Subcutaneous ertapenem delivered by an Australian outpatient parenteral antimicrobial therapy service: a retrospective comparative efficacy study

Subcutaneous (SC) administration of ertapenem in outpatient parenteral antimicrobial therapy (OPAT) services may be a practical alternative to intravenous delivery for complicated infections. The clinical features and outcomes according to route of administration were compared from a large Australian OPAT service. Chronic renal impairment was more common in the SC group, reflecting an opportunity for route of administration as a vein preservation strategy. Adverse events were uncommon and successful outcomes were not different between the groups.

Measurement of the Positive Muon Anomalous Magnetic Moment to 0.46 ppm

We present the first results of the Fermilab National Accelerator Laboratory (FNAL) Muon g-2 Experiment for the positive muon magnetic anomaly a_{μ}≡(g_{μ}-2)/2. The anomaly is determined from the precision measurements of two angular frequencies. Intensity variation of high-energy positrons from muon decays directly encodes the difference frequency ω_{a} between the spin-precession and cyclotron frequencies for polarized muons in a magnetic storage ring. The storage ring magnetic field is measured using nuclear magnetic resonance probes calibrated in terms of the equivalent proton spin precession frequency ω[over ˜]_{p}^{'} in a spherical water sample at 34.7 °C. The ratio ω_{a}/ω[over ˜]_{p}^{'}, together with known fundamental constants, determines a_{μ}(FNAL)=116 592 040(54)×10^{-11} (0.46 ppm). The result is 3.3 standard deviations greater than the standard model prediction and is in excellent agreement with the previous Brookhaven National Laboratory (BNL) E821 measurement. After combination with previous measurements of both μ^{+} and μ^{-}, the new experimental average of a_{μ}(Exp)=116 592 061(41)×10^{-11} (0.35 ppm) increases the tension between experiment and theory to 4.2 standard deviations.

Human dimethylarginine dimethylaminohydrolase 1 inhibition by proton pump inhibitors and the cardiovascular risk marker asymmetric dimethylarginine: in vitro and in vivo significance

Proton pump inhibitor (PPI)-induced inhibition of dimethylarginine dimethylaminohydrolase 1 (DDAH1), with consequent accumulation of the nitric oxide synthase inhibitor asymmetric dimethylarginine (ADMA), might explain the increased cardiovascular risk with PPI use. However, uncertainty exists regarding whether clinical PPI concentrations significantly inhibit DDAH1 under linear initial rate conditions, and whether PPI-induced DDAH1 inhibition significantly increases ADMA in humans. DDAH1 inhibition by esomeprazole, omeprazole, pantoprazole, lansoprazole and rabeprazole was determined by quantifying DDAH1-mediated L-citrulline formation in vitro. Plasma ADMA was measured in PPI users (n = 134) and non-users (n = 489) in the Hunter Community Study (HCS). At clinical PPI concentrations (0.1–10 μmol/L), DDAH1 retained >80% activity vs. baseline. A significant, reversible, time-dependent inhibition was observed with lansoprazole (66% activity at 240 min, P = 0.034) and rabeprazole (25% activity at 240 min, P < 0.001). In regression analysis, PPI use was not associated with ADMA in HCS participants (beta 0.012, 95% CI −0.001 to 0.025, P = 0.077). Furthermore, there were no differences in ADMA between specific PPIs (P = 0.748). At clinical concentrations, PPIs are weak, reversible, DDAH1 inhibitors in vitro. The lack of significant associations between PPIs and ADMA in HCS participants questions the significance of DDAH1 inhibition as a mechanism explaining the increased cardiovascular risk reported with PPI use.

Network meta-analysis of antibiotic prophylaxis for prevention of surgical-site infection after groin hernia surgery

BACKGROUND

First-generation cephalosporins (such as cefazolin) are recommended as antibiotic prophylaxis in groin hernia repair, but other broad-spectrum antibiotics have also been prescribed in clinical practice. This was a systematic review and network meta-analysis to compare the efficacy of different antibiotic classes for prevention of surgical-site infection (SSI) after hernia repair.

METHODS

RCTs were identified that compared efficacy of antibiotic prophylaxis on SSI after inguinal or femoral hernia repair from PubMed and Scopus databases up to March 2016. Data were extracted independently by two reviewers. Network meta-analysis was applied to assess treatment efficacy. The probability of being the best antibiotic prophylaxis was estimated using surface under the cumulative ranking curve (SUCRA) analysis.

RESULTS

Fifteen RCTs (5159 patients) met the inclusion criteria. Interventions were first-generation (7 RCTs, 1237 patients) and second-generation (2 RCTs, 532) cephalosporins, β-lactam/β-lactamase inhibitors (6 RCTs, 619) and fluoroquinolones (2 RCTs, 581), with placebo as the most common comparator (14 RCTs, 2190). A network meta-analysis showed that β-lactam/β-lactamase inhibitors and first-generation cephalosporins were significantly superior to placebo, with a pooled risk ratio of 0·44 (95 per cent c.i. 0·25 to 0·75) and 0·62 (0·42 to 0·92) respectively. However, none of the antibiotic classes was significantly different from the others. SUCRA results indicated that β-lactam/β-lactamase inhibitors and first-generation cephalosporins were ranked first and second respectively for best prophylaxis.

CONCLUSION

β-Lactam/β-lactamase inhibitors followed by first-generation cephalosporins ranked as the most effective SSI prophylaxis for adult patients undergoing groin hernia repair.

Autoantibodies are not Predictive Markers for the Development of Depressive Symptoms in a Population-Based Cohort of Older Adults

Background

Autoantibodies have been implicated in the etiologic pathway of depressive disorders. Here, we determine the association between the presence of a panel of autoantibodies at baseline and change in depression symptom score over 5-year follow-up in a cohort of healthy elderly Australians.

Methods

Serum samples from 2049 randomly selected subjects enrolled in the Hunter Community Study (HCS) aged 55–85 years were assayed for a range of autoimmune markers (anti-nuclear autoantibodies, extractable nuclear antigen autoantibodies, anti-neutrophil cytoplasmic autoantibodies, thyroid peroxidase autoantibodies, tissue transglutaminase autoantibodies, anti-cardiolipin autoantibodies, rheumatoid factor and cyclic citrullinated peptide autoantibodies) at baseline. Depression symptom score was assessed using the Centre for Epidemiological Study (CES-D) scale at baseline and 5 years later.

Results

Autoantibody prevalence varied amongst our sample with ANA being the most prevalent; positive in 16% and borderline in 36% of study population. No evidence for a relationship was found between change in CES-D score over time and any autoimmune marker. Statins and high cholesterol were significantly associated with change in CES-D score over time in univariate analysis; however, these were probably confounded since they failed to remain significant following multivariable analysis.

Conclusions

Autoantibodies were not associated with change in CES-D score over time. These findings point to an absence of autoimmune mechanisms in the general population or in moderate cases of depression.

Valuing forages for genetic selection: what traits should we focus on?

Failure over the past two to three decades to implement industry-led, systematic forage evaluation systems that translate forage performance data to animal production and economics means that the livestock industries are poorly positioned to judge how much economic benefit they are gaining from forage plant improvement and to propose future priorities and targets. The present paper identifies several knowledge gaps that must be filled to enable the value being delivered to pasture-based livestock industries by forage improvement to be determined, demonstrated to farmers and increased in the future. Seasonal yield, total annual yield, nutritive value and feeding value of pasture are all important traits for driving the productivity of pasture-based livestock production systems. From a farm systems perspective, persistence of the yield or quality advantage of new cultivars is also economically important. However, this is the least well defined of the productivity traits considered in the paper. Contrary to anecdotal reports, evidence indicates that the genetic potential of modern ryegrass cultivars to survive in grazed pastures is at least equivalent to that of older cultivars. Plant breeding in Europe and New Zealand has changed the seasonal yield, quality and intake potential of perennial ryegrass. On the basis of dry matter (DM) yield data from small-plot evaluation trials, the New Zealand forage value index indicates that the top-ranked perennial ryegrass cultivars offer between NZ$280 and NZ $650/ha per year potential additional operating profit to dairy businesses (depending on region), compared with a historical genetic base of cultivars that were first entered into yield testing programs between 1991 and 1996. The equivalent figure in Ireland (including nutritive value effects) is about €325/ha per year. These estimates are yet to be confirmed in animal production studies. In intensive dairy systems, current rates of genetic gain in DM yield lag well behind realised rates of gain in animal genetics and associated increases in feed demand per animal. Genetic gains in yield need to double from current rates (estimated at 0.5% per year); but, it is not known whether this is possible in an outcrossing species such as perennial ryegrass, which is normally grown in a mixture with other species, especially white clover. Improvements in DM yield in seasons where extra DM has greatest economic value in grazing systems should dominate breeding objectives, but this must now be augmented by consideration of the environmental impacts of intensive pasture-based livestock production systems and opportunities to mitigate this through germplasm selection. There is less evidence that nutritive or feeding value of ryegrass cultivars significantly limits animal production and profitability and useful improvements have already been made using tetraploids and later heading material.

The association between dietary patterns and type 2 diabetes: a systematic review and meta-analysis of cohort studies

BACKGROUND

Observational studies suggest that dietary pattern intake plays an important role in the development of type 2 diabetes. A meta-analysis was performed of existing cohort studies on the association between dietary patterns and the risk of type 2 diabetes.

METHODS

Pertinent studies were identified by searching MEDLINE, EMBASE, Cumulative Index to Nursing and Allied Health Literature, PROQUEST, MEDNAR and the Joanna Briggs Institute Library of Systematic Reviews, as well as the reference lists of all identified studies up to September 2012. A random-effects meta-analysis was performed to pool relative risk (RR) estimates from individual studies to assess the relationship between dietary pattern intake and the risk of type 2 diabetes. Statistical heterogeneity was assessed using I(2) and sensitivity analyses were conducted. Publication bias was evaluated by visual inspection of funnel plots and was formally assessed using Egger's test.

RESULTS

There were fifteen cohort studies that met the inclusion criteria. There was evidence of a reduction in the risk of type 2 diabetes in the highest adherence compared to the lowest adherence to healthy dietary patterns [RR = 0.79, 95% confidence interval (CI) = 0.74-0.86, P < 0.005]. An increase in the risk of type 2 diabetes was evident for the highest adherence compared to the lowest adherence to unhealthy dietary patterns (RR = 1.44, 95% CI = 1.33-1.57, P < 0.005).

CONCLUSIONS

The results of this systematic review and meta-analysis indicate that dietary patterns may be associated with the risk of type 2 diabetes.

Systematic review and meta-analysis of safety of laparoscopic versus open appendicectomy for suspected appendicitis in pregnancy

BACKGROUND

Laparoscopic appendicectomy has gained wide acceptance as an alternative to open appendicectomy during pregnancy. However, data regarding the safety and optimal surgical approach to appendicitis in pregnancy are still controversial.

METHODS

This was a systematic review and meta-analysis of studies comparing laparoscopic and open appendicectomy in pregnancy identified using PubMed and Scopus search engines from January 1990 to July 2011. Two reviewers independently extracted data on fetal loss, preterm delivery, wound infection, duration of operation, hospital stay, Apgar score and birth weight between laparoscopic and open appendicectomy groups.

RESULTS

Eleven studies with a total of 3415 women (599 in laparoscopic and 2816 in open group) were included in the analysis. Fetal loss was statistically significantly worse in those who underwent laparoscopy compared with open appendicectomy; the pooled relative risk (RR) was 1·91 (95 per cent confidence interval (c.i.) 1·31 to 2·77) without heterogeneity. The pooled RR for preterm labour was 1·44 (0·68 to 3·06), but this risk was not statistically significant. The mean difference in length of hospital stay was - 0·49 (-1·76 to - 0·78) days, but this was not clinically significant. No significant difference was found for wound infection, birth weight, duration of operation or Apgar score.

CONCLUSION

The available low-grade evidence suggests that laparoscopic appendicectomy in pregnant women might be associated with a greater risk of fetal loss.

Current state of medical-advice-seeking behaviour for symptoms of colorectal cancer: determinants of failure and delay in medical consultation

AIM

There are few data on the factors associated with healthcare-seeking behaviour for symptoms of colorectal cancer. This study describes the determinants of failure and delay in seeking medical advice for rectal bleeding and change in bowel habit.

METHOD

In total, 1592 persons (56-88 years) were randomly selected from the Hunter Community Study and mailed a questionnaire.

RESULTS

In all, 18% (60/332) of respondents experiencing rectal bleeding and 20% (39/195) reporting change in bowel habit had never consulted a doctor. The rate of delay (>1 month) for each symptom was 18% and 37%. The reasons for delay included the assumption that the symptoms were not serious or that they were benign. Triggers for seeking medical advice varied. Healthcare-seeking behaviour for rectal bleeding had not significantly improved compared with a previous community-based study.

CONCLUSION

The seriousness of symptoms, importance of early detection and prompt medical consultation must be articulated in health messages to at-risk persons.

Pneumococcal vaccination may induce anti-oxidized low-density lipoprotein antibodies that have potentially protective effects against cardiovascular disease

Many animal and human studies have found an inverse association between anti-oxidized low-density lipoprotein (oxLDL) antibodies (anti-oxLDL) and atherosclerotic burden. Furthermore, anti-oxLDL antibodies have been shown to cause regression of atherosclerotic plaque in mice. Animal studies indicate that the 23-valent pneumococcal vaccine may induce the production of these potentially protective anti-oxLDL antibodies, and human epidemiological studies support their potentially beneficial effect in reducing cardiovascular events. Here we describe the association between self-reported pneumococcal vaccination, vaccination verified by linkage to health records, and anti-pneumococcal antibody titers, and anti-ox-LDL titers in a group of 116 older people. We found a bimodal distribution of anti-oxLDL antibodies, and a significant association between pneumococcal IgG and anti-oxLDL antibody titers that remained after multivariate adjustment for potential confounders (p=0.04). There was no significant association between self-reported vaccination or vaccination verified by health record linkage and ox-LDL titers, which may be due to reporting error or variability in response to the vaccine. These results support a mechanistic link between pneumococcal vaccination and a potential protective effect on cardiovascular disease, and indicate that self-reported or verified vaccine status may not be sufficient to detect this association.

Assessment of dietary fat intake and innate immune activation as risk factors for impaired lung function

BACKGROUND/OBJECTIVES

Preservation of lung health with aging is an important health issue in the general population, as loss of lung function with aging can lead to the development of obstructive lung disease and is a predictor of all-cause and cardiovascular mortality. Inflammation is increasingly linked to loss of lung function and evidence suggests that consumption of dietary fat exacerbates inflammation. We aimed to determine the association between dietary fat intake and lung function in older people.

SUBJECTS/METHODS

Participants from the Hunter community study, a population-based cohort, were recruited during 2004 and 2005. Participants received a clinical assessment, including spirometry, and provided a blood sample. Diets were analyzed using food-frequency questionnaires. Plasma interleukin (IL)-6 and C-reactive protein was measured by Enzyme-Linked immunosorbent assay.

RESULTS

Using backward stepwise linear regression, %energy from dietary fat, age and plasma IL-6 were considered as negative predictors of forced expiratory volume in one second (FEV(1)) in men. Also in men, % energy intake from dietary fat, age, body mass index and IL-6 were negative predictors of %predicted forced vital capacity (FVC). Smoking and age were negative predictors of FEV(1)/FVC. In women, plasma IL-6 and age were negative predictors of %FVC, whereas obesity was positively associated with FEV(1)/FVC.

CONCLUSIONS

An increased proportion of fat in the diet is associated with the reduced lung function in older men. Dietary-fat induced innate immune activation and IL-6 release may contribute to this effect. Dietary interventions involving fat restriction should be further investigated as means of preserving lung function with aging.

Fatty acid intake and milk fatty acid composition of Holstein dairy cows under different grazing strategies: herbage mass and daily herbage allowance

The objective of this study was to investigate the effect of level of 1) pregrazing herbage mass (HM) and 2) level of daily herbage allowance (DHA) on the performance and fatty acid (FA) composition of milk from grazing dairy cows. Sixty-eight Holstein-Friesian dairy cows were allocated to either a high or low pregrazing HM (1,700 vs. 2,400 kg of DM/ha; >40 mm), and within HM treatment, cows were further allocated to either a high or low DHA (16 vs. 20 kg of DM/d per cow; >40 mm) in a 2 x 2 factorial design. Pregrazing HM did not affect dry matter intake (17.5 +/- 0.75 kg/d), milk production (22.1 +/- 0.99 kg/d), milk composition (milk fat, 3.88 +/- 0.114%; milk protein, 3.28 +/- 0.051%), body weight (525 +/- 16 kg), or body condition score (2.65 +/- 0.064). Increasing DHA increased dry matter intake (+1.5 kg/d) but did not affect any other variable measured. Cows grazing the low HM or high DHA had a higher daily intake of total FA (+0.12 and +0.09 kg/d, respectively, for the low HM and high DHA), alpha-linolenic acid (LNA; +0.08 and +0.05 kg/d, respectively, for the low HM and high DHA), and linoleic acid (+0.01 for both the low HM and high DHA) compared with either the high HM or low DHA. Milk conjugated linoleic acid (cis-9, trans-11 isomer) was not affected by treatment (13.0 +/- 0.77 g/kg of total FA); however, large variation was recorded between individual animals (range from 5.9 to 20.6 g/kg of total FA). Milk concentrations of LNA were higher for animals offered the low HM (5.3 g/kg of total FA), but across treatments, milk concentrations of LNA were low (4.9 +/- 0.33 g/kg of total FA). The present study indicates that changes in HM and DHA do not have a great effect on the milk FA composition of grazing dairy cows. Further enhancement of the beneficial FA content in milk purely from changes in grazing strategy may be difficult when pasture quality is already high.

Estrogen receptor polymorphisms and the risk of endometrial cancer

OBJECTIVE

There is evidence that estrogens and some of their metabolites are involved in endometrial cancer pathogenesis. As estrogens mediate their effects via the estrogen receptors, ESR1 and ESR2, the objective of this investigation was to determine whether six single nucleotide polymorphisms (SNPs) in these two genes were over-represented in a population of endometrial cancer patients compared with a healthy matched control population, thereby associating differences in these genes with endometrial cancer.

DESIGN

The study is a case-control investigation large enough to detect a two-fold increased risk, assuming a dominant genetic model, with P = 0.05 and 80% power.

SETTING

The study and control populations were all from the Hunter-New England region of New South Wales, Australia collected between the years 1992 and 2005.

POPULATION

The study consisted of 191 endometrial cancer patients and 291 healthy controls matched for gender and age.

METHODS

Two SNPs in ESR1 and four SNPs in ESR2 were genotyped using PCR-based restriction fragment length polymorphism analysis and real-time PCR. Odds ratios were calculated using unconditional logistic regression and SIMHAP was used for haplotype analysis, adjusting for potential endometrial cancer risk factors. Kaplan-Meier survival analysis, Cox regression and t tests were used to examine the patient's age of diagnosis of endometrial cancer and genotype.

MAIN OUTCOME MEASURES

Over-representation of ESR1 and ESR2 polymorphisms in the endometrial cancer population compared with the control population indicates an involvement in the development and/or progression of disease.

RESULTS

Two ESR1 (rs2234693 and rs9340799) and two ESR2 (rs1255998 and rs944050) polymorphisms were associated with an increased risk of endometrial cancer. Following adjustment for risk factors, the association with the ESR1 and ESR2 polymorphisms (rs2234693, rs1255998 and rs944050) remained highly significant. Haplotype analysis revealed that carriers of the ESR1 haplotype (variant alleles; rs2234693 and rs9340799) and the ESR2 haplotype (variant allele; rs1255998 and wild-type alleles; rs944050, rs4986938 and rs1256049) were at an increased risk (OR 1.862, P = 0.013 and OR 1.918, P = 0.046 respectively). This risk was even greater in women carrying both risk haplotypes (OR 5.041, P = 0.007).

CONCLUSIONS

Our data suggest that the ESR1 (rs2234693 and rs9340799) and the ESR2 (rs1255998 and rs944050) polymorphisms may be associated with an increased risk of developing endometrial cancer.

Effect of pregrazing herbage mass and pasture allowance on the lactation performance of Holstein-Friesian dairy cows

The objective of this study was to investigate the effect of pregrazing herbage mass (HM) and pasture allowance (PA) on the grazing management and lactation performance of spring-calving dairy cows. Sixty-eight Holstein-Friesian dairy cows (mean calving date, February 6) were randomly assigned across 4 treatments (n = 17) in a 2 x 2 factorial arrangement. The 4 treatments consisted of 2 pregrazing HM (>4 cm) and 2 PA (>4 cm): 1,700 kg of dry matter (DM)/ha (medium, M) or 2,200 kg of DM/ha (high, H), and 16 or 20 kg of pasture DM/cow per day. The experimental period lasted 30 wk. The experimental area was divided into 4 farmlets, with 1 farmlet per treatment. Mean HM throughout the experimental period was 1,767 kg of DM/ha (M HM) compared with 2,358 kg of DM/ha (H HM). Offering an M HM sward resulted in significantly greater milk protein yield (+31.7 g/d) and lower mean body weight (-12.8 kg). The body condition score change was significantly smaller (-0.21) with the M HM treatments compared with the H HM treatment (-0.34). Milk solids output per hectare was 6% greater on the M HM treatments compared with the H HM treatments. Increasing PA significantly increased milk (+0.9 kg/d), solids-corrected milk (+0.7 kg/d), protein (+43.9 g/d), and lactose (+52.7 g/d) yields. Mean body weight was also significantly greater for cows offered 20 kg of PA (+11.4 kg/cow). It was concluded that in rotational grazing systems, adapting the concept of grazing M HM pastures (1,700 kg of DM/ha) will result in increased sward quality and increased milk solids output per hectare. At medium levels of pregrazing HM, offering animals 20 kg of DM PA will result in increased milk yield per cow.

Dietary fat and sleep duration in Chinese men and women

BACKGROUND

Many recent studies have highlighted the complex interaction between sleep duration, food intake and metabolic balance. Although a causal link is yet to be established, emerging evidence suggests that short sleep duration may alter the balance between energy intake and energy expenditure. Thus far, most research has focussed on the link between sleep duration and carbohydrate metabolism. The role of sleep duration in fat intake and vice versa remains relatively unknown.

OBJECTIVE

The aim of this analysis was to determine whether there exists a significant association between sleep duration and fat intake.

DESIGN

Data from 2828 adults living in Jiangsu province, China, collected during a national survey of nutrition and health conducted in 2002.

RESULTS

The analysis showed a statistically significant association between sleep duration and fat and carbohydrate intake but not protein or fasting blood glucose. Those who slept for less than 7 h a day had significantly higher (P=0.005) percentage of energy from fat intake than those who slept for 7-9 h per day. Analysis of the influence of high fat intake upon sleep demonstrated a trend to reduced sleep duration between the highest and lowest quartiles of fat intake (P=0.056).

CONCLUSIONS

To our knowledge, this is the first data from a large cross-sectional study to show an association between decreased sleep duration and increased fat intake in humans. Given the trend towards decreased sleep duration in modern societies and the parallel obesity epidemic, the significance of this association warrants more research.

Pedometer counts superior to physical activity scale for identifying health markers in older adults

OBJECTIVE

Measuring physical activity is a key part of studying its health effects. Questionnaires and pedometers each have weaknesses but are the cheapest and easiest to use measurement methods for large-scale studies. We examined their capacity to detect expected associations between physical activity and a range of surrogate health measures.

DESIGN

Cross-sectional analysis of 669 community-dwelling participants (mean age 63.3 (7.7) years) who completed the Physical Activity Scale for the Elderly (PASE) questionnaire and who, within 2 weeks, wore a pedometer for 7 days.

RESULTS

PASE score and step count were only poorly correlated (r = 0.37 in women, r = 0.30 in men). Of 12 expected associations examined between activity and surrogate markers of health, 10 were detected as statistically significant by step counts but only 3 by PASE scores. Significant associations in the expected direction were found between step counts and high-density lipoprotein, body mass index, waist circumference, waist-to-hip ratio, blood glucose level, white cell count and fibrinogen. There was no association with either systolic or diastolic blood pressure. The association between PASE score and these markers was detected as significant only for body mass index and waist circumference in women and waist-to-hip ratio in both sexes. Associations were stronger for steps multiplied by stride length than for raw step count.

CONCLUSIONS

Pedometer-derived step counts are a more valid measurement of overall physical activity in this sample than PASE score. Researchers should use objective measures of physical activity whenever possible.

Vibrotactile threshold measurement for detecting peripheral neuropathy: defining variability and a normal range for clinical and research use

AIMS/HYPOTHESIS

We aimed to define normal ranges for vibration sense as measured by vibratory perception thresholds (VPTs) using biothesiometry.

METHODS

We performed biothesiometry in a community-dwelling sample of 901 people aged 55 to 85 years who did not have diabetes. We quantitated the variation between repeat measures using analysis of variance and Bland-Altman plots. We also plotted the age- and sex-specific reference ranges.

RESULTS

We found small but statistically significant differences between repeat measures using the ascending and descending method of limits. Statistically higher vibration thresholds were noted on the right arm and leg compared with the left. Significantly higher vibration thresholds were also seen in men vs women for both lower limbs. We also defined sex-specific reference intervals (normal ranges) for biothesiometry for older persons and quantitated the increase in vibration threshold with increasing age.

CONCLUSIONS/INTERPRETATION

For reliability, it may be sufficient to obtain the average of two ascending measures separated by at least 1 min in just the right hand or right foot, since this is usually the one with the higher threshold. Although identical reference ranges can be used for men and women for the upper limb, there are significant differences in the lower limbs. The major determinant of VPT is age: we have established age-specific norms for VPT testing for adults between 55 and 85 years of age.

Genetics of Grass Dry Matter Intake, Energy Balance, and Digestibility in Grazing Irish Dairy Cows

The objective of this study was to estimate genetic parameters for grass dry matter intake (DMI), energy balance (EB), and cow internal digestibility (IDG) in grazing Holstein-Friesian dairy cows. Grass DMI was estimated up to 4 times per lactation on 1,588 lactations from 755 cows on 2 research farms in southern Ireland. Simultaneously measured milk production and BW records were used to calculate EB. Cow IDG, measured as the ratio of feed and fecal concentrations of the natural odd carbon-chain n-alkane pentatriacontane, was available on 583 lactations from 238 cows. Random regression and multitrait animal models were used to estimate residual, additive genetic and permanent environmental (co)variances across lactations. Results were similar for both models. Heritability for DMI, EB, and IDG across lactation varied from 0.10 [8 days in milk (DIM)] to 0.30 (169 DIM), from 0.06 (29 DIM) to 0.29 (305 DIM), and from 0.08 (50 DIM) to 0.45 (305 DIM), respectively, when estimated using the random regression model. Genetic correlations within each trait tended to decrease as the interval between periods compared increased for DMI and EB, whereas the correlations with IDG in early lactation were weakest when measured midlactation. The lowest correlation between any 2 periods was 0.10, -0.36, and -0.04 for DMI, EB, and IDG, respectively, suggesting the effect of different genes at different stages of lactations. Eigenvalues and associated eigenfunctions of the additive genetic covariance matrix revealed considerable genetic variation among animals in the shape of the lactation profiles for DMI, EB, and IDG. Genetic parameters presented are the first estimates from dairy cows fed predominantly grazed grass and imply that genetic improvement in DMI, EB, and IDG in Holstein-Friesian cows fed predominantly grazed grass is possible.

Outbreak of Salmonella Enteritidis phage type 13a: case-control investigation in Hertsmere, United Kingdom

Binary file ES_Abstracts_Final_ECDC.txt matches

Outbreak of tuberculosis in a junior school in south-eastern England

Several tuberculosis outbreaks in schools have been reported in the last decade, usually following transmission from an infectious staff member.

The long sitting screening test in elite cyclists

Pelvic rotation during cycling is important because it influences aerodynamics, cycling efficiency and the occurrence of overuse injuries. The aim of this study was to determine whether or not pelvic position in long sitting influences pelvic position during cycling. An observational, cross sectional, within-subjects study design was used. Thirty elite international track and road cyclists participated as subjects and two measures were undertaken. In long sitting, a digital inclinometer was positioned on the lumbosacral junction to give a static measure in degrees of sacral inclination (SI) relative to the horizontal. During active cycling, video analysis of reflective surface markers over the anterior superior iliac spine and posterior superior iliac spine was used to give a measure in degrees of anterior pelvic rotation (APR), by the angle between these two landmarks and the horizontal. No significant linear relationship was found between the two testing positions (r = 0.23, p = 0.22).

Allergic contact dermatitis in venous leg ulcer patients

Our aim was to determine the frequency and nature of contact sensitivity in venous leg ulcer patients in Lanarkshire. We performed patch testing with the European standard series, antimicrobials and medicaments on 200 patients referred to our leg ulcer clinics. Positive patch tests were found in 136 (68%) patients. Multiple allergies occurred in 102 (51%). The most frequent allergen groups were fragrances (30.5%), antimicrobials (19.5%), topical excipients (19.5%), rubber accelerators (13.5%) and topical corticosteroids (8%). We also found a high prevalence of positive patch tests to Intrasite gel (9.5%) and Hioxyl cream (8.5%), medicaments which are commonly used to treat leg ulcers in our area. Contact sensitivity is common in venous leg ulcer patients and has important implications for patient management. The allergens involved vary depending on local nursing practice. We suggest that all venous leg ulcer patients be patch tested with a locally relevant patch test series.

An Australian survey of in-patient protocols for quadriceps exercises following anterior cruciate ligament reconstruction

Current practices regarding in-patient strengthening exercise prescription following anterior cruclate ligament (ACL) reconstruction are scarcely addressed in the literature and remain unreported for Australian hospitals. An observational, questionnaire-based study was used to Investigate in-patient quadriceps strengthening practices in Australian hospitals after ACL reconstruction. Questionnaires were returned by 248 hospitals (76% response rate) and of these 88 hospitals reported performing ACL reconstructions. These hospitals were surveyed to determine the types of quadriceps strengthening exercises prescribed during the in-patient period. Information was sought regarding routine management strengthening practices. A variety of quadriceps exercises such as static quadriceps contractions (SQC), straight leg raises (SLR) and inner range quadriceps (IRQ) were frequently prescribed, although no standard practice currently exists. Static quadriceps exercises were prescribed by 91% of hospitals surveyed, IRQ exercises were used by 30%, and 49% reported using SLR exercises. Current literature tends to support the performance of SQC and SLR exercises during the early postoperative period following ACL reconstruction. Conversely, current clinical practice is incongruent with regard to the scientific recommendations for IRQ performance.

Telemedicine for the delivery of professional development for health, education and welfare professionals in two remote mining towns

Over a two-year period, telemedicine was used to deliver training and development services for health, education and welfare staff in two remote towns in South Australia - Roxby Downs and Coober Pedy. Both are mining towns but they have different profiles in terms of the community's mental health needs. The services were provided by the Child and Adolescent Mental Health Services (CAMHS) from the Women's and Children's Hospital in Adelaide, South Australia. The media used were videoconferencing, telephone, video-tapes, the Internet and printed material. During 1998-9, professional staff in the two locations participated in structured videoconferencing seminars that addressed important mental health topics, chosen in response to surveys of the needs of the participants. The videoconferencing sessions were sometimes used to discuss specific patient cases. Each remote town was also supported via videoconferencing by a nominated office of the CAMHS: Roxby Downs by the suburban office at Port Adelaide and Coober Pedy by the office in the industrial town of Port Pirie. This customized support was an important factor in the success of the professional development network.

An added dimension to the pediatric health maintenance visit: the spiritual history

The initial pediatric health maintenance visit gives the nurse practitioner (NP) an opportunity to gather information about a family that can be used to devise an effective and culturally sensitive plan of care. NPs have a history of exploring spirituality as a segment of a family's culture to help children and their parents cope with an acute or chronic illness. However, spirituality should also be discussed with a family because it may affect their normal, everyday lives. Religious traditions, values, and ethical concerns may provide rich insight into a family's dynamic, which can increase an NP's understanding. The mnemonic B-E-L-I-E-F is used to guide NPs through a discussion of spirituality within a pediatric health care maintenance context. This framework, which incorporates an added dimension of spirituality into the health history, will further advance efforts to assist families in fostering optimal childhood growth and development during a routine health care maintenance visit.

Empowerment & reminiscence: possible tools in dietary health promotion in the elderly

The COMA report "The Nutrition of Elderly People" recommended that elderly people should be targeted for health education programmes in order to maintain nutritional status in this group. Recent research indicates that interventions which aim to influence nutritional behaviour are more likely to succeed if they involve target populations at all stages of the process. This paper outlines a preliminary action research project which attempted to identify some key issues influencing eating behaviour in a group of elderly people based in the Halewood area of Knowsley, Merseyside. An innovative methodology, combining empowerment and reminiscence, was used to produce a nutritional advice leaflet which will be used as a resource within the local community.

Development of a new approach to palliative care documentation

Efficient, comprehensive documentation is a vital element of all healthcare provision. It not only provides a record of care, but should reflect the quality of that care, enable continuity of care between practitioners and reinforce care standards. However, documentation in palliative care often falls short of these ideals. This article describes the formulation of an integrated system of documentation which aims to address the failings of documentation procedures in one hospice/palliative care unit. The resulting system seeks to embody the rationale of palliative care within a dynamic, patient-centred approach to nursing documentation.

Pulse oximetry: a new tool to assess patients with leg ulcers

The objective of the study was to investigate pulse oximetry as a guide to assessing patients with leg ulcers before treatment. Graduated elastic compression is the treatment of choice for uncomplicated venous leg ulcers, but is contra-indicated in patients with significant arterial disease. The standard assessment of arterial insufficiency by Doppler ultrasound ankle branchial pressure index (ABPI) has shortcomings which prompted this investigation of pulse oximetry as a possible additional, or alternative, method of assessment of patients with leg ulcers, prior to treatment with compression. The study, carried out on a population of patients attending hospital leg ulcer clinics, was designed to evaluate pulse oximetry assessment in the selection and monitoring of patients with venous leg ulceration leading to a prospective controlled study of ulcer healing in groups of patients with reduced and normal ABPI, selected for compression therapy by pulse oximetry criteria. Outcome measurement required follow-up of patients selected for compression therapy by pulse oximetry to record time to healing and rate of healing of leg ulcers. Results from the study show a fair correlation between the toe-finger oximetry index (TFOI) and Doppler ABPI. There is no difference between ulcer healing in patients with reduced and normal ABPI selected for treatment on the basis of pulse oximetry maximum compression pressure (MCP). In conclusion, pulse oximetry is an aid to the selection of patients who will benefit from compression therapy, but would be excluded on the basis of Doppler ABPI.

A cluster of cases of legionnaires' disease associated with exposure to a spa pool on display

Interviews with four apparently sporadic cases of legionnaires' disease identified by laboratory reporting in one health district revealed that three of the four cases had been exposed to a new design of spa pool on display at a retail outlet. The fourth case had been exposed to the same design of spa pool in a private home. None had bathed in the spa pool. Legionella pneumophila serogroup 1 mAB subgroup 'Philadelphia' was isolated from samples taken from both spa pools. The display pool had not been maintained as recommended for a public spa pool in use by bathers. Revised maintenance instructions were issued to all purchasers of these spa pools in the United Kingdom (UK) and overseas. Patients may not remember specific exposures; scrutiny of activity diaries helped to identify exposure to a common location. Even when not in use by bathers, spa pools on display can be a source of legionella infection and should be maintained according to current hygiene guidelines.

Safety, tolerance, and pharmacokinetics of a small unilamellar liposomal formulation of amphotericin B (AmBisome) in neutropenic patients

The safety, tolerance, and pharmacokinetics of a small unilamellar liposomal formulation of amphotericin B (AmBisome) administered for empirical antifungal therapy were evaluated for 36 persistently febrile neutropenic adults receiving cancer chemotherapy and bone marrow transplantation. The protocol was an open-label, sequential-dose-escalation, multidose pharmacokinetic study which enrolled a total of 8 to 12 patients in each of the four dosage cohorts. Each cohort received daily doses of either 1.0, 2.5, 5.0, or 7.5 mg of amphotericin B in the form of AmBisome/kg of body weight. The study population consisted of patients between the ages of 13 and 80 years with neutropenia (absolute neutrophil count, <500/mm3) who were eligible to receive empirical antifungal therapy. Patients were monitored for safety and tolerance by frequent laboratory examinations and the monitoring of infusion-related reactions. Efficacy was assessed by monitoring for the development of invasive fungal infection. The pharmacokinetic parameters of AmBisome were measured as those of amphotericin B by high-performance liquid chromatography. Noncompartmental methods were used to calculate pharmacokinetic parameters. AmBisome administered as a 1-h infusion in this population was well tolerated and was seldom associated with infusion-related toxicity. Infusion-related side effects occurred in 15 (5%) of all 331 infusions, and only two patients (5%) required premedication. Serum creatinine, potassium, and magnesium levels were not significantly changed from baseline in any of the dosage cohorts, and there was no net increase in serum transaminase levels. AmBisome followed a nonlinear dosage relationship that was consistent with reticuloendothelial uptake and redistribution. There were no breakthrough fungal infections during empirical therapy with AmBisome. AmBisome administered to febrile neutropenic patients in this study was well tolerated, was seldom associated with infusion-related toxicity, was characterized by nonlinear saturation kinetics, and was effective in preventing breakthrough fungal infections.

Survey of food safety awareness among HIV positive individuals

A survey was carried out by personal interview to assess the awareness of basic food hygiene and food safety amongst 77 HIV-positive individuals attending a single hospital. There was some confusion and lack of knowledge about aspects of food storage and despite the fact that 74% of subjects had modified their diet since learning their HIV status (mainly for nutritional reasons) only 25% reported receiving information on food safety. Of the subjects interviewed 96%, 66% and 23% were aware of the risks of infection from Salmonella, Listeria monocytogenes and Cryptosporidium, respectively; although most were not aware of the UK Government's advice on the consumption of eggs, soft cheese, pâté and cook-chill foods. Over 40% of those interviewed reported that they did not drink tap water (most drank bottled water instead), but few were aware of infections potentially transmitted through water. Although pets represent a potential source of a wide variety of infectious agents, there was a high level of awareness of this problem. This study highlights the need for improving the availability of information on food hygiene and infections acquired through food and water to HIV-positive individuals.