Frequency dependence of surface acoustic wave swimming

Surface acoustic waves (SAWs) are elastic waves that can be excited directly on the surface of piezoelectric crystals using a transducer, leading to their exploitation for numerous technological applications, including for example microfluidics. Recently, the concept of SAW streaming, which underpins SAW microfluidics, was extended to make the first experimental demonstration of ‘SAW swimming’, where instead of moving water droplets on the surface of a device, SAWs are used as a propulsion mechanism. Using theoretical analysis and experiments, we show that the SAW swimming force can be controlled directly by changing the SAW frequency, due to attenuation and changing force distributions within each SAW streaming jet. Additionally, an optimum frequency exists which generates a maximum SAW swimming force. The SAW frequency can therefore be used to control the efficiency and forward force of these SAW swimming devices. The SAW swimming propulsion mechanism also mimics that used by many microorganisms, where propulsion is produced by a cyclic distortion of the body shape. This improved understanding of SAW swimming provides a test-bed for exploring the science of microorganism swimming, and could bring new insight to the evolutionary significance for the length and beating frequency of swimming microbial flagella.

Effective general practice: audit and feedback for the primary series of immunisations

INTRODUCTION

General practice immunisation audits do not always match the national rates recorded on the New Zealand (NZ) National Immunisation Register (NIR).

AIM

To complete audits at one general practice for infants requiring the primary series of immunisations (6-week, 3-month and 5-month vaccines) over a 12-month period and compare findings with the NIR audit.

METHODS

A manual and electronic practice management system (PMS) audit were compared with identical NIR audit parameters for completion of the 5-month vaccination from 1 February 2011 to 1 February 2012. All three results were then combined with further sub-audits of the total practice newborn population to produce a multifaceted audit, identifying further eligible patients. The NIR database query tool was used to corroborate data on partially immunised and unimmunised patients identified.

RESULTS

All three initial audits produced different results for vaccinated and eligible patients: NIR 31/36; PMS audit 39/43; manual audit 41/48. The multifaceted audit identified 48 eligible infants. All 48 (100%) started their primary series-95.8% (46 of 48) fully immunised; 4.2% (2 of 48) partially immunised, missing only one injection. None were unimmunised, contrary to initial audits. Lower levels of timeliness of delivery were confirmed for this practice, with 52.1% (25 of 48) immunised on time.

DISCUSSION

Results show 9.7% higher levels of immunisation than reported by NIR statistics for this practice (95.8% vs 86.1%), above current NZ government and World Health Organization targets. The multifaceted audit produced the best estimate of eligible patients and identified deficiencies in vaccine delivery.

Effective general practice: audit and feedback for the primary series of immunisations

INTRODUCTION: General practice immunisation audits do not always match the national rates recorded on the New Zealand (NZ) National Immunisation Register (NIR). AIM: To complete audits at one general practice for infants requiring the primary series of immunisations (6-week, 3-month and 5-month vaccines) over a 12-month period and compare findings with the NIR audit. METHODS: A manual and electronic practice management system (PMS) audit were compared with identical NIR audit parameters for completion of the 5-month vaccination from 1 February 2011 to 1 February 2012. All three results were then combined with further sub-audits of the total practice newborn population to produce a multifaceted audit, identifying further eligible patients. The NIR database query tool was used to corroborate data on partially immunised and unimmunised patients identified. RESULTS: All three initial audits produced different results for vaccinated and eligible patients: NIR 31/36; PMS audit 39/43; manual audit 41/48. The multifaceted audit identified 48 eligible infants. All 48 (100%) started their primary series – 95.8% (46 of 48) fully immunised; 4.2% (2 of 48) partially immunised, missing only one injection. None were unimmunised, contrary to initial audits. Lower levels of timeliness of delivery were confirmed for this practice, with 52.1% (25 of 48) immunised on time. DISCUSSION: Results show 9.7% higher levels of immunisation than reported by NIR statistics for this practice (95.8% vs 86.1%), above current NZ government and World Health Organization targets. The multifaceted audit produced the best estimate of eligible patients and identified deficiencies in vaccine delivery. KEYWORDS: Children; general practice; immunisation schedule; medical audit; New Zealand

Human papillomavirus vaccination in Auckland: reducing ethnic and socioeconomic inequities

BACKGROUND

The New Zealand HPV publicly funded immunisation programme commenced in September 2008. Delivery through a school based programme was anticipated to result in higher coverage rates and reduced inequalities compared to vaccination delivered through other settings. The programme provided for on-going vaccination of girls in year 8 with an initial catch-up programme through general practices for young women born after 1 January 1990 until the end of 2010.

OBJECTIVE

To assess the uptake of the funded HPV vaccine through school based vaccination programmes in secondary schools and general practices in 2009, and the factors associated with coverage by database matching.

METHODS

Retrospective quantitative analysis of secondary anonymised data School-Based Vaccination Service and National Immunisation Register databases of female students from secondary schools in Auckland District Health Board catchment area. Data included student and school demographic and other variables. Binary logistic regression was used to estimate odds ratios and significance for univariables. Multivariable logistic regression estimated strength of association between individual factors and initiation and completion, adjusted for all other factors.

RESULTS

The programme achieved overall coverage of 71.5%, with Pacific girls highest at 88% and Maori at 78%. Girls higher socioeconomic status were more likely be vaccinated in general practice.

CONCLUSION

School-based vaccination service targeted at ethic sub-populations provided equity for the Maori and Pacific student who achieved high levels of vaccination.

Early connections: effectiveness of a pre-call intervention to improve immunisation coverage and timeliness

INTRODUCTION

Children who have missed or delayed immunisations are at greater risk of vaccine-preventable diseases and getting their first scheduled dose on time strongly predicts subsequent complete immunisation. Developing a relationship with an infant's parents and general practice staff soon after birth followed by a systematic approach can reduce the number of delayed first immunisations.

AIM

To assess the effectiveness of a general practice-based pre-call intervention to improve immunisation timeliness.

METHODS

Clustered controlled trial of general practices in a large urban district randomised to either delivery of pre-call intervention to all babies at aged four weeks or usual care.

RESULTS

Immunisation timeliness for infants receiving the primary series of immunisations among their nominated Auckland general practices was higher than expected at 98% for the six week event. The intervention was statistically but not clinically significant. Coverage was significantly lower among infants with no nominated practice which reduced overall coverage rate for the district.

DISCUSSION

Pre-call letters with telephone follow-up are simple interventions to introduce into the practice management system and can be easily implemented as usual standard of care. Early identification of newborn infants, primary care engagement and effective systems including tracking of infants not enrolled in general practices has the greatest potential to improve immunisation coverage rates even further.

Febrile events including convulsions following the administration of four brands of 2010 and 2011 inactivated seasonal influenza vaccine in NZ infants and children: the importance of routine active safety surveillance

OBJECTIVE

To evaluate and compare rates of febrile events, including febrile convulsion, following immunisation with four brands of inactivated 2010 and 2011 influenza vaccine in NZ infants and children.

DESIGN

Retrospective telephone surveys of parents of infants and children who received at least one dose of the vaccines of interest.

SETTING

184 NZ General Practices who received the vaccines of interest.

PARTICIPANTS

Recipients of 4088 doses of trivalent inactivated vaccines Fluvax(®), Vaxigrip(®), Influvac(®) and Fluarix(®) and/or monovalent Celvapan. Vaccinees were identified via the electronic Practice Management System and contacted consecutively.

MAIN OUTCOME MEASURES

Primary outcome was febrile convulsive seizure. Secondary outcomes were presence of fever plus other organ system specific symptoms.

RESULTS

The parental response rate was 99%. Of 4088 doses given, 865 were Fluvax(®), 2571 Vaxigrip(®), 204 Influvac(®), 438 Fluarix(®) and 10 Celvapan. Three febrile convulsions followed Fluvax(®), a rate of 35 per 10,000 doses. No convulsions occurred following any dose of the other vaccines. There were nine febrile events that included rigors, all following Fluvax(®). Fever occurred significantly more frequently following administration of Fluvax(®) compared with the other brands of vaccines (p<0.0001) and Fluvax recipients were more likely to seek medical attention. Influvac(®) also had higher rates of febrile reactions (OR 0.54, 0.36-0.81) than the other two brands Vaxigrip(®) (OR 0.21, 0.16-0.27) and Fluarix(®) (OR 0.10, 0.05-0.20). After multivariable analysis vaccine, European ethnicity and second dose of vaccine were significantly associated with reporting of fever within 24h of vaccination.

CONCLUSIONS

Influenza vaccines have different rates of reactogenicity in children which varies between ethnic groups. High rates of febrile convulsions and reactions in children receiving Fluvax(®) and to a lesser extent the higher fever rates in those receiving Influvac(®) compared with the other two brands of influenza vaccines in this study suggests that reactogenicity profiles need to be considered prior to national policy advice each season. The risk-benefit profile in children might not be equally favourable for all licensed paediatric influenza vaccines. More attention needs to be given to comparative research for all trivalent seasonal vaccines, and with all strain changes.

Early connections: effectiveness of a pre-call intervention to improve immunisation coverage and timeliness

INTRODUCTION: Children who have missed or delayed immunisations are at greater risk of vaccine-preventable diseases and getting their first scheduled dose on time strongly predicts subsequent complete immunisation. Developing a relationship with an infant’s parents and general practice staff soon after birth followed by a systematic approach can reduce the number of delayed first immunisations. AIM: To assess the effectiveness of a general practice–based pre-call intervention to improve immunisation timeliness. METHODS: Clustered controlled trial of general practices in a large urban district randomised to either delivery of pre-call intervention to all babies at aged four weeks or usual care. RESULTS: Immunisation timeliness for infants receiving the primary series of immunisations among their nominated Auckland general practices was higher than expected at 98% for the six week event. The intervention was statistically but not clinically significant. Coverage was significantly lower among infants with no nominated practice which reduced overall coverage rate for the district. DISCUSSION: Pre-call letters with telephone follow-up are simple interventions to introduce into the practice management system and can be easily implemented as usual standard of care. Early identification of newborn infants, primary care engagement and effective systems including tracking of infants not enrolled in general practices has the greatest potential to improve immunisation coverage rates even further. KEYWORDS: Randomized controlled trial; immunization; vaccination; general practice; intervention studies

Conjugative plasmid transfer between Salmonella enterica Newport and Escherichia coli within the gastrointestinal tract of the lesser mealworm beetle, Alphitobius diaperinus (Coleoptera: Tenebrionidae)

The objective of this study was to determine if conjugative transfer of antimicrobial resistance plasmids could occur between donor and recipient bacteria within the gastrointestinal tract of lesser meal-worm beetles, a common pest in poultry production facilities. In 3 replicate studies (n = 40 overall), beetles were allowed to feed for 2 h on brain heart infusion agar inoculated with a multidrug-resistant Salmonella enterica serotype Newport strain (SN11 that carried plasmid replicons A/C and N) at 1.0 x 10(8) cfu/mL. Beetles were surface-disinfected and allowed to feed for 16 h on brain heart infusion agar inoculated with nalidixic acid- and rifampicin-resistant Escherichia coli JM109 at 9.0 x 10(6) cfu/mL. After bacterial exposure, beetles were surface-disinfected, homogenized, and selectively plated for transconjugants. Serial dilutions were done for conjugation frequencies. In vitro filter conjugations were performed simultaneously with beetle conjugations. Transconjugants were produced in all beetles exposed to both donor and recipient bacteria. Ninety-five percent of the beetle and 100% of the in vitro filter transconjugants were positive for the N plasmid replicon. The A/C replicon, which was also detected in the SN11 donor strain, did not transfer in any of the conjugation studies. None of the transconjugants displayed resistance to extended-spectrum cephalosporins. The geometric mean conjugation frequency in the beetle gut was 1.07 x 10(-1). The average conjugation frequencies for the beetle gut were 2 logs higher than those for the filter conjugations 4.1 x 10(-3). This study demonstrates that horizontal transfer of antimicrobial resistance plasmids can occur between Salmonella and E. coli within the gut of beetles and that beetles may be used as an in vivo model to study resistance gene transfer.

A short γ-ray burst apparently associated with an elliptical galaxy at redshift z = 0.225

Gamma-ray bursts (GRBs) come in two classes: long (> 2 s), soft-spectrum bursts and short, hard events. Most progress has been made on understanding the long GRBs, which are typically observed at high redshift (z approximately 1) and found in subluminous star-forming host galaxies. They are likely to be produced in core-collapse explosions of massive stars. In contrast, no short GRB had been accurately (< 10'') and rapidly (minutes) located. Here we report the detection of the X-ray afterglow from--and the localization of--the short burst GRB 050509B. Its position on the sky is near a luminous, non-star-forming elliptical galaxy at a redshift of 0.225, which is the location one would expect if the origin of this GRB is through the merger of neutron-star or black-hole binaries. The X-ray afterglow was weak and faded below the detection limit within a few hours; no optical afterglow was detected to stringent limits, explaining the past difficulty in localizing short GRBs.

Effect of hyaluronidase on ocular motility and eyelid function in sub-Tenon's anaesthesia: randomised controlled trial

PURPOSE

To assess the effect of hyaluronidase on eye and eyelid movements when used as an adjunct in sub-Tenon's anaesthesia.

METHODS

A total of 60 patients who had sub-Tenon's anaesthesia prior to phacoemulsification surgery were divided into two equal groups in a double-masked randomised controlled fashion. Of these, Group A had 4 ml lignocaine 2%, while Group B had 4 ml lignocaine 2% with the addition of sodium hyaluronidase 75 IU/ml. Ocular motility, levator, and orbicularis oculi function were measured in all patients at 5 and 8 min. Levator function was scored from 0 (no function) to 3 (complete function) while orbicularis function was scored from 0 to 2. The score for ocular motility was the sum in four positions of gaze, each position scoring from 0 to 2. Results were compared using a nonparametric test.

RESULTS

Group B achieved significantly better ocular and lid akinesia than Group A both at 5 and 8 min with P<0.01. The median scores for levator function at 5 and 8 min were 2 for Group A and 0 for Group B. For orbicularis function, the median scores at both time intervals were 2 for Group A and 1 for Group B. For ocular motility, the median score for Group A at 5 min was 3 and at 8 min was 2.5; for Group B at 5 min was 0.5 and at 8 min was 0.

CONCLUSIONS

The addition of hyaluronidase in sub-Tenon's anaesthesia has a significant effect in improving ocular and lid (levator and orbicularis) akinesia.

A case of bilateral manual eye-gouging of a British soldier

Peacetime assault-related injuries amongst soldiers are common. Whilst the majority of incidents of assault do not result in permanent physical incapacity, some may be devastating, ruining careers and lives. Here we describe one such injury. There is no national register of such injuries; they may, therefore, be under-reported.

Happy animals make good science

In this paper the question is posed whether it is not only better for the animal to be happy, but whether its state of mind may also have the potential to influence the scientific results derived from it. To ensure good science, the animal should have a normal physiology and behaviour, apart from specific adverse effects under investigation. There is a growing body of evidence from a wide variety of sources to show that animals whose well-being is compromised are often physiologically and immunologically abnormal and that experiments using them may reach unreliable conclusions. On scientific, as well as ethical grounds, therefore, the psychological well-being of laboratory animals should be an important concern for veterinarians, animal technicians and scientists.

Increasing OR efficiency with a specialty services manual

The successful operation of a modern ophthalmology OR is dependent on a knowledgeable, well-educated nursing staff. To improve communication and teamwork between ophthalmology surgeons and nursing staff members at the Louisiana State University Medical Center University Hospital, Shreveport, we developed an OR manual. We reduced our level of frustration by producing a manual that facilitates the day-to-day operation of the surgical services department. The manual provides consistent information for our ophthalmic surgical procedures; functions as a reference source; and promotes an efficient, productive OR. Although we designed this manual for the ophthalmology surgical service at our medical center, its structure can be applied to other surgical specialties.

Early use of the Gore-Tex Stretch Graft

This study reports firstly the overall outcome with the 4-7 mm tapered Gore-Tex Stretch Vascular Graft and secondly the feasibility of early (< 14 days) cannulation hemodialysis in 270 consecutive patients for first-time forearm loop placement. Ninety-six (36%) cases were cannulated within 14 days and 78 cases within 7 days. The overall results with the stretch graft are excellent. The statistically significantly worse outcome with early cannulation was mainly due to a select patient population (as determined by proportional hazards regression analysis) being more acutely ill, urgently needing hemodialysis and having no other options for needle puncture. A prospective randomized study, however, is warranted to fully resolve the safety issue of early cannulation.

Characterization of skin-infiltrating cells during acute graft-versus-host disease following bone marrow transplantation using unrelated marrow donors

To characterize skin-infiltrating T lymphocytes during acute GVHD, skin biopsies were obtained from two patients who received unrelated marrow matched for HLA-A, -B, -DR, and -DQ but mismatched for -DP. A total of 120 T-cell clones were generated. Phenotype analysis of the clones showed that the majority of cells were CD4+ and expressed alpha/beta TCR. HLA-DP oligonucleotide genotyping of the clones revealed the presence of lymphoid chimerism. PLT assay showed the lack of HLA specificity, including mismatched HLA-DP. However, mAb to HLA antigens blocked proliferation of the majority of the clones, indicating that the clones recognized HLA-associated molecules. Interestingly, proliferation of two CD4+ T-cell clones was inhibited by class I mAb. A few of the clones revealed augmented proliferation in the presence of CMV antigens and a few revealed cytolytic activity. The above study suggests that (a) CD4+ helper T cells may be primarily responsible for immunopathogenesis of skin manifestations during acute GVHD, (b) there is a mixed lymphoid chimerism in skin during acute GVHD, (c) HLA-DP may not be a factor contributing to the development of acute GVHD, (d) the peptide of the HLA groove or superantigen associated with HLA molecules may be the stimulatory antigen, and (e) CMV antigens appear to stimulate some of the skin-infiltrating T lymphocytes.

A five-year analysis of botulinum toxin type A injections: some unusual features

We analyzed patients treated during the past five years with botulinum toxin type A for strabismus and blepharospasm, reviewed our successes, failures, and unusual cases, and drew conclusions based on these treatments. Thirty-seven percent of the strabismus patients were cured, but many patients who were outside the strict definitions, still believed that they were significantly improved. A prominent feature in the treatment of strabismus was variability. Frequently, patients expected to do poorly had encouraging results. One permanent overcorrection occurred, and it converted an esotopic patient into an exotropic one with diplopia. This has persisted for 2.5 years and is the longest reported overcorrection to our knowledge. Our results indicate that larger doses of botulinum toxin produce longer spasm-free intervals in the treatment of blepharospasm. One patient receiving injections for her blepharospasm discovered that its cause was her sedative medication. This is the first reported case of a benzodiazepine inducing blepharospasm to our knowledge.

Randomised double blind controlled trial of cyclosporin in multiple sclerosis

In a 2 year double blind controlled trial of cyclosporin against placebo in multiple sclerosis conducted at two centres there was a beneficial effect of the therapy upon the progression of the disease, relapse rate and relapse severity at one of the centres where the patients received a mean dose of 7.2 mg/kg/day. This beneficial effect was not seen in the other centre where a lower dose (mean 5 mg/kg/day) was given. Reduction in clinical progression was accompanied by decreased IgG synthesis in the central nervous system. Side effects included hypertension, renal insufficiency and anaemia and were of such severity to preclude the use of cyclosporin in a high enough dose to alter the course of the disease.

Cricoid pressure and the pressor response to tracheal intubation

Forty healthy adults who underwent rapid sequence induction of anaesthesia were allocated randomly to receive either cricoid pressure or its stimulation. The anticipated increase in systolic arterial pressure and heart rate after laryngoscopy and tracheal intubation were not altered significantly by the application of cricoid pressure.

Relationship of duration of analgesia to opioid pharmacokinetic variables

That physiological effects are directly related to concentration at the site of action has been validated for only a few classes of drugs. For opiates, a direct correlation is known to exist between concentration and magnitude of analgesia, but has not been shown for duration of analgesia. These experiments in rats, using opiates whose elimination half-lives differ by a factor of 2 1/2, in a range of doses that produce 10-90% of maximal analgesic effect, show that duration is not dependent on dose or rate of elimination of opiate analgesics. The data suggest that analgesic duration is not determined by the pharmacokinetics of opiates at the receptors where these drugs act to elicit analgesia.

The measurement of urethral resistance and mural tension using simple programmable modules

The theory of urethral resistance and the derivation or mural tension have been discussed. A method for the continuous calculation and presentation of these parameters has been described. Urethral resistance and mural tensions are altered by the presence of bladder outflow obstruction and have been shown to return to normality after the obstruction is removed.