distribution extending to 350nm. Using anodic oxidation and etching, a procedure is described which allows details of the defect tails beyond the range of the implanted ion, usually inaccessible to positron -2 annihilation measurements, to be determined. For a time averaged dose-rate (Jr) of 0.02μA cm−2 and incident angle of 7°, open-volume defects are found to exist at concentrations exceeding 1016cm−3 at depths upto 600nm whereas the peak of the depth distribution of the implanted ions (Rp) is 76nm, measured using SIMS. When the time-average dose-rate is increased by a factor of 10, defects persist at concentrations in excess of 1017cm−3 beyond lμm and the Rp increases to 101nm. The open-volume defect profiles are compared to those deduced from Rutherford backscattering-channeling using the fitting routine DICADA.
The evolution of defects in Czochralski and epitaxial p- and n-type silicon wafers following irradiation with He. Si or Ge ions at 80 K has been investigated by in situ deep level transient spectroscopy (DLTS). Defect annealing and formation reactions have been observed over the temperature range 80–350 K. In p-type silicon, new species-dependent levels are observed immediately after implantation, but these levels anneal out at or below room temperature. The wellknown divacancy and interstitial defects, usually reported after room temperature implantation, are revealed in the DLTS spectra only upon annealing at 160–200 K. In n-type silicon, vacancy-oxygen pairs are observed immediately after implantation. However, vacancy-related defects continue to form over a broad temperature range in samples implanted with Si or Ge. These observations are consistent with a model whereby vacancies and interstitials are released from defect clusters at temperatures >200 K to form divacancies and other defect pairs which are stable at room temperature.
We present out-diffusion of Zn in Si as a new method to study properties of Si vacancies. Out-diffusion experiments were performed on homogeneously Zn-doped Si samples at 1107°C and 1154°C. The resulting concentration-depth profiles were measured by means of spreading-resistance profiling. Based on a diffusion model in which Zn migrates simultaneously via the kick-out and the dissociative mechanism all experimental profiles were modeled by computer simulations. The calculations reveal that out-diffusion of Zn from Si occurs to a considerable extent via the dissociative mechanism. Hence, vacancy properties like the equilibrium concentration CVeq and the transport capacity CveqDV can be extracted from profile fittings. The results are compared with literature data deduced from in-diffusion experiments.
We have studied by SIMS the diffusion of boron in Ge-preamorphised silicon over a range of anneal temperatures and times, focusing on the influence of the depth of the boron profile relative to the crystalline-amorphous (c/a) interface. It is shown that, for all durations, transient enhanced diffusion (TED) occurs on both sides of the c/a interface. For short annealing times, the amplitude of TED varies by about two orders of magnitude between the surface and the end-of-range (EOR) defect band, formed just below the original c/a interface. We propose a model in which TED arises from the coupling between a Si-interstitial supersaturated « box », the EOR defect region, whose supersaturation decreases with time as the EOR defects grow, and a surface whose recombination efficiency is close to that of a perfect sink. The model successfully describes the different behavior of deep and shallow boron profiles, without requiring the existence of a diffusion barrier.
A wide range of well validated instruments is now available to assess voice quality and voice-related quality of life, but comparative studies of the responsiveness to change of these measures are lacking. The aim of this study was to assess the responsiveness to change of a range of different measures, following voice therapy and surgery.
Longitudinal, cohort comparison study.
Two UK voice clinics.
One hundred and forty-four patients referred for treatment of benign voice disorders, 90 undergoing voice therapy and 54 undergoing laryngeal microsurgery.
Main outcome measures:
Three measures of self-reported voice quality (the vocal performance questionnaire, the voice handicap index and the voice symptom scale), plus the short form 36 (SF 36) general health status measure and the hospital anxiety and depression score. Perceptual, observer-rated analysis of voice quality was performed using the grade–roughness–breathiness–asthenia–strain scale. We compared the effect sizes (i.e. responsiveness to change) of the principal subscales of all measures before and after voice therapy or phonosurgery.
All three self-reported voice measures had large effect sizes following either voice therapy or surgery. Outcomes were similar in both treatment groups. The effect sizes for the observer-rated grade–roughness–breathiness–asthenia–strain scale scores were smaller, although still moderate. The roughness subscale in particular showed little change after therapy or surgery. Only small effects were observed in general health and mood measures.
The results suggest that the use of a voice-specific questionnaire is essential for assessing the effectiveness of voice interventions. All three self-reported measures tested were capable of detecting change, and scores were highly correlated. On the basis of this evaluation of different measures' sensitivities to change, there is no strong evidence to favour either the vocal performance questionnaire, the voice handicap index or the voice symptom scale.
There is an increasing choice of voice outcome research tools, but good comparative data are lacking.
To evaluate the reliability and validity of three voice-specific, self-reported scales.
Longitudinal, cohort comparison study.
Two UK voice clinics: the Freeman Hospital, Newcastle upon Tyne, and the Glasgow Royal Infirmary.
One hundred and eighty-one patients presenting with dysphonia.
Main outcome measures:
All patients completed the vocal performance questionnaire, the voice handicap index and the voice symptom scale. For comparison, each patient's voice was recorded and assessed perceptually using the grade–roughness–breathiness–aesthenia–strain scale. The reliability and validity of the three self-reported vocal performance measures were assessed in all subjects, while 50 completed the questionnaires again to assess repeatability.
The results of the 170 participants with completed data sets showed that all three questionnaires had high levels of internal consistency (Cronbach's alpha = 0.81–0.95) and repeatability (voice handicap index = 0.83; vocal performance questionnaire = 0.75; voice symptom scale = 0.63). Concurrent and criterion validity were also good, although, of the grade–roughness–breathiness–aesthenia–strain subscales, roughness was the least well correlated with the self-reported measures.
The vocal performance questionnaire, the voice handicap index and the voice symptom scale are all reliable and valid instruments for measuring the patient-perceived impact of a voice disorder.
The northern Prince Charles Mountains overlook the western side of the 700 km long Lambert Glacier–Amery Ice Shelf drainage system. Within these mountains, at Amery Oasis (70°50′S, 68°00′E) and Fisher Massif (71°31′S, 67°40′E), the Cenozoic glaciomarine Pagodroma Group consists of four uplifted Miocene and Pliocene–early Pleistocene formations here named the Mount Johnston, Fisher Bench, Battye Glacier and Bardin Bluffs formations. These are composed of massive and stratified diamicts, boulder gravels and minor laminated sandstones, siltstones and mudstones. Each formation rests on either Precambrian metamorphic rocks, or on Permo-Triassic fluvial strata. The unconformity surfaces are parts of the walls and floors of palaeofjords. The Miocene Fisher Bench Formation exceeds 350 m in thickness at Fisher Massif, where the yet older Miocene (or Oligocene) Mount Johnston Formation overlies basement rocks at up to 1400 m above sea level. Individual formations contain either Miocene diatoms, or else Pliocene–early Pleistocene diatom-foram assemblages. The diamicts are interpreted as fjordal ice-proximal or ice-contact sediments, deposited seawards of tidewater glacier fronts located some 250 to 300 km inland of the present ocean margin. Each formation records an ice recession following a glacial expansion.
Most patients with the Mustard procedure are now adults. To date, however, there have been few reports on resting and exercise hemodynamics in a large population of adults with this circulation. The aim of this study is to describe such parameters in one of the largest and oldest populations of adults with the Mustard procedure. The database of the University of Toronto Congenital Cardiac Centre for Adults was examined to identify 84 adults with the Mustard procedure who have undergone cardiopulmonary exercise tests. Magnetic resonance imaging and echocardiography studies were obtained in order to assess right ventricular size, function and baseline hemodynamics. Patients achieved lower maximum uptake of oxygen, maximal heart rate, forced vital capacity, forced expiratory volume in 1 second, and oxygen saturations at maximal exercise compared to a healthy population. Magnetic resonance imaging showed significantly different right ventricular ejection fractions between patients and controls. There were no effects of operative variables or preoperative hemodynamics on current exercise capacity. Patients after the Mustard procedure have subnormal exercise capacities. Factors such as chronotropic incompetence, peripheral deconditioning, and impaired lung function may be responsible for these results.
The recent exposure of the plight of inmates living in poor conditions at the state asylum on the Greek island of Leros has caused public and professional outrage. If Greece is to avoid mistakes made by other countries, the plans for rehabilitating the patients and closing the hospital should from the outset include identification of the precise needs of patients for support and care. This survey of the patients' characteristics and needs for care found that most patients had no outside friends or relatives, and most were unable to perform basic daily skills. They shared many basic characteristics, however, with a large sample of the long-stay population in the UK, and 25% were thought to be able to live independently.
All serum transfers from donor rats or rabbits given single or multiple vaccinations of ultraviolet (u.v.)-attenuated Schistosoma japonicum cercariae conferred significant resistance against challenge to mice. Donors given 5 vaccinations, however, produced the most effective sera; rat sera giving up to 88% protection and rabbit sera up to 80%. This protective effect was species-specific and titratable. Sera from vaccinated rabbits and rats were were most effective when transferred to mice 2 h before challenge, but became progressively less effective when transferred with increasing time after challenge. These sera had no efficacy when given 6 days after challenge. Thus, sera from vaccinated rabbits and rats were effective against the early stage of migration, but did not necessarily have to act in the skin as all serum transfers were as effective against intraperitoneal as percutaneous challenge. By contrast, serum from multiply vaccinated mice had little or no protective effect when transferred to mice before challenge, but conferred 62% resistance when transferred 5 days after challenge. Further, there was an additive protective effect when vaccinated rat and mouse sera were given in combination at their optimum transfer times (days 0 and +5, respectively). Thus, there appears to be a stage-specific immune response induced by vaccination depending upon whether the vaccinated hosts are truly permissive or not. Vaccinated rats and rabbits respond to the early phase of migration and vaccinated mice make protective responses against the lung phase of migration.
Mice presensitized with SEA and subsequently injected with S. japonicum eggs into their lungs or liver developed pathology similar to that found in infected mice and were consequently resistant to challenge (average 33% and 53%, respectively). However, soluble egg antigens were also capable of inducing low levels of resistance in mice (average 22·5%), but intact eggs alone injected into the lungs, liver or subcutance tissues were not. Thus, prior sensitization to ‘marginally’ protective soluble egg antigens is necessary for egg induced resistance.
Single percutaneous immunizations of Fischer rats with 1000 ultra-violet attenuated Schistosoma japonicum cercariae induced 52–88% resistance to challenge 4 weeks later. Increasing this to 3 immunizations induced 90% resistance to challenge, and this level of protection remained undiminished for up to 40 weeks after vaccination. Rats vaccinated with gamma-irradiated S. mansoni cercariae were resistant to challenge with S. mansoni but not S. japonicum. Similarly rats vaccinated with u.v.-attenuated S. japonicum cercariae were not resistant to heterologous challenge. Thus irradiated vaccines are species-specific in both permissive and non-permissive hosts.