Performance of the ImmunoCard STAT! E. coli O157:H7 test for detection of Escherichia coli O157:H7 in stools

ImmunoCard STAT! E. coli O157:H7 (Meridian Diagnostics, Inc., Cincinnati, Ohio) is a novel rapid (10-min) test for the presence of Escherichia coli O157:H7 in stools. The test may be performed either directly on stool specimens or on an overnight broth culture of stool. In a multicenter prospective study, 14 of 14 specimens positive by culture for E. coli O157:H7 were positive by the ImmunoCard STAT! O157:H7 test, and there were no false positives from 263 culture-negative specimens. In a retrospective study, the test was positive in 339 (81%) of 417 stored culture-positive specimens and the specificity was 95% (98 of 103 specimens). No false positives were associated with alternate stool pathogens. The ImmunoCard STAT! O157:H7 test has high sensitivity and specificity.

Cost-effectiveness analysis of case management versus a routine community care organization for patients with chronic schizophrenia

This article reports the economic analysis of a study on the implementation of case management in the Community Psychiatric Nursing Service (CPNS) caring for chronic schizophrenic clients in Hong Kong. The purpose of the study was to compare the outcome of case management service with the conventional practice CPNS. Sixty-two subjects participated in the analysis. Cost-effectiveness analysis showed that case management costs more in Hong Kong $3,600 (US$450) per person and that over a 5-month period, case management was associated with improvements in psychological and functional outcomes and patient satisfaction. The results of this study will inform policy makers about resource allocation and policy development in the implementation of case management for the care of mentally ill clients.

A comparison of the diagnostic utility of two image receptors for panoramic radiography

OBJECTIVE

To compare the diagnostic utility of two screen-film systems for panoramic radiography, one based on green and the other on ultraviolet light.

MATERIALS AND METHODS

Two hundred consecutive adult patients with teeth in all four quadrants requiring panoramic radiographs were randomly allocated to one of two groups. One group was imaged with OGA L (CEA AB, Strängnäs, Sweden) film using Lanex Regular (Eastman Kodak, Rochester, NY, USA) screens (the Lanex group). The other group was imaged using Ultra-Vision (Dupont UK Limited, Hertfordshire, UK) film and screens (the Ultra-vision group). Two different panoramic machines were used, a Planmeca (Planmeca OY, Helsinki, Finland) and Cranex (Soredex Orion Corporation, Helsinki, Finland). The radiographs were evaluated by two radiographers for overall quality and any faults recorded. Two dental radiologists evaluated the crestal and apical areas of every standing tooth on a 4-point scale. The likelihood of getting a high-quality image with the different films was modelled using logistic regression, adjusting for the radiologist and the area of the tooth being examined. Inter- and intra-examiner agreement was calculated using Kappa and weighted Kappa where appropriate.

RESULTS

The radiographers recorded no significant differences in positioning errors between the two groups of film. However, the films produced on the Cranex were less likely to be recorded as excellent. The radiologists' interexaminer agreement for the lower molars and upper incisors was only moderate at best (kappa = 0.56). No significant differences were found between the likelihood of the two types of film providing a high-quality image. Crestal areas were more likely to be scored well than apical areas.

CONCLUSION

There were no differences in ease of discerning apical and crestal areas between the two screen-film systems. There was only poor to moderate agreement between the two radiologists. Ultra-Vision can be recommended as an alternative to existing rare earth systems for panoramic radiography.

Unenhanced helical CT for renal colic--is the radiation dose justifiable?

AIM

The purpose of this study was to define and compare the radiation doses to patients undergoing computed tomography (CT) or intravenous urography (IVU) for the investigation of renal colic.

METHODS

The IVU dose was calculated from dose area product measurements for 27 abdominal films (AXR) and a review of 30 IVUs performed to investigate renal colic. The effective dose to a patient undergoing CT was calculated using anthropomorphic model data. Fifty patients underwent CT for the investigation of renal colic over a 6-week period.

RESULTS

CT following our protocol confers an average effective dose of 4.7 mSv. An IVU to investigate renal colic used 2.5 AXRs. A 3 film IVU gives an average dose of 1.5 mSv. Forty-two CT examinations were abnormal and the findings are described in the text.

CONCLUSION

Although unenhanced CT confers diagnostic advantages and avoids the risks of intravenous contrast medium, this should be considered against the increased radiation dose to the patient which in our institution is over three times that of an IVU.

Incidence and predictors of central venous catheter related infection in intensive care patients

This study investigated the incidence of and risk factors for central venous catheter (CVC) infection in intensive care. CVCs were prospectively studied in patients who had lines inserted in general or neurosurgical intensive care and were expected to have the line in situ for at least 72 hours. Catheters (n = 119) were cultured for CVC-related infection (CRI; > 15 colony forming units) and blood cultures done when indicated. CRI was identified in 32 (26.9%) catheters, CVC related bacteraemia in five cases (4.2%) and CVC related sepsis in none. After adjustment for duration of catheterization, independent predictors of CVC related infection were catheter insertion site, with jugular sites having the highest risk, and primary diagnosis, with neurosurgical patients at least risk.

Sleep, anxiety, and depression in abstinent and drinking alcoholics

A group of alcoholic men were followed-up 8 years after discharge from hospital. The interview included items on sleep, anxiety, and depression. The sample was divided into abstinent and drinking subjects. Sleep data were factor analyzed. Only the Alcohol-Abstinence Sleep Factor significantly correlated with drinking status. The Alcohol-Abstinence Sleep Factor was also the primary correlate of anxiety and depression. Fewer abstinent subjects reported anxiety and depression. Sleep variables, anxiety, and depression are considered as possible markers of relapse in persons treated for alcoholism.

Individual mating success, lek stability, and the neglected limitations of statistical power

The evolution of leks (aggregations of males displaying to females) cannot be explained solely by an increasing average gain in matings for each male as group size increases. This is because the mating skew, that is, the inequality among males in mating success, is often high and may vary with lek size. Here, we show that the common observation that matings become more evenly divided as lek size increases is also insufficient to explain by itself the benefits of aggregating. The benefits to individual males are highly sensitive to the exact relationship between mating skew and lek size, and very similar relationships can lead to opposite predictions concerning individual benefits. With data on published mating success for 18 species (71 leks), we show that different species have very similar skew versus lek size relationships. With current sample sizes, however, there is insufficient statistical power to distinguish between completely different alternatives concerning individual optima of males. Copyright 1998 The Association for the Study of Animal Behaviour

Distribution of neuronal apoptosis inhibitory protein-like immunoreactivity in the rat central nervous system

We have recently shown that spinal muscular atrophy (SMA), an autosomal recessive disorder characterized by motor neuron loss, is associated with deletion of a gene that encodes the neuronal apoptosis inhibitory protein (NAIP). In the present study, we have examined the distribution of NAIP-like immunoreactivity (NAIP-LI) in the rat central nervous system (CNS) by using an affinity-purified polyclonal antibody against NAIP. In the forebrain, immunoreactive neurons were detected in the cortex, the hippocampus (pyramidal cells, dentate granule cells, and interneurons), the striatum (cholinergic interneurons), the basal forebrain (ventral pallidum, medial septal nucleus, and diagonal band), the thalamus (lateral and ventral nuclei), the habenula, the globus pallidus, and the entopenduncular nucleus. In the midbrain, NAIP-LI was located primarily within neurons of the red nucleus, the substantia nigra pars compacta, the oculomotor nucleus, and the trochlear nucleus. In the brainstem, neurons containing NAIP-LI were observed in cranial nerve nuclei (trigeminal, facial, vestibular, cochlear, vagus, and hypoglossal nerves) and in relay nuclei (pontine, olivary, lateral reticular, cuneate, gracile nucleus, and locus coeruleus). In the cerebellum, NAIP-LI was found within both Purkinje and nuclear cells (interposed and lateral nuclei). Finally, within the spinal cord, NAIP-LI was detected in Clarke's column and in motor neurons. Taken together, these results indicate that NAIP-LI is distributed broadly in the CNS. However, high levels of NAIP-LI were restricted to those neuronal populations that have been reported to degenerate in SMA. This anatomical correspondence provides additional evidence for NAIP involvement in the neurodegeneration observed in acute SMA.

Reduction of extremity dose in the radiopharmacy

With the future introduction of legislation originating from ICRP60 in mind, the operating procedures for the radiopharmacy were reviewed, with the intention of reducing extremity radiation dose. The radiopharmacist's index fingertip dose was measured using TLDs. The radiopharmacist received a mean dose of 0.7 mSv per 10 GBq of administered activity for the right (non-dominant hand) index finger and 0.2 mSv per 10 GBq for the left (dominant hand) index finger. These doses were comparable with other publications. The radiopharmacist received the largest part of the radiation dose during the preparation of 99Tc(m)-MDP. During this preparation, the saline was withdrawn into a syringe already containing 99Tc(m)-eluate, which results in a dose to the fingers. The technique was changed so that the saline and 99Tc(m)-eluate were withdrawn and injected separately into a MDP kit. This reduced the right finger radiation dose to 0.4 mSv per 10 GBq, while the left finger radiation dose remained at 0.2 mSv per 10 GBq. This shows that radiation doses can be effectively reduced using simple changes in procedure.

A multicopy transcription-repair gene, BTF2p44, maps to the SMA region and demonstrates SMA associated deletions

The childhood-onset spinal muscular atrophies are a clinically heterogeneous group of autosomal recessive disorders characterized by selective degeneration of the anterior horn cells with subsequent weakness and atrophy of limb muscles. The disease locus has been mapped to a region of chromosome 5q13 characterized by genetic instability and DNA duplication. Among the duplicated genes in this region, SMNT (telomeric copy; survival motor neuron) is thought to be the major disease determining gene since it is missing in the majority of SMA patients and since small, intragenic mutations in the gene have been associated with the disorder. Approximately half of the severely affected SMA I patients are also missing both homologues of a neighboring gene, the neuronal apoptosis inhibitory protein (NAIP). These data indicate that loss of NAIP may affect disease severity and further, that the molecular events underlying the childhood-onset SMAs are complex, possibly involving multiple genes. We report a third multicopy gene in the SMA region, encoding the p44 subunit of basal transcription factor II (BTF2p44). One copy of this transcription-repair gene is deleted in at least 15% of all SMA cases.

A primer pair for amplifying part of the genome of all potyvirids by RT-PCR

Sequence analysis was used to design a pair of degenerate oligonucleotide primers that amplified a 1.6-2.1 kbp fragment from the 3' end of the genome (virion protein gene and part of the NIb gene) of 17 species of the Potyviridae ('potyvirids'); 11 potyviruses, 2 bymoviruses, 2 macluraviruses, an ipomovirus and a rymovirus. The 'potyvirid primer 1' hybridizes to the 3' terminal poly-A region of the genome, and 'potyvirid primer 2' to the genomic region encoding the-GNNSGQ-motif of the NIb protein. Database searches showed that the potyvirid 2 primer is specific for potyvirids. Associated analyses indicated that the published amino acid sequence of part of the wheat streak mosaic rymovirus NIb protein is probably incorrect in part.

Prevalence of Dientamoeba fragilis antibodies in children and recognition of a 39 kDa immunodominant protein antigen of the organism

Dientamoeba fragilis, a common intestinal protozoan parasite in Canada, has been associated with diarrhoea and abdominal pain in some patients. Seroprevalence of this organism has not been reported previously. In the present study sera from three symptomatic patients, 12 age- and sex-matched controls, and 189 randomly selected healthy individuals (age 6 months to 19 years) were tested for antibodies against Dientamoeba fragilis by an indirect immunofluorescence (IIF) assay. All three symptomatic patients infected with Dientamoeba fragilis had positive IIF titres of 80, and all 12 matched controls had positive titres ranging 20 to 160 (geometric mean titre 48). Of the 189 healthy children, 172 (91%) were positive at a serum dilution of 1:10 or higher. The specificity of the IIF assay was reinforced by immunoblotting 20 representative serum samples against Dientamoeba fragilis. In all 17 IIF-positive serum samples, a 39 kDa protein band of Dientamoeba fragilis was identified, the same band recognized by a mouse monoclonal antibody raised in our laboratory. Findings over a five-year period indicate that Dientamoeba fra-gilis was the most common protozoan, followed closely by Giardia lamblia and more distantly by Cryptosporidium parvum. The high seropositivity of 91% for Dientamoeba fragilis compares reasonably well with serologic data obtained by IIF and reported previously for Giardia lamblia (85.6%) and Cryptosporidium parvum (86%).

Attributes of nurses that determine the quality of care for mentally handicapped people in an institution

This is an ethnographic study that examines, from the relatives' perspective, the attributes of nurses that are considered important in the caring process of mentally handicapped people in an institutional setting in Hong Kong. Twelve interviews were carried out with a family member who had a relative living in a special unit for severely mentally handicapped people. Empirical studies, mainly from the west, have shown that decisions to place a mentally handicapped family member in residential care is a complex process. Family characteristics, the relatives' characteristics as well as the availability of support, have been found to influence decisions about out-of-home placement. Once this decision has been made, a new caring relationship between nurse, family and relative needs to be established. The final categories that emerged from the data show that families have expectations about the nurses' competence and commitment to the job and about their relationships with the client and the family. Consequently quality is judged, not only by the way in which nurses work with the clients, but also by the way in which they work with the family. Implications for practice and education of nurses working with mentally handicapped people and for nursing administration in Hong Kong are discussed.

Hemostasis-altering drugs and central neural block. A survey of anesthetic practice in Scotland and the United Kingdom

BACKGROUND AND OBJECTIVES

There is debate regarding the use of central neural block in the presence of hemostasis-altering drugs. This study aims to examine current practice.

METHODS

A survey was made of the members of the Scottish Society of Anaesthetists and the U.K. branch of the European Society of Regional Anaesthesia to determine the pattern of use of central neural block in patients who are receiving drugs known to alter hemostasis.

RESULTS

Spinal anesthetics were considered safer than single epidural injections (P < .05) and single epidural injections safer than infusions via epidural catheters (P < .05).

CONCLUSIONS

There is general agreement regarding contraindication of central neural block in the presence of full anticoagulation with either heparin or warfarin, but there is less consensus about the use of central neural block in the presence of low-dose subcutaneous heparin. There is some confusion about the role of aspirin and its duration of action.

The association between mortality rates and decreased concentrations of interleukin-10 and interleukin-1 receptor antagonist in the lung fluids of patients with the adult respiratory distress syndrome

OBJECTIVES

To determine the relation between 1) intra-alveolar concentrations of the proinflammatory cytokines (tumor necrosis factor, interleukin-1 beta, and interleukin-8) and the anti-inflammatory cytokines (interleukin-10 and interleukin-1 receptor antagonist) in patients with early adult respiratory distress syndrome (ARDS) and 2) subsequent patient mortality rates.

DESIGN

Prospective cohort study.

SETTING

University medical center.

PATIENTS

28 consecutive patients in whom ARDS was prospectively identified during hospitalization and 9 ventilated controls.

MEASUREMENTS

Concentrations of proinflammatory cytokines and anti-inflammatory cytokines in bronchoalveolar lavage fluid.

RESULTS

The concentrations of proinflammatory and anti-inflammatory cytokines within the alveolar air spaces were significantly elevated in patients with ARDS compared with controls (P = 0.01 for tumor necrosis factor [median, 90 pg/mL (range, 0 to 2500 pg/mL) for patients with ARDS; median, 0 pg/mL (range, 0 to 118 pg/mL) for controls]; P = 0.001 for interleukin-1 beta [median, 179 pg/mL (range, 0 to 2200 pg/mL) for patients with ARDS; median, 0 pg/mL (range, 0 to 80 pg/mL) for controls]; P = 0.0001 for interleukin-8 [median, 628 pg/mL (range, 0 to 4700 pg/mL) for patients with ARDS; median, 0 pg/mL (range, 0 to 278 pg/mL) for controls]; P = 0.0005 for interleukin-10 [median, 100 pg/mL (range, 0 to 1600 pg/mL) for patients with ARDS; median, 0 pg/mL (range, 0 to 50 pg/mL) for controls], and P = 0.002 for interleukin-1 receptor antagonist [median, 820 pg/mL (range, 0 to 18,900 pg/mL) for patients with ARDS; median, 50 pg/mL (range, 0 to 240 pg/mL) for controls]). A highly significant correlation was found between low concentrations of anti-inflammatory cytokines and subsequent patient mortality rates (P = 0.003 for interleukin-10 [median, 120 pg/mL (range, 30 to 1600 pg/mL) for survivors; median, 40 pg/mL (range, 0 to 110 pg/mL) for nonsurvivors]; P = 0.008 for interleukin-1 receptor antagonist [median, 1600 pg/mL (range, 80 to 18,900 pg/mL) for survivors; median, 90 pg/mL (range, 0 to 3400 pg/mL) for nonsurvivors. No significant correlation was found between the concentrations of the proinflammatory cytokines and mortality rates.

CONCLUSION

Low concentrations of the anti-inflammatory cytokines interleukin-10 and interleukin-1 receptor antagonist in bronchoalveolar lavage fluid obtained from patients with early ARDS are closely associated with poor prognosis. These findings support the hypothesis that failure to mount a localized intrapulmonary anti-inflammatory response early in the pathogenesis of ARDS contributes to more severe organ injury and worse prognosis. Our findings suggest that augmenting anti-inflammatory cytokine defenses would be a beneficial therapeutic approach to patients with ARDS and other inflammatory diseases.

The use of factor analysis for ascertaining patterns of psychopathology in children with intellectual disability

The Developmental Behaviour Checklist (DBC) was developed to assess psychopathology in children with intellectual disabilities. A cut-off point between "non-cases' and "cases' was determined by comparison of the total scores with psychiatric clinical assessment. This paper describes a method aimed at determining the types of psychiatric problems in those regarded as "cases'. Factor analysis with varimax rotation carried out on a sample of 1093 subjects extracted six factors. Standardized factor scores were calculated for each subject in a community sample (n = 450), and the only or the dominant positive score was determined for each of the "cases'. Over 80% of "cases' could be allotted to one condition. Only a small number had none, or three or more conditions. The same procedure was replicated on a validation sample (n = 448) with even more satisfactory results. Differences in the prevalence of the six conditions by sex, age and level of mental retardation were ascertained. The validity and clinical relevance of this method are discussed.

Comparison of rectal, axillary, and forehead temperatures

OBJECTIVE

To assess whether axillary and forehead temperatures accurately reflect the rectal temperature (the criterion standard)

DESIGN

Prospective study with calculation of paired axillary-rectal and forehead-rectal temperature differences and their SDs.

SETTING

Referral hospital.

PARTICIPANTS

Convenience sample of 120 patients, with 20 patients in each of six age groups (ie, < 1 month, 1 to 5 months, 6 to 11 months, 12 to 23 months, 2 to 14 years, and adults)

RESULTS

In newborns, the rectal temperature was equal to the axillary temperature plus 0.2 degrees C for each week of age up to 5 weeks; forehead strip thermometers gave inaccurate readings in this age group. In patients older than 1 month, the mean difference (SD) between the rectal and axillary temperatures was 1.04 degrees C (0.45 degrees C); thus the axillary temperature was adjusted by adding 1 degree C, and no adjusted axillary temperature differed from the rectal temperature by more than 1 degree C. The mean difference (SD) between the forehead temperature that was measured by the best forehead liquid crystal strip thermometer (FeverScan) and the rectal temperature was 0.14 degrees C (0.60 degrees C); 10 forehead temperatures differed from the rectal temperature by more than 1 degree C.

CONCLUSIONS

Previous studies that have suggested that axillary and forehead temperatures do not provide a reliable guide to the rectal temperature have all used inappropriate methods of analysis (correlation coefficients or sensitivity and specificity); previous studies that have based their conclusions on the correct method of analysis (paired differences and their SDs) have all found that the axillary temperature gives a good indication of the rectal temperature. The axillary temperature can be measured safely at any age, and the axillary temperature plus 1 degree C is a good guide to the rectal temperature in patients older than 1 month. Forehead strip thermometers are easy to use, but they do not estimate the rectal temperature as accurately as the axillary temperature does.