Epidemiology and cost of nosocomial gastroenteritis, Avon, England, 2002-2003

Implementing control measures rapidly may be effective in controlling gastroenteritis outbreaks.

Healthcare-associated outbreaks of gastroenteritis are an increasingly recognized problem, but detailed knowledge of the epidemiology of these events is lacking. We actively monitored three hospital systems in England for outbreaks of gastroenteritis in 2002 to 2003. A total of 2,154 patients (2.21 cases/1,000-hospital-days) and 1,360 healthcare staff (0.47 cases/1,000-hospital-days) were affected in 227 unit outbreaks (1.33 outbreaks/unit-year). Norovirus, detected in 63% of outbreaks, was the predominant etiologic agent. Restricting new admissions to affected units resulted in 5,443 lost bed-days. The cost of bed-days lost plus staff absence was calculated to be £635,000 (U.S.$ 1.01 million) per 1,000 beds. By our extrapolation, gastroenteritis outbreaks likely cost the English National Health Service £115 million (U.S.$ 184 million) in 2002 to 2003. Outbreaks were contained faster (7.9 vs. 15.4 days, p = 0.0023) when units were rapidly closed to new admissions (<4 days). Implementing control measures rapidly may be effective in controlling outbreaks.

Social exchange of cigarettes by youth

OBJECTIVE

This study seeks to determine the magnitude, nature, and correlates of social exchange of cigarettes among youth who smoke.

DESIGN

Cross sectional survey.

SETTING

Schools in 29 Minnesota communities.

PARTICIPANTS

All students in grades 8, 9, and 10 (ages 13-16 years) in each participating school. The parent/child response rate for the survey was 90%. Analyses included 4124 respondents who smoked at least one cigarette in the month before the survey.

OUTCOME MEASURES

Social exchange scale, consisting of 16 items assessing aspects of social provision and acquisition of cigarettes.

RESULTS

Almost 90% of youth in this study had obtained a cigarette from, and about 75% of them had provided cigarettes to, another teen in the prior month. Daily smokers provided to more teens and provided more often than those who smoked less than daily. Daily smokers also reported having more social sources, both teens and adults, than lighter smokers, and were more likely to have both bought from and sold cigarettes to other teens (p < 0.0001 for all comparisons between daily and less than daily smokers). In a multivariate analysis, social exchange was associated with grade, whether siblings and friends smoke, level of smoking, age of smoking initiation, parental influences and community norms about teen smoking, and buying cigarettes.

CONCLUSIONS

Social provision and acquisition of cigarettes among teens are widespread, reciprocal behaviours. Parental and community expectations about smoking influence social exchange, possibly by providing opportunities or barriers for social smoking. Commercial and social availability are not mutually exclusive; rather social exchange extends the reach of commercial sources.

Weight-teasing among adolescents: correlations with weight status and disordered eating behaviors

OBJECTIVES

This study aimed to assess the prevalence of perceived weight-teasing and associations with unhealthy weight-control behaviors and binge eating in a population-based sample of youth. Particular focus was placed on overweight youth, who may be most vulnerable to weight-teasing.

METHODS

The study population included 4746 adolescents from St Paul/Minneapolis public schools who completed surveys and anthropometric measurements as part of Project EAT, a population-based study of eating patterns and weight concerns among teens.

RESULTS

There were statistically significant associations between perceived weight-teasing and weight status; both overweight and underweight youth reported higher levels of teasing than average weight youth. Very overweight youth (body mass index (BMI) > or = 95th percentile) were most likely to be teased about their weight; 63% of very overweight girls, and 58% of very overweight boys reported being teased by their peers, while weight-teasing by family members was reported by 47% of these girls and 34% of these boys. Youth who were teased about their weight, particularly overweight girls, reported that it bothered them. Perceived weight-teasing was significantly associated with disordered eating behaviors among overweight and non-overweight girls and boys. For example, among overweight youth, 29% of girls and 18% of boys who experienced frequent weight-teasing reported binge-eating as compared to 16% of girls and 7% of boys who were not teased.

CONCLUSIONS

Many adolescents, in particular those who are overweight, report being teased about their weight and being bothered by the teasing. Weight-teasing is associated with disordered eating behaviors that may place overweight youth at increased risk for weight gain. Educational interventions and policies are needed to curtail weight-related mistreatment among youth.

Identical words are read differently in different languages

It is hypothesized that written languages differ in the preferred grain size of units that emerge during reading acquisition. Smaller units (graphemes, phonemes) are thought to play a dominant role in relatively consistent orthographies (e.g., German), whereas larger units (bodies, rhymes) are thought to be more important in relatively inconsistent orthographies (e.g., English). This hypothesis was tested by having native English and German speakers read identical words and nonwords in their respective languages (zoo-Zoo, sand-Sand, etc.). Although the English participants exhibited stronger body-rhyme effects, the German participants exhibited a stronger length effect for words and nonwords. Thus, identical items were processed differently in different orthographies. These results suggest that orthographic consistency determines not only the relative contribution of orthographic versus phonological codes within a given orthography; but also the preferred grain size of units that are likely to be functional during reading.

Horner's syndrome after carotid endarterectomy--a case report

Horner's syndrome is described in a patient with anisocoria and unilateral lid ptosis 48 hours after an ipsilateral carotid endarterectomy. This case illustrates a rare iatrogenic complication of sympathetic nerve dysfunction following elective surgery.

Bacterial contamination of uniforms

Microbiological sampling of nurses' uniforms was undertaken using a Casella slit sampler. Staphylococcus aureus, Clostridium difficile and vancomycin-resistant enterococci were detected on uniforms both before and after a span of duty. Recommendations for provision and changing of nurses' uniforms are made.

DRC: a dual route cascaded model of visual word recognition and reading aloud

This article describes the Dual Route Cascaded (DRC) model, a computational model of visual word recognition and reading aloud. The DRC is a computational realization of the dual-route theory of reading, and is the only computational model of reading that can perform the 2 tasks most commonly used to study reading: lexical decision and reading aloud. For both tasks, the authors show that a wide variety of variables that influence human latencies influence the DRC model's latencies in exactly the same way. The DRC model simulates a number of such effects that other computational models of reading do not, but there appear to be no effects that any other current computational model of reading can simulate but that the DRC model cannot. The authors conclude that the DRC model is the most successful of the existing computational models of reading.

DRC: a dual route cascaded model of visual word recognition and reading aloud

This article describes the Dual Route Cascaded (DRC) model, a computational model of visual word recognition and reading aloud. The DRC is a computational realization of the dual-route theory of reading, and is the only computational model of reading that can perform the 2 tasks most commonly used to study reading: lexical decision and reading aloud. For both tasks, the authors show that a wide variety of variables that influence human latencies influence the DRC model's latencies in exactly the same way. The DRC model simulates a number of such effects that other computational models of reading do not, but there appear to be no effects that any other current computational model of reading can simulate but that the DRC model cannot. The authors conclude that the DRC model is the most successful of the existing computational models of reading.

A prospective, randomised trial of prophylactic antibiotics versus bag extraction in the prophylaxis of wound infection in laparoscopic cholecystectomy

Septic complications are rare following laparoscopic cholecystectomy if prophylactic antibiotics are given, as demonstrated in previous studies. Antibiotic treatment may be unnecessary and, therefore, undesirable, so we compared two forms of prophylaxis: a cephalosporin antibiotic and bag extraction of the dissected gallbladder. A total of 76 patients undergoing laparoscopic cholecystectomy were randomised to either receive an antibiotic or to have their gallbladder removed from the abdomen in a plastic bag. Complicated cases were excluded. There was a total of 6 wound infections (7.9%), 3 in each of the study groups. All these were associated with skin commensals. There were no other septic complications. Bacteriological studies grouped the organisms isolated from the bile and the wound as potential pathogens and likely commensals. A total of 10 potential pathogens were isolated, 9 of which were found in the group receiving antibiotics. We conclude that septic sequelae of uncomplicated laparoscopic cholecystectomy are uncommon, but clearly not entirely prevented by antibiotic or mechanical prophylaxis. Prophylactic antibiotics may not be required in uncomplicated laparoscopic cholecystectomy. Further study is warranted.

CD40 ligand trimer and IL-12 enhance peripheral blood mononuclear cells and CD4+ T cell proliferation and production of IFN-gamma in response to p24 antigen in HIV-infected individuals: potential contribution of anergy to HIV-specific unresponsiveness

It has been suggested that CD4+ T cell proliferative responses to HIV p24 Ag may be important in the control of HIV infection. However, these responses are minimal or absent in many HIV-infected individuals. Furthermore, while in vitro and in vivo responses to non-HIV recall Ags improve upon administration of highly active antiretroviral therapy, there does not appear to be a commensurate enhancement of HIV-specific immune responses. It is possible that CD4+ p24-specific T cells are deleted early in the course of infection. However, it is also possible that a discrete unresponsiveness, or anergy, contributes to the lack of proliferation to p24. To evaluate the possible contribution of unresponsiveness to the lack of CD4+ T cell proliferation to p24 in HIV-infected individuals, we attempted to overcome unresponsiveness. CD40 ligand trimer (CD40LT) and IL-12 significantly increased PBMC and CD4+ T cell proliferative responses to p24 Ag in HIV-infected, but not uninfected, individuals. No increase in proliferative response to CMV Ag was observed. CD40LT exerted its effect through B7-CD28-dependent and IL-12- and IL-15-independent mechanisms. Finally, the increase in proliferation with CD40LT and IL-12 was associated with an augmented production of IFN-gamma in most, but not all, individuals. These data suggest the possible contribution of HIV-specific unresponsiveness to the lack of CD4+ T cell proliferation to p24 Ag in HIV-infected individuals and that clonal deletion alone does not explain this phenomenon. They also indicate the potential for CD40LT and IL-12 as immune-based therapies for HIV infection.

Linguistic difficulties in language and reading development constrain skilled adult reading

This study investigated whether the quality and specification of phonological representations in early language development would predict later skilled reading. Two perceptual identification experiments were performed with skilled readers. In Experiment 1, spelling difficulties in Grade 1 were used as a proxy measure for poorly specified representations in early language development. In Experiment 2, difficulties in perceiving and representing liquid and nasalized phonemes in final consonant clusters were used for the same purpose. Both experiments showed that words that were more likely to develop underspecified lexical representations in early language development remained more difficult in skilled reading. This finding suggests that early linguistic difficulties in speech perception and structuring of lexical representations may constrain the long-term organization and dynamics of the skilled adult reading system. The present data thus challenge the assumption that skilled reading can be fully understood without taking into account linguistic constraints acting upon the beginning reader.

Training strategies to maintain immunocompetence in athletes

Clinical experience and empirical evidence have led to the modeling of exercise and training as a form of stress on the immune system. Coaches, athletes, and medical personnel are seeking guidelines on ways to reduce the risk of illness that compromises training or competitive performance. The immune system is influenced by a wide range of physical, environmental, psychological, and behavioural factors which, combined with clinical assessment, collectively form the basis of the following intervention strategies: 1) training: careful management of training volume and intensity, variety to overcome training monotony and strain, a periodised approach to increasing loads, and provision of adequate rest and recovery periods; 2) environmental: limiting initial exposure when training or competing in adverse environmental conditions (heat, humidity, altitude, air pollution) and acclimatising where appropriate; 3) psychological: teaching athletes self-management and coping skills and monitoring of athletes' responses to the psychological and psychosocial stresses of high-level training and competition; 4) behavioural: adopting a well-balanced diet with adequate intake of macro- and micro-nutrients, limiting transmission of contagious illnesses by reducing exposure to common infections, airborne pathogens, and physical contact with infected individuals; and 5) clinical considerations: medical screening, pathology testing, immunization and prophylaxis, and routine management of illness-prone athletes. Future experimental studies are required to develop and enhance the effectiveness of these strategies in reducing illness in athletes.

Phonology matters: the phonological frequency effect in written Chinese

Does phonology play a role in silent reading? This issue was addressed in Chinese. Phonology effects are less expected in Chinese than in alphabetical languages like English because the basic units of written Chinese (the characters) map directly into units of meaning (morphemes). This linguistic property gave rise to the view that phonology could be bypassed altogether in Chinese. The present study, however, shows that this is not the case. We report two experiments that demonstrate pure phonological frequency effects in processing written Chinese. Characters with a high phonological frequency were processed faster than characters with a low phonological frequency, despite the fact that the characters were matched on orthographic (printed) frequency. The present research points to a universal phonological principle according to which phonological information is routinely activated as a part of word identification. The research further suggests that part of the classic word-frequency effect may be phonological.

Gastropod mollusc aliphatic alcohol oxidase: subcellular localisation and properties

The digestive gland and other tissues of several species of terrestrial gastropod mollusc contain an aliphatic alcohol oxidase activity (EC1.1.3.13). The enzyme is FAD dependent, consumes oxygen and generates hydrogen peroxide and the corresponding aldehyde. Saturated primary alcohols are favoured as substrates with octanol preferred with an apparent Km of 3-4 microM. The activity is clearly distinguishable from previously reported molluscan aromatic alcohol oxidase (EC1.1.3.7) on the basis of FAD dependence, sensitivity to heat treatment and high salt concentration and with regard to substrate preferences. The aliphatic alcohol oxidase is membrane associated and most likely localised to the endoplasmic reticulum. Extraction of membranes with 1% Igipal solubilises the enzyme in active form. This enzyme is a further example of an oxidase apparently restricted to molluscs.

Functional outcome in knee osteoarthritis after treatment with hylan G-F 20: a prospective study

OBJECTIVE

To assess functional change in patients with knee osteoarthritis (OA) after treatment with intra-articular hyaluronic acid (Hylan G-F 20; Synvisc).

DESIGN

Prospective case series with 6-month follow-up.

SETTING

Outpatient community orthopedic practice.

PARTICIPANTS

Eighty-four consecutive patients referred to private orthopedic group with symptoms and radiographic evidence of unilateral or bilateral knee OA who had either failed or could not tolerate the side effects of conservative treatment. Sixty-one patients completed the study. Nineteen patients were lost to follow-up. Four patients withdrew from study due to subsequent knee arthroplasty.

INTERVENTION

Three weekly injections of Hylan G-F 20 into one or both (if bilaterally symptomatic) knees (110 knees total).

OUTCOME MEASURE

SF-36 Health Survey was completed before treatment and 6 months after treatment.

RESULTS

Statistically significant improvement (p < .001) in Physical Functioning, Role-Physical, Bodily Pain, Social Functioning, and Role-Emotional categories on 6-month follow-up survey. Age and percent above ideal body weight were not significant predictors of functional change.

CONCLUSION

Efficacy of intra-articular injection of Hylan G-F 20 for knee OA 6 months after injection is demonstrated in several categories of the SF-36, indicating a measurable improvement in overall functioning in these patients.