Determining the Efficacy of Liquid Sporicides Against Spores of Bacillus subtilis on a Hard Nonporous Surface Using the Quantitative Three Step Method: Collaborative Study

A collaborative study was conducted to validate the quantitative Three Step Method (TSM), a method designed to measure the performance of liquid sporicides on a hard nonporous surface. Ten laboratories agreed to participate in the collaborative study; data from 8 of 10 participating laboratories were used in the final statistical analysis. The TSM uses 5 5 1 mm glass coupons (carriers) upon which spores have been inoculated and which are introduced into liquid sporicidal agent contained in a microcentrifuge tube. Following exposure to a test chemical and a neutralization agent, spores are removed from carriers in 3 fractions: passive removal (Fraction A), sonication (Fraction B), and gentle agitation (Fraction C). Liquid from each fraction is serially diluted and plated on a recovery medium for spore enumeration. Control counts are compared to the treated counts, and the level of efficacy is determined by calculating the log10 reduction (LR) of spores. The main statistical goals were to evaluate the repeatability and reproducibility of the LR values, to estimate the components of variance for LR, and to assess method responsiveness. AOAC Method 966.04Method II was used as a reference method. The scope of the validation was limited to testing liquid formulations against spores of Bacillus subtilis, a surrogate for virulent strains of B. anthracis, on a hard nonporous surface (glass). The test chemicals used in the study were sodium hypochlorite, a combination of peracetic acid and hydrogen peroxide, and glutaraldehyde. Each test chemical was evaluated at 3 levels of presumed efficacy: high, medium, and low. Three replications were required. The TSM was validated as it successfully met the statistical parameters for quantitative test methods. Satisfactory validation parameters, such as the repeatability standard deviation (Sr) and reproducibility standard deviation (SR), were obtained for control carrier counts and LR values. Both the TSM and the reference method were responsive to the efficacy levels of the test chemicals. For the 72 total TSM tests conducted, the mean ( standard error of the mean) log density of spores per control carrier was 6.86 ( 0.08); the Sr and SR were low at 0.15 and 0.27, respectively. Across the range of test chemicals, the Sr and SR estimates associated with LR were also acceptably low. The Sr rangedfrom 0.17 to 0.72 and the SR ranged from 0.34 to 1.43. Overall, the Sr and SR estimates associated with the efficacy data were within the ranges published for other quantitative methods and meet the performance characteristics necessary for validation.

A new adaptation for a secure surgical drain placement and a comparison with four common drain fixation methods

INTRODUCTION

The importance of postoperative drain fixation cannot be overemphasised. There are numerous described techniques for drain fixation. However, to our knowledge, there is no evidence-based comparison between the various techniques of drain fixation used in postoperative management. We describe a new method and compare its reliability with four other commonly used methods.

MATERIALS AND METHODS

Five methods were chosen for testing based on current trends in clinical practice: centurion sandal with plastic locking ties, centurion sandal or lattice method, centurion sandal with half-inch Steristrips®, double and multiple looped methods. We used an Instron 8872® tensiometer to apply a measured force to a secured drain. Each fixation method was tested ten times and all fixation methods were performed by the same experienced surgeon. We measured the average number of cycles before failure, the average displacement of the tube at failure and the time needed to apply each fixation method.

RESULTS

The number of cycles completed before failure showed that the centurion sandal method, the centurion sandal with plastic ties and the centurion sandal method with Steristrips had the lowest failure rate. The amount of displacement was the least in the centurion sandal with plastic ties followed by the double-loop method and centurion sandal with Steristrips. There was little difference in the time taken to complete the fixation methods (range 21-33 seconds).

DISCUSSION

We recommend the use of the centurion sandal with plastic locking ties, centurion sandal with Steristrips followed by the centurion sandal method alone as fixation techniques that are quick to perform, secure and reliable.

Enhanced γ-Ray Emission from Neutron Unbound States Populated in β Decay

Total absorption spectroscopy is used to investigate the β-decay intensity to states above the neutron separation energy followed by γ-ray emission in (87,88)Br and (94)Rb. Accurate results are obtained thanks to a careful control of systematic errors. An unexpectedly large γ intensity is observed in all three cases extending well beyond the excitation energy region where neutron penetration is hindered by low neutron energy. The γ branching as a function of excitation energy is compared to Hauser-Feshbach model calculations. For (87)Br and (88)Br the γ branching reaches 57% and 20%, respectively, and could be explained as a nuclear structure effect. Some of the states populated in the daughter can only decay through the emission of a large orbital angular momentum neutron with a strongly reduced barrier penetrability. In the case of neutron-rich (94)Rb the observed 4.5% branching is much larger than the calculations performed with standard nuclear statistical model parameters, even after proper correction for fluctuation effects on individual transition widths. The difference can be reconciled by introducing an enhancement of 1 order of magnitude in the photon strength to neutron strength ratio. An increase in the photon strength function of such magnitude for very neutron-rich nuclei, if it proves to be correct, leads to a similar increase in the (n,γ) cross section that would have an impact on r process abundance calculations.

Tag rugby: a safe alternative? A review of hand injuries sustained playing tag rugby (2007 season)

INTRODUCTION

Tag rugby is a non-contact, seven-a-side, team sport in which each player wears specially designed shorts with velcro 'tags' attached to them. While tag rugby is a relatively new sport it has grown rapidly in popularity. As a result of its increasing popularity an increased frequency of attendances at plastic surgery clinics was observed and it was decided a review of all hand injuries associated with this new sport was required.

MATERIALS AND METHODS

A retrospective case note review of all hand injuries occurring during the tag rugby season for 2007 (March-August) was conducted, with any tag rugby-related hand injuries being selected for further examination.

RESULTS

Tag rugby, while being a non-contact sport, is certainly not without a definite injury risk with 12 patients having single digit injuries, ranging from tendon avulsions to phalangeal fractures. The mean age of the injured patients was 26.8 years.

DISCUSSION

All of the hand injuries were sustained while 'tackling' during regular play, the hand injuries sustained were all treated using well-described methods and all the patients are recovering well. While the risk of a severe, life-threatening injury is unlikely while playing tag rugby, there is a real risk of sustaining a potentially debilitating hand injury.

Inadequacies in the first aid management of burns presenting to plastic surgery services

Burn injury is a significant cause of mortality and morbidity in Ireland. Simple first aid measures such as immediate wound cooling and removal of the source of injury can significantly improve clinical outcome. We conducted a six-month study, investigating the first aid measures taken by both patients and their primary carers following burn injury. Of the 63 patients referred to the plastic surgery services, only 23.2% had employed the correct first aid principles. Only 20% of patients who sustained burns at work reported that first aid was available in the workplace. This study illustrates that knowledge regarding the initial management of burn injury is very poor. We suggest that a national public health education campaign could have a positive effect on the outcome of burn injury.

The trap door flap for reconstructing defects of the concha

We report six cases of conchal neoplasms where the defect was reconstructed with a Trap Door Flap based on the post auricular vessels. The flap was reliable and gave good cosmetic results.

Pregnancy as an autologous tissue expander for closure of an abdominal-wall defect

We report the reconstruction of a complex abdominal-wall defect using expanded skin from pregnancy. Wound closure was achieved using a vertical abdominoplasty.

Soft tissue infection with Absidia corymbifera in a patient with idiopathic aplastic anemia

We describe a case of primary cutaneous mucormycosis (zygomycosis) in a patient with idiopathic aplastic anemia which responded to surgical debridement and therapy with liposomal amphotericin B. The tissue removed at surgery showed dense infiltration with fungal hyphae on histopathological examination. Primary cultures of tissue on solid media were negative, but Absidia corymbifera was isolated from unprocessed tissue placed in brain heart infusion broth.

A sacrococcygeal extraspinal ependymoma in a 67-year-old man: a case report and review of the literature

Extraspinal ependymomas are extremely uncommon tumours of glial origin. They occur predominantly in children and adolescents. We report a case of a subcutaneous extraspinal ependymoma in a 67-year-old man. This was excised, and the defect reconstructed with a V-Y advancement flap.

SMOKING, ALCOHOL AND THE RISK OF DUPUYTREN’S CONTRACTURE

We investigated the association of Dupuytren’s contracture with smoking and with alcohol by a case-control study in which 222 patients having an operation for this condition were matched for age, operation date and gender with control patients having other orthopaedic operations. Fifty of the cases were also each matched with four community controls. Data were collected by postal questionnaire.

Dupuytren’s contracture needing operation was strongly associated with current cigarette smoking (adjusted odds ratio 2.8 (95% confidence interval (CI) 1.5 to 5.2)). The mean lifetime cigarette consumption was 16.7 pack-years for the cases compared with 12.0 pack-years for the controls (p = 0.016). Dupuytren’s contracture was also associated with an Alcohol Use Disorders Test score greater than 7 (adjusted odds ratio 1.9 (95% CI 1.02 to 3.57)). Mean weekly alcohol consumption was 7.3 units for cases and 5.4 units for controls (p = 0.016). The excess risk associated with alcohol did not appear to be due to a confounding effect of smoking, or vice versa.

Smoking increases the risk of developing Dupuytren’s contracture and may contribute to its prevalence in alcoholics, who tend to smoke heavily.

Smoking, alcohol and the risk of Dupuytren's contracture

We investigated the association of Dupuytren's contracture with smoking and with alcohol by a case-control study in which 222 patients having an operation for this condition were matched for age, operation date and gender with control patients having other orthopaedic operations. Fifty of the cases were also each matched with four community controls. Data were collected by postal questionnaire. Dupuytren's contracture needing operation was strongly associated with current cigarette smoking (adjusted odds ratio 2.8 (95% confidence interval (CI) 1.5 to 5.2)). The mean lifetime cigarette consumption was 16.7 pack-years for the cases compared with 12.0 pack-years for the controls (p = 0.016). Dupuytren's contracture was also associated with an Alcohol Use Disorders Test score greater than 7 (adjusted odds ratio 1.9 (95% CI 1.02 to 3.57)). Mean weekly alcohol consumption was 7.3 units for cases and 5.4 units for controls (p = 0.016). The excess risk associated with alcohol did not appear to be due to a confounding effect of smoking, or vice versa. Smoking increases the risk of developing Dupuytren's contracture and may contribute to its prevalence in alcoholics, who tend to smoke heavily.

Colocutaneous fistula as a complication of PEG tube placement

Individuals with prolonged swallowing difficulties may require enteral supplementation to maintain a healthy nutritional status. Until the advent of the percutaneous endoscopic gastrostomy (PEG) tube in 1980, feeding was usually accomplished by a nasogastric feeding tube. The initial insertion of a PEG tube requires endoscopic or radiologic guidance but has the advantages of being easy to care for and being a permanent or temporary access site for enteral nutrition. Complications associated with PEG tube placement are relatively infrequent. We present a case of a percutaneous fistula as a rare complication associated with reinsertion of a PEG tube.

Essential skills for baccalaureate graduates: perspectives of education and service

What psychomotor tasks should baccalaureate graduates be able to perform when they arrive on the doorsteps of practice settings? This article describes a research study in which a representative sample of nursing educators and nursing service personnel provide their perceptions in regard to that question. The content offers a clear view of the expectations of both groups, emphasizes the need for dialogue on this topic between educational service, and raises important issues for nursing administrators regarding the role of staff development and the transition of new graduates to the work setting.