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To determine: (1) the incidence of incidental ‘mastoiditis’ reported on magnetic resonance imaging scans performed in patients with asymmetrical sensorineural hearing loss and/or unilateral tinnitus; (2) how many of those patients have actual otological pathology and/or require treatment; and (3) the financial implications of such a reporting practice.
Retrospective case series.
Between October 2015 and November 2016, 500 patients underwent magnetic resonance imaging of the internal auditory meatus to rule out cerebellopontine angle lesions. There was an incidental finding of increased mastoid signalling in 5.8 per cent (n = 29), of which 20.7 per cent (6 of 29) were reported as bilateral cases. The diagnosis of ‘mastoiditis’ was found in 39.7 per cent (29 of 73). None of these patients had any pathology identified clinically. Other significant pathology was identified in a further 8.8 per cent (n = 44).
The diagnosis of mastoiditis is primarily clinical. An incidental finding of high signalling in the mastoid region on magnetic resonance imaging is highly unlikely to represent actual clinical disease. In patients who are scanned for other reasons and who do not complain of otological symptoms, such findings are unlikely to require otolaryngology input.
Background: With advancements in technology, the use of video as a pedagogical method in medical education has gained in popularity, and may aid in teaching clinical skills. In the UBC MD program, videos have been used to assist in teaching the -neurological exam for several decades, but the currently available videos are outdated and not of contemporary quality. Methods: Drawing upon the cognitive theory of multimedia learning from Mayer and Moreno (2003) which describes methods to maximize learning by minimizing cognitive load, we developed a tool to systematically assess pedagogical videos. We inventoried twelve existing neurology videos and analyzed their use of methods such as weeding (removing extraneous information), signalling (visually highlighting important information), and chunking (grouping similar information together). Results: Generally, older videos had poor audiovisual quality that introduced extraneous load, while more current videos had higher production value, albeit inconsistent with the depth of their content. We therefore produced a new three-part neurological exam video series. We wrote storyboards, filmed with a focus on visually depicting the exam and findings, and edited to elucidate relevant physiological concepts. Conclusions: The end product has been adopted by the UBC MD program, and can be shared with other programs who may wish to adopt them.
Multidrug-resistant organisms (MDROs) are increasingly reported in residential care homes for the elderly (RCHEs). We assessed whether implementation of directly observed hand hygiene (DOHH) by hand hygiene ambassadors can reduce environmental contamination with MDROs.
From July to August 2017, a cluster-randomized controlled study was conducted at 10 RCHEs (5 intervention versus 5 nonintervention controls), where DOHH was performed at two-hourly intervals during daytime, before meals and medication rounds by a one trained nurse in each intervention RCHE. Environmental contamination by MRDOs, such as methicillin-resistant Staphylococcus aureus (MRSA), carbapenem-resistant Acinetobacter species (CRA), and extended-spectrum β-lactamse (ESBL)–producing Enterobacteriaceae, was evaluated using specimens collected from communal areas at baseline, then twice weekly. The volume of alcohol-based hand rub (ABHR) consumed per resident per week was measured.
The overall environmental contamination of communal areas was culture-positive for MRSA in 33 of 100 specimens (33%), CRA in 26 of 100 specimens (26%), and ESBL-producing Enterobacteriaceae in 3 of 100 specimens (3%) in intervention and nonintervention RCHEs at baseline. Serial monitoring of environmental specimens revealed a significant reduction in MRSA (79 of 600 [13.2%] vs 197 of 600 [32.8%]; P<.001) and CRA (56 of 600 [9.3%] vs 94 of 600 [15.7%]; P=.001) contamination in the intervention arm compared with the nonintervention arm during the study period. The volume of ABHR consumed per resident per week was 3 times higher in the intervention arm compared with the baseline (59.3±12.9 mL vs 19.7±12.6 mL; P<.001) and was significantly higher than the nonintervention arm (59.3±12.9 mL vs 23.3±17.2 mL; P=.006).
The direct observation of hand hygiene of residents could reduce environmental contamination by MDROs in RCHEs.
The aim of this study was to compare the dosimetric parameters and effects of simultaneous integrated boost (SIB) and traditional sequential electron boost, after helical tomotherapy, because of the lack of studies in this field in the current literature.
Computed tomographic data of 14 patients who received SIB in 2012–2015 were collected from Hong Kong Sanatorium & Hospital. New tomotherapy with SIB plans and tomotherapy with sequential boost plans were generated for each patient, and results were compared.
Conformation number, mean dose, dose received by 95% volume (both sides), ipsilateral lung volume receiving 20 Gy (V20) and skin dose (right side) were found to be significantly better for SIB (p<0·05), however coverage index and gross target volume dose showed no significant difference, and heart dose was significantly higher for SIB on the right side.
Tomotherapy with SIB may be able to offer less organ at risk dose (except for the heart), while maintaining the ability to deliver adequate dose coverage.
To study the association between gastrointestinal colonization of carbapenemase-producing Enterobacteriaceae (CPE) and proton pump inhibitors (PPIs).
We analyzed 31,526 patients with prospective collection of fecal specimens for CPE screening: upon admission (targeted screening) and during hospitalization (opportunistic screening, safety net screening, and extensive contact tracing), in our healthcare network with 3,200 beds from July 1, 2011, through December 31, 2015. Specimens were collected at least once weekly during hospitalization for CPE carriers and subjected to broth enrichment culture and multiplex polymerase chain reaction.
Of 66,672 fecal specimens collected, 345 specimens (0.5%) from 100 patients (0.3%) had CPE. The number and prevalence (per 100,000 patient-days) of CPE increased from 2 (0.3) in 2012 to 63 (8.0) in 2015 (P<.001). Male sex (odds ratio, 1.91 [95% CI, 1.15–3.18], P=.013), presence of wound or drain (3.12 [1.70–5.71], P<.001), and use of cephalosporins (3.06 [1.42–6.59], P=.004), carbapenems (2.21 [1.10–4.48], P=.027), and PPIs (2.84 [1.72–4.71], P<.001) in the preceding 6 months were significant risk factors by multivariable analysis. Of 79 patients with serial fecal specimens, spontaneous clearance of CPE was noted in 57 (72.2%), with a median (range) of 30 (3–411) days. Comparing patients without use of antibiotics and PPIs, consumption of both antibiotics and PPIs after CPE identification was associated with later clearance of CPE (hazard ratio, 0.35 [95% CI, 0.17–0.73], P=.005).
Concomitant use of antibiotics and PPIs prolonged duration of gastrointestinal colonization by CPE.
Carbapenem-resistant Acinetobacter baumannii (CRAB) with diverse multilocus sequence typing emerged among our nursing home residents (6.5%) with a high background rate of MRSA (32.2%). Rectal swabs yielded a higher rate of CRAB detection than axillary or nasal swabs. Bed-bound status, use of adult diapers, and nasogastric tube were risk factors for CRAB colonization.
To assess the effectiveness of infection control preparedness for human infection with influenza A H7N9 in Hong Kong.
A descriptive study of responses to the emergence of influenza A H7N9.
A university-affiliated teaching hospital.
Healthcare workers (HCWs) with unprotected exposure (not wearing N95 respirator during aerosol-generating procedure) to a patient with influenza A H7N9.
A bundle approach including active and enhanced surveillance, early airborne infection isolation, rapid molecular diagnostic testing, and extensive contact tracing for HCWs with unprotected exposure was implemented. Seventy HCWs with unprotected exposure to an index case were interviewed especially regarding their patient care activities.
From April 1, 2013, through May 31, 2014, a total of 126 (0.08%) of 163,456 admitted patients were tested for the H7 gene by reverse transcription-polymerase chain reaction per protocol. Two confirmed cases were identified. Seventy (53.8%) of 130 HCWs had unprotected exposure to an index case, whereas 41 (58.6%) and 58 (82.9%) of 70 HCWs wore surgical masks and practiced hand hygiene after patient care, respectively. Sixteen (22.9%) of 70 HCWs were involved in high-risk patient contacts. More HCWs with high-risk patient contacts received oseltamivir prophylaxis (P=0.088) and significantly more had paired sera collected for H7 antibody testing (P<0.001). Ten (14.3%) of 70 HCWs developed influenza-like illness during medical surveillance, but none had positive results by reverse transcription-polymerase chain reaction. Paired sera was available from 33 of 70 HCWs with unprotected exposure, and none showed seroconversion against H7N9.
Despite the delay in airborne precautions implementation, no patient-to-HCW transmission of influenza A H7N9 was demonstrated.
The large and optically clear embryos of the zebrafish provide an excellent model system in which to study the dynamic assembly of the essential contractile band components, actin and myosin, via double fluorescent labelling in combination with confocal microscopy. We report the rapid appearance (i.e. within <2 min) of a restricted arc of F-actin patches along the prospective furrow plane in a central, apical region of the blastodisc cortex. These patches then fused with each other end-to-end forming multiple actin cables, which were subsequently bundled together forming an F-actin band. During this initial assembly phase, the F-actin-based structure did not elongate laterally, but was still restricted to an arc extending ~15° either side of the blastodisc apex. This initial assembly phase was then followed by an extension phase, where additional F-actin patches were added to each end of the original arc, thus extending it out to the edges of the blastodisc. The dynamics of phosphorylated myosin light chain 2 (MLC2) recruitment to this F-actin scaffold also reflect the two-phase nature of the contractile apparatus assembly. MLC2 was not associated with the initial F-actin arc, but MLC2 clusters were recruited and assembled into the extending ends of the band. We propose that the MLC2-free central region of the contractile apparatus acts to position and then extend the cleavage furrow in the correct plane, while the actomyosin ends alone generate the force required for furrow ingression. This biphasic assembly strategy may be required to successfully divide the early cells of large embryos.
Based on X-ray photoelectron spectroscopy, Gd5Ge4(010) does not show evidence of surface segregation. Scanning tunneling microscopy reveals two types of terraces which alternate laterally on the surface. From the step heights, these two surface terminations are assigned as dense, Gd-pure layers in the bulk structure. There is evidence of reconstruction on one type of terrace.
Weed-suppressive soils contain naturally occurring microorganisms that suppress a weed by inhibiting its growth, development, and reproductive potential. Increased knowledge of microbe–weed interactions in such soils could lead to the identification of management practices that create or enhance soil suppressiveness to weeds. Velvetleaf death and growth suppression was observed in a research field (fieldA) that was planted with high populations of velvetleaf, which may have developed via microbial mediated plant–soil feedback. Greenhouse studies were conducted with soil collected from fieldA (soilA) to determine if it was biologically suppressive to velvetleaf. In one study, mortality of velvetleaf grown for 8 wk in soilA was greatest (86%) and biomass was smallest (0.3 g plant−1) in comparison to soils collected from surrounding fields with similar structure and nutrient content, indicating that suppressiveness of soilA was not likely caused by physical or chemical factors. When soilA was autoclaved in another study, mortality of velvetleaf plants in the heat-treated soil was reduced to 4% compared to 55% for the untreated soil, thus suggesting that suppressiveness of soilA is biological in nature. A third set of experiments showed that suppressiveness to velvetleaf could be transferred to an autoclaved soil by amending the autoclaved soil with untreated soilA; this provided additional evidence for a biological basis for the effects of soilA. The suppressive condition in these greenhouse experiments was associated with high soil populations of fusaria. Fusarium lateritium was the most frequently isolated fungus from roots of diseased velvetleaf plants collected from fieldA, and also was the most virulent when inoculated onto velvetleaf seedlings. Results of this research indicate that velvetleaf suppression can occur naturally in the field and that F. lateritium is an important cause of velvetleaf mortality in fieldA.
A novel MEMS technology using multi-layer poly-silicon (poly-Si) is proposed. The poly-Si film is formed from the new Nickel-Induced-Lateral-Crystallization (NILC) method and has very large grain (>10νm) and near crystal quality. 700 nm thermal oxide was grown on a Si wafer. 100 nm LPCVD amorphous Si was deposited and followed by a 50 Å Ni deposition. The a-Si was crystallized at 550°C for 65 hours and subsequent 800°C for 2 hours to form the first (lower) NILC poly-Si layer. N-channel TFTs were fabricated on the NILC polysilicon layer. The process was repeated and a second (upper) polysilicon layer and TFTs were formed on top of the first polysilicon layer.
The lower polysilicon has slightly larger grains and better material quality. Thin-film- transistors (TFT) fabricated on the 3-dimensional (3-D) poly-Si layers have I-V characteristics similar to (>40%) silicon-on-insulator TFTs. While TFTs on lower layer have better mobility and device properties, TFTs on upper layer have better uniformity. The accumulated heating and other effects have also been studied.
Nosocomial outbreaks of norovirus infection pose a great challenge to the infection control team.
Between November 1, 2009, and February 28, 2010, strategic infection control measures were implemented in a hospital network. In addition to timely staff education and promotion of directly observed hand hygiene, reverse-transcription polymerase chain reaction for norovirus was performed as an added test by the microbiology laboratory for all fecal specimens irrespective of the request for testing. Laboratory-confirmed cases were followed up by the infection control team for timely intervention. The incidence of hospital-acquired norovirus infection per 1,000 potentially infectious patient-days was compared with the corresponding period in the preceding 12 months, and the incidence in the other 6 hospital networks in Hong Kong was chosen as the concurrent control. Phylogenetic analysis of norovirus isolates was performed.
Of the 988 patients who were tested, 242 (25%) were positive for norovirus; 114 (47%) of those 242 patients had norovirus detected by our added test. Compared with the corresponding period in the preceding 12 months, the incidence of hospital-acquired norovirus infection decreased from 131 to 16 cases per 1,000 potentially infectious patient-days (P < .001 ), although the number of hospital-acquired infections was low in both the study period (n = 8) and the historical control periods (n = 11). The incidence of hospital-acquired norovirus infection in our hospital network (0.03 cases per 1,000 patient-days) was significantly lower than that of the concurrent control (0.06 cases per 1,000 patient-days) (P = .015). Forty-three (93%) of 46 norovirus isolates sequenced belonged to the genogroup II.4 variant.
Strategic infection control measures with an added test maybe useful in controlling nosocomial transmission of norovirus.
Lattice matched InP HEMT has demonstrated superior gain and noise figure performance compared to the AlGaAs HEMT and PHEMT. The gain and noise figure advantages of the InP HEMT have been transferred to the excellent MMIC performance in the millimeter-wave region.
The reaction of molybdenum trioxide dihydrate, MoO3·2H2O, with methanol produces the title compounds. That these molybdenum oxy-methoxides decompose with liberation of CH2O suggests that they represent exquisite models for selective oxidation of methanol to formaldehyde over molybdate catalysts. While a number of physical techniques have been employed to elucidate certain of their structural aspects, unfortunately, the detailed structures of these materials remain unknown. Problems, both physical and crystallographic, encountered in attempts to determine these structures are discussed. Also discussed is the recent progress made by employing the complimentary nature of electron and powder diffraction techniques.
Arsenic-rich InAs/InAs1−x Sbx strained-layer superlattices (SLS's) are studied in time-resolved optical, and CW magneto-optical spectroscopies. A pronounced type-II offset, with electrons confined to the alloy layers, is found. High radiative efficiencies at wavelengths well into the mid-IR, and the suppression of Auger recombination yield LED's operating at 3–10 μm. Present room temperature powers are ∼30 μW, probably limited by inadequate carrier confinement.
Conductive-polymer coated fabrics have been investigated as intelligent materials in the past years. In this paper, a flexible fabric strain sensor coated with polypyrrole is reported, which is featured with high sensitivity, good stability and large deformation. It is fabricated by chemical vapor deposition at low temperature. The effects of temperature, humidity, acid and alkaline medium have been assessed. The conductivity-strain tests reveal the sensor exhibits a high strain sensitivity of ~160 for a deformation as large as 50%, while its good stability is indicated by a small loss of conductivity after the thermal and humidity aging tests, and supported by the slight change in conductivity and sensitivity over a storage of eighteen months. The acid and alkaline solution mainly decreased their initial conductivity but have the slight effect to their sensitivity. The flexible fabric strain sensor is expected to be a promising “soft” smart material in the smart garment, wearable hardware and biomedical applications.
Patients with nasopharyngeal carcinoma may have residual cervical lymphadenopathy after definitive treatment of the primary tumour and regional cervical nodal disease. Whether such lymphadenopathy truly represents persistent disease is unclear. There are few published studies addressing this clinical problem.
We retrospectively and systematically reviewed the clinical records of 12 patients with nasopharyngeal carcinoma who had presented to a tertiary academic hospital, over an 11-year period, with suspected persistent cervical nodal disease after definitive radiotherapy or concurrent chemoradiotherapy. Findings on fine needle aspiration cytology and computed tomography scanning were correlated with final histopathological results.
The incidence of negative neck dissection was 41.7 per cent. The positive and negative predictive values of fine needle aspiration cytology in identifying disease were 100 and 42.9 per cent, respectively. Computed tomography scanning had a positive predictive value of 58.3 per cent in identifying disease.
In patients treated definitively for nasopharyngeal carcinoma, residual cervical lymphadenopathy may not represent persistent disease. Head and neck surgeons involved in the management of these patients should bear in mind the current limitations of fine needle aspiration cytology and computed tomography in confirming the diagnosis pre-operatively. Salvage neck dissection may over-treat some of these patients.
We report a case of otogenic fungal pachymeningitis in a diabetic patient who presented with multiple cranial nerve palsies and nasopharyngeal swelling.
We present a case report, we describe the investigations, management and clinical course of fungal pachymeningitis, and we present a review of the world literature on fungal and non-fungal pachymeningitis.
To our knowledge, this is the first report of fungal pachymeningitis with magnetic resonance imaging features suggestive of nasopharyngeal carcinoma. It is also the first reported case with aspergillus cultured from both a dural biopsy and the ear canal.
Fungal pachymeningitis is a rare condition which may present to otorhinolaryngologists. Its clinical and radiological findings can be confused with those of nasopharyngeal carcinoma; fungal pachymeningitis should thus be included in the differential diagnosis of nasopharyngeal carcinoma.
Hand, foot and mouth disease (HFMD) is generally a benign febrile exanthematous childhood disease caused by human enteroviruses. The route of transmission is postulated to be faeco-oral in developing areas but attributed more to respiratory droplet in developed areas. Transmission is facilitated by the prolonged environmental survival of these viruses and their greater resistance to biocides. Serious outbreaks with neurological and cardiopulmonary complications caused by human enterovirus 71 (HEV-71) seem to be commoner in the Asian Pacific region than elsewhere in the world. This geographical predilection is unexplained but could be related to the frequency of intra- and inter-typic genetic recombinations of the virus, the host populations' genetic predisposition, environmental hygiene, and standard of healthcare. Vaccine development could be hampered by the general mildness of the illness and rapid genetic evolution of the virus. Antivirals are not readily available; the role of intravenous immunoglobulin in the treatment of serious complications should be investigated. Monitoring of this disease and its epidemiology in the densely populated Asia Pacific epicentre is important for the detection of emerging epidemics due to enteroviruses.