Heterogeneity in Trail Making Test performance in OEF/OIF/OND veterans with mild traumatic brain injury

This study used cluster analysis to examine variability in Trail Making Test (TMT) performance in a sample of Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn (OEF/OIF/OND) veterans referred for mild traumatic brain injury (mTBI). Three clusters were extracted, two of which were characterized by level of performance and the third with a unique performance pattern characterized by slow performance on the TMT B (Low B). Clusters did not differ on demographic or psychiatric variables. The Above Average cluster had better performance on measures of processing speed, working memory, and phonemic fluency compared with the Low B cluster. Results suggest that a subset of patients with mTBI perform poorly on TMT B, which subsequently predicts poorer cognitive functioning on several other neuropsychological measures. This subset may be vulnerable to cognitive changes in the context of mTBI and multiple comorbidities while a number of other patients remain cognitively unaffected under the same circumstances.

Underwater behavior of sperm whales off Kaikoura, New Zealand, as revealed by a three-dimensional hydrophone array

Observations are presented of the vocal behavior and three dimensional (3D) underwater movements of sperm whales measured with a passive acoustic array off the coast of Kaikoura, New Zealand. Visual observations and vocal behaviors of whales were used to divide dive tracks into different phases, and depths and movements of whales are reported for each of these phases. Diving depths and movement information from 75 3D tracks of whales in Kaikoura are compared to one and two dimensional tracks of whales studied in other oceans. While diving, whales in Kaikoura had a mean swimming speed of 1.57 m/s, and, on average, dived to a depth of 427 m (SD = 117 m), spending most of their time at depths between 300 and 600 m. Creak vocalizations, assumed to be the prey capture phase of echolocation, occurred throughout the water column from sea surface to sea floor, but most occurred at depths of 400-550 m. Three dimensional measurement of tracking revealed several different "foraging" strategies, including active chasing of prey, lining up slow-moving or unsuspecting prey, and foraging on demersal or benthic prey. These movements provide the first 3D descriptions underwater behavior of whales at Kaikoura.

First field records of Pachycrepoideus vindemiae as a parasitoid of Drosophila suzukii in European and Oregon small fruit production areas

Drosophila suzukii (Matsumura) (Diptera: Drosophilidae) is a destructive crop pest native to Southeast Asia that recently invaded countries in Europe and North America, severely impacting commercial fruit production in its new host range. Here we report the results of a survey aimed at determining the presence of indigenous D. suzukii parasitoid populations carried out from May to October 2012 in two areas negatively affected by this fruit pest: Trento Province, Northern Italy, and Oregon in the Pacific Northwest of the USA. We conducted field and laboratory studies in order to determine the status of biological control agents utilizing D. suzukii as a host. Our study sites included a range of commercial soft fruits and natural non-commercial habitats. In each site, sentinel traps were baited with either D. suzukii or Drosophila melanogaster Meigen (Diptera: Drosophilidae) larvae in different food substrates. The generalist parasitoid, Pachycrepoideus vindemiae (Rondani) (Hymenoptera: Pteromalidae), was collected from both D. suzukii and D. melanogaster pupae in traps deployed in a selection of these sites. This report of P. vindemiae in 2012 represents the first identification of D. suzukii parasitoids in Europe. A successive parasitism efficacy test was set up under controlled laboratory conditions confirming the ability of P. vindemiae to attack D. suzukii pupae. In addition, an historical digression with analysis of the original documents in the Italian archives has been provided in order to unravel the correct species name. We finally discuss the possible practical implications of this finding for the biological control of D. suzukii.

Negotiating hope with chronic obstructive pulmonary disease patients: a qualitative study of patients and healthcare professionals

BACKGROUND

The information needs of patients with chronic obstructive pulmonary disease (COPD) towards the end of life are poorly understood.

AIM

This study explored the views of patients with COPD and healthcare professionals, focusing upon information needs and treatment preferences.

METHOD

In-depth, semi-structured interviews were held with patients with COPD following admission to hospital with respiratory failure, and focus groups held with healthcare professionals from hospital and community settings.

RESULTS

Ten patients were interviewed, who had a median 4 previous hospital admissions, and had smoked for median 47 years. Five focus groups were held with 31 healthcare professionals (18 nurses, 7 doctors, 6 allied health). The theme underpinning all discussions was of tension between maintaining hope and negotiating the reality of the illness and its consequences. Within this theme, patients tended to be optimistic, viewed acute exacerbations as separate from their underlying chronic illness, and were keen for intensive treatments, including intubation if acutely unwell. They had little understanding of the complexities of decision-making around treatment escalation. Both patients and health workers believed that information around end of life should be offered routinely, but delivered in a manner that recognises and maintains a form of hope.

CONCLUSION

Patients and healthcare professionals believe information around illness course, future goals and treatment is important to care. An expanded view of hope may assist when providing such information, including when discussing goals of care in the setting of advanced illness.

The value of enrichment to reintroduction success

Reintroduction attempts have faced low, albeit improving, success rates, especially for threatened and endangered species reintroduced from captivity to the wild. This is not only a concern for conservation, as the low success of reintroduction also implies an animal welfare issue for the individuals concerned. Success rates are particularly low for species that live in complex social structures, require greater training during development, and exhibit higher levels of intelligence. Aside from mitigating the original cause of a species extirpation from an area, behavior factors arguably represent the most important aspect influencing an animal's survival following reintroduction. Indeed, we previously recommended using behavioral indicators for determining relative reintroduction success, especially as practitioners develop and compare protocols or if survivorship is difficult to gauge. Strategic enrichment programs targeted toward developing specific skills important for survival in the wild promise to improve reintroduction success by providing individuals with opportunities to develop and improve behavioral skills, such as avoiding predation, foraging (especially for predators and primates), interacting in social groups, courtship and mating, habitat selection, and learning movement and migration routes. Enrichment also improves the physical condition of most individuals, which should also increase reintroduction success. Last but not least, such programs offer the prospect of improved animal welfare both pre- and post-release. We explore how behavioral enrichment has influenced reintroduction success and welfare in a variety of different species.

[Laboratory survey on the incidence of Pneumocystis jirovecii - obviously a peculiar fungus, but also a rare pathogen?]

Pneumocystsis jirovecii is a peculiar fungus for a variety of reasons. This opportunistic pathogen multiplies in humans only under certain conditions; a defect in the T-cell defense system creates a predisposition to this infection. In 2010 a data survey (IFT as well as PCR) from a few laboratories in Germany revealed 412 positive individuals. Even if only a few patients test positive for the colonization stage of this pathogen, the sheer number of individuals testing positive for other stages of infection indicate that the incidence of pneumocystosis in immunocompromised patients in Germany is underestimated.

Walking stabilizes cognitive functioning in Alzheimer's disease (AD) across one year

AD is a public health epidemic, which seriously impacts cognition, mood and daily activities; however, one type of activity, exercise, has been shown to alter these states. Accordingly, we sought to investigate the relationship between exercise and mood, in early-stage AD patients (N=104) from California, over a 1-year period. Patients completed the Mini-Mental State Examination (MMSE), Geriatric Depression Scale (GDS), and Blessed-Roth Dementia Rating Scale (BRDRS), while their caregivers completed the Yale Physical Activity Survey (YALE), Profile of Mood States (POMS), the Neuropsychiatric Inventory (NPI) and Functional Abilities Questionnaire (FAQ). Approximately half of the participants were female, from a variety of ethnic groups (Caucasian=69.8%; Latino/Hispanic Americans=20.1%). Our results demonstrated that the patients spent little time engaged in physical activity in general, their overall activity levels decreased over time, and this was paired with a change in global cognition (e.g., MMSE total score) and affect/mood (e.g., POMS score). Patients were parsed into Active and Sedentary groups based on their Yale profiles, with Active participants engaged in walking activities, weekly, over 1 year. Here, Sedentary patients had a significant decline in MMSE scores, while the Active patients had an attenuation in global cognitive decline. Importantly, among the Active AD patients, those individuals who engaged in walking for more than 2 h/week had a significant improvement in MMSE scores. Structured clinical trials which seek to increase the amount of time AD patients were engaged in walking activities and evaluate the nature and scope of beneficial effects in the brain are warranted.

SU-E-T-197: A Comprehensive Variance Reporting System and an Analysis of Variances Reported at Our Institution

PURPOSE

It is essential for radiation oncology departments to have comprehensive patient safety and quality programs. Two years ago we undertook a systematic review of our safety/QA program. Existing policies were updated and new policies created where necessary. One crucial component of any safety/QA program is continually updating it based on current information, the 'check' and 'act' portions of the Deming Cycle. We accomplished this with a transparent variance reporting system and a safety/QA committee reviewing and acting on reported variances.

METHODS

With 5 radiation oncology centers in our institution, we needed to devise a system that would allow anyone to report a variance and provide our QA committee the ability to review variances system-wide. We developed the system using web-based tools. The system allows individuals to report variances, anonymously or named, specify the nature of the variance and indicate the tools used to identify the variance.

RESULTS

In 2011, 285 variances were reported, 102 were reported by physicists, 86 anonymously, 71 by therapists and 26 by dosimetrists. We realized the need to develop clear classifications for variances. We added a high priority category, defined as variances which resulted in or had the potential to result in harm to a patient or when a policy is purposely overridden. Of the 285 variances reported, 5 were high priority. We created a process variance category, defined as variances where a specific clinical process is not followed. Of the 285 reported variances 155 were process variances.

CONCLUSIONS

Reporting of variances through a centralized database is central toward developing a robust patient safety/quality assurance program. Anonymous reporting fosters a non-punitive environment, and promotes the 'safety culture'. The goal of such a system is to review trends in clinical processes and ultimately to improve safety/quality by reducing variances associated with these processes.

Detection of Cryptosporidium in miniaturised fluidic devices

Contamination of drinking water with the protozoan pathogen, Cryptosporidium, represents a serious risk to human health due to the low infectious dose and the resistance of this parasite to chlorine disinfection. Therefore, several countries have legislated for the frequent monitoring of drinking water for Cryptosporidium presence. Existing approved monitoring protocols are however time-consuming and do not provide essential information on the species, virulence or viability of detected oocysts. Rapid, more information-rich and automatable systems for Cryptosporidium detection are highly sought-after, and numerous miniaturised devices have been developed to address this need. This review article aims to summarise the state-of-the-art and compare the performance of these systems in terms of detection limit, ability to determine species, viability and performance in the presence of interferents. Finally, conclusions are drawn with regard to the most promising methods and directions of future research.