The Trauma Dyad: The Role of Informal Caregivers for Older Adults After Traumatic Injury

OBJECTIVE

To investigate the association between higher injury severity and increased informal caregiving received by injured older adults.

SUMMARY OF BACKGROUND DATA

Injured older adults experience high rates of functional decline and disability after hospitalization. Little is known about the scope of caregiving received post-discharge, particularly from informal caregivers such as family.

METHODS

We used the National Health and Aging Trends Study 2011 to 2018 linked to Medicare claims to identify adults ≥65 with hospital admission for traumatic injury and a National Health and Aging Trends Study interview within 12 months pre- and post-trauma. Injury severity was assessed using the injury severity score (ISS, low 0-9; moderate 10-15; severe 16-75). Patients reported the types and hours of formal and informal help received and any unmet care needs. Multi variable logistic regression models examined the association between ISS and increase in informal caregiving hours after discharge.

RESULTS

We identified 430 trauma patients. Most were female (67.7%), non-Hispanic White (83.4%) and half were frail. The most common mechanism of injury was fall (80.8%) and median injury severity was low (ISS = 9). Those reporting receiving help with any activity increased post-trauma (49.0% to 72.4%, P < 0.01), and unmet needs nearly doubled (22.8% to 43.0%, P < 0.01). Patients had a median of 2 caregivers and most (75.6%) were informal, often family members. Median weekly hours of care received pre- versus post-injury increased from 8 to 14 (P < 0.01). ISS did not independently predict increase in caregiving hours; pre-trauma frailty predicted an increase in hours ≥8 per week.

CONCLUSIONS

Injured older adults reported high baseline care needs which increased significantly after hospital discharge and were mostly met by informal caregivers. Injury was associated with increased need for assistance and unmet needs regardless of injury severity. These results can help set expectations for caregivers and facilitate post-acute care transitions.

A novel patient-reported outcomes instrument assessing the side effects of peanut oral immunotherapy

BACKGROUND

Patients treated with peanut oral immunotherapy (OIT) may experience adverse reactions, particularly during up-dosing.

OBJECTIVE

To develop the Side Effects of Peanut Oral Immunotherapy Diary (SEPOD), an electronic questionnaire assessing the daily side effects of peanut OIT in clinical trials.

METHODS

Content and design of the SEPOD were informed by empirical literature review and meetings with 3 allergy-immunology experts. Interviews to confirm content and inform revisions were conducted in 24 pediatric patients with peanut allergy (14 treated with peanut OIT) aged 6 to 17 years; children aged 6 to 11 years were interviewed with their caregiver.

RESULTS

The SEPOD was drafted after literature review and expert interviews; the initial measurement approach comprised 2 SEPOD versions, a patient-reported outcome (PRO) version for children aged 12 to 17 years, and a caregiver-administered PRO version for children aged 6 to 11 years with instructions for caregiver questionnaire administration. Pediatric patients were expected to respond independently on both versions. Patient interviews indicated that some younger children (ie, aged 6-8 years) had difficulty understanding questions, even when reading aloud; therefore, a caregiver-administered outcome version, identical in content to the caregiver-administered PRO version, was developed for this age group. The final electronic SEPOD covered 23 peanut OIT side effects within the following 7 domains: gastrointestinal, dermatologic, itching, nasal, and respiratory, swelling (eyelid or periorbital, lip, tongue, and throat), pain (tongue, mouth, and throat), and dizziness.

CONCLUSION

This study yielded the SEPOD, a new clinical outcome assessment instrument with various methods of administration that can be used to assess the side effects of peanut OIT experienced by pediatric patients in a clinical trial setting.

Health assessments and screening tools for adults experiencing homelessness: a systematic review

Background

Homelessness is increasing globally. It results in poorer physical and mental health than age matched people living in permanent housing. Better information on the health needs of people experiencing homelessness is needed to inform effective resourcing, planning and service delivery by government and care organisations.

The aim of this review was to identify assessment tools that are valid, reliable and appropriate to measure the health status of people who are homeless.

Methods

Data sources: A systematic literature search was conducted in PubMed (and Medline), PsychInfo, Scopus, CINAHL and ERIC from database inception until September 2018. Key words used were homeless, homelessness, homeless persons, vagrancy, health status, health, health issues, health assessment and health screening. The protocol was registered with PROSPERO. The National Health and Medical Research Council of Australia (NHMRC) hierarchy of evidence was applied; methodological quality of included articles was assessed using the McMaster critical appraisal tools and psychometric properties of the tools were appraised using the International Centre for Allied Health Evidence Ready Reckoner.

Results

Diverse tools and measures (N = 71) were administered within, and across the reviewed studies (N = 37), with the main focus being on general health, oral health and nutrition. Eleven assessment tools in 13 studies had evidence of appropriate psychometric testing for the target population in domains of quality of life and health status, injury, substance use, mental health, psychological and cognitive function. Methodological quality of articles and tools were assessed as moderate to good. No validated tools were identified to assess oral health, chronic conditions, anthropometry, demography, nutrition, continence, functional decline and frailty, or vision and hearing. However, assessments of physical constructs (such as oral health, anthropometry, vision and hearing) could be applied to homeless people on a presumption of validity, because the constructs would be measured with clinical indicators in the same manner as people living in permanent dwellings.

Conclusions

This review highlighted the need to develop consistent and comprehensive health assessment tools validated with, and tailored for, adults experiencing homelessness.

Electronic supplementary material

The online version of this article (10.1186/s12889-019-7234-y) contains supplementary material, which is available to authorized users.

Laser interferometric method for measuring linear polymerization shrinkage in light cured dental restoratives

OBJECTIVE

A novel laser interferometric method for monitoring linear polymerization shrinkage in dental restoratives is demonstrated.

METHODS

The experimental apparatus consists of a low power Helium-Neon laser, a home-built Michelson interferometer, amplified photodiode detectors, and a computer data acquisition system. The feasibility of using interferometry to measure linear shrinkage was evaluated by measuring the percent linear contraction in five commercially available light cured restorative systems.

RESULTS

Five-min interferometric curing profiles were collected for each restorative using a 400 mW/cm2 curing light irradiance. The 'interferograms' were converted into percent linear contraction profiles that revealed the relative kinetics of material shrinkage. The overall percent linear contraction after 5 min compares favorably with literature data for the five commercial restoratives studied here.

SIGNIFICANCE

Interferometry offers several advantages over conventional methods of measuring polymerization contraction. These advantages include the inherent sensitivity and accuracy offered by interferometric measurements; the instrument does not need to be calibrated since the wavelength of the laser light source provides an accurate length standard. Also, the ability to collect data at high acquisition rates allows for the real-time characterization of unusually fast photopolymerization reactions. The low cost and relative ease of use associated with the apparatus are also advantageous.

Bogorol A produced in culture by a marine Bacillus sp. reveals a novel template for cationic peptide antibiotics

[figure: see text] Bogorol A (1), a novel peptide antibiotic active against MRSA and VRE, has been isolated from cultures of a marine Bacillus sp. collected in Papua New Guinea. The structure of bogorol A was elucidated by a combination of spectroscopic analyses and chemical degradation. Bogorol A illustrates a new structural template for "cationic peptide antibiotics".

Transcription initiation-defective forms of sigma(54) that differ in ability To function with a heteroduplex DNA template

Transcription by sigma(54)-RNA polymerase holoenzyme requires an activator that catalyzes isomerization of the closed promoter complex to an open complex. We examined mutant forms of Salmonella enterica serovar Typhimurium sigma(54) that were defective in transcription initiation but retained core RNA polymerase- and promoter-binding activities. Four of the mutant proteins allowed activator-independent transcription from a heteroduplex DNA template. One of these mutant proteins, L124P V148A, had substitutions in a sequence that had not been shown previously to participate in the prevention of activator-independent transcription. The remaining mutants did not allow efficient activator-independent transcription from the heteroduplex DNA template and had substitutions within a conserved 20-amino-acid segment (Leu-179 to Leu-199), suggesting a role for this sequence in transcription initiation.

Cell-based screen for antimitotic agents and identification of analogues of rhizoxin, eleutherobin, and paclitaxel in natural extracts

We describe a cell-based assay for antimitotic compounds that is suitable for drug discovery and for quantitative determination of antimitotic activity. In the assay, cells arrested in mitosis as a result of exposure to antimitotic agents in pure form or in crude natural extracts are detected by ELISA using the monoclonal antibody TG-3. The assay was used to screen >24,000 extracts of marine microorganisms and invertebrates and terrestrial plants and to guide the purification of active compounds from 5 of 119 positive extracts. A new rhizoxin analogue was found in a Pseudomonas species, six new eleutherobin analogues were identified from the octocoral Erythropodium caribaeorum, and two paclitaxel analogues were found in the stem bark of the tree Ilex macrophylla. The assay was also used for quantitative comparison of the antimitotic activity of different analogues. It revealed the importance of the C-11 to C-13 segment of the diterpene core of eleutherobin for its antimitotic activity. The identification of antimitotic compounds in very low abundance and their high (0.5%) occurrence in natural extracts indicates that drug discovery efforts using this cell-based assay may lead to the identification of structurally novel antimitotic agents.

Determination of taurine in plasma by capillary zone electrophoresis following derivatisation with fluorescamine

A novel capillary zone electrophoresis method is described for the determination of taurine in plasma. The method is rapidly executed and is highly selective for taurine as separation is based on the difference in ionisation of this amino acid from that of other amino acids. Following addition of homotaurine as internal standard, plasma proteins were precipitated with acetonitrile and the supernatant was derivatised with fluorescamine in the presence of a borate buffer. Capillary electrophoresis (CE) separations were carried out in reverse polarity mode at 27.5 kV on a Beckman P/ACE MDQ CE instrument, equipped with a diode array detector (DAD) set at 266 nm. The sample tray was cooled to 5 degrees C and separations were carried out at 20 degrees C. The fused-silica capillary was 50.2 cm in length (40.2 cm to detector) with an internal diameter of 75 microm. A capillary conditioning solution was applied daily in order to suppress the residual electroosmotic flow (EOF). The method, which was validated using feline plasma as the blank matrix, was shown to be linear and reproducible over the concentration range 2.5-100 microg/mL. The coefficients of variation (CVs) of replicate analyses were less than 4.5% at 1 microg/mL taurine in feline plasma and less than 3% for 2.5 microg/mL in human plasma. Recovery was estimated at 99.2% with a CV of 4.85%. It has been demonstrated that quantitation in aqueous solution yields similar results to those obtained by interpolation on a plasma calibration curve provided that subtraction for the taurine peak in unspiked plasma is carried out and that a suitable internal standard is employed.

The amino terminus of Salmonella enterica serovar Typhimurium sigma(54) is required for interactions with an enhancer-binding protein and binding to fork junction DNA

Transcription initiation by the sigma(54)-RNA polymerase holoenzyme requires an enhancer-binding protein that is thought to contact sigma(54) to activate transcription. To identify potential enhancer-binding protein contact sites in sigma(54), we compared the abilities of wild-type and truncated forms of Salmonella enterica serovar Typhimurium sigma(54) to interact with the enhancer-binding protein DctD in a chemical cross-linking assay. Removal of two regions in the amino-terminal portion of sigma(54), residues 57 to 105 and residues 144 to 179, prevented cross-linking, but removal of either region alone did not. In addition, deletion of 56 amino-terminal residues of sigma(54) (region I) reduced the affinity of the protein for a fork junction DNA probe.

Comparison of molecular methods for typing Vibrio parahaemolyticus

An outbreak of Vibrio parahaemolyticus gastroenteritis on Canada's west coast in 1997 emphasized the need to develop molecular methods for differentiation and typing of these organisms. Isolates were analyzed by enterobacterial repetitive intergenic consensus sequence (ERIC) PCR, detection of restriction fragment length polymorphisms (RFLP) in rRNA genes (ribotyping), pulsed-field gel electrophoresis (PFGE), and RFLP analysis of the genetic locus encoding the polar flagellum (Fla locus RFLP analysis). ERIC PCR and ribotyping were the most informative typing methods, especially when used together, while Fla locus RFLP analysis was the least discriminatory. PFGE exhibited good discrimination but suffered from a high incidence of DNA degradation. ERIC PCR and ribotyping will be useful for the evaluation of genetic and epidemiological relationships among V. parahaemolyticus strains.

Mutant forms of Salmonella typhimurium sigma54 defective in transcription initiation but not promoter binding activity

Transcription initiation with sigma54-RNA polymerase holoenzyme (sigma54-holoenzyme) has absolute requirements for an activator protein and ATP hydrolysis. sigma54's binding to core RNA polymerase and promoter DNA has been well studied, but little is known about its role in the subsequent steps of transcription initiation. Following random mutagenesis, we isolated eight mutant forms of Salmonella typhimurium sigma54 that were deficient in transcription initiation but still directed sigma54-holoenzyme to the promoter to form a closed complex. Four of these mutant proteins had amino acid substitutions in region I, which had been shown previously to be required for sigma54-holoenzyme to respond to the activator. From the remaining mutants, we identified four residues in region III which when altered affect the function of sigma54 at some point after closed-complex formation. These results suggest that in addition to its role in core and DNA binding, region III participates in one or more steps of transcription initiation that follow closed-complex formation.

Multinational outbreak of Salmonella enterica serotype Newport infections due to contaminated alfalfa sprouts

CONTEXT

In December 1995, reported Salmonella enterica serotype Newport (SN) infections increased sharply in Oregon and British Columbia but not elsewhere in North America. Similar unexplained increases had been noted in 6 other states in the fall of 1995.

OBJECTIVE

To determine the source of the outbreak(s).

DESIGN

Case-control studies, environmental investigations, bacterial subtyping, and surveillance information review.

SETTINGS

Oregon and British Columbia communities (winter 1995-1996) and Georgia, Oklahoma, Pennsylvania, Vermont, Virginia, and West Virginia (fall 1995).

PARTICIPANTS

Oregon and British Columbia residents with culture-confirmed SN infections and onset from December 1, 1995, through February 29, 1996, and healthy community controls.

MAIN OUTCOME MEASURES

Odds ratio (OR) of illness associated with exposures; distribution patterns and culture of alfalfa seeds and sprouts; subtyping of SN isolates.

RESULTS

We identified 133 cases in Oregon and British Columbia; 124 (93%) occurred in patients older than 18 years; 87 (65%) were female. Case patients were more likely than community control subjects to report having eaten alfalfa sprouts in the 5 days preceding illness (41% [17/41] vs 4% [3/75]; OR, 17.0; 95% confidence interval, 4.3-96.0). Case isolates shared a distinctive pulsed-field gel electrophoresis (PFGE) pattern. The SN was grown from seeds and alfalfa sprouts. The distribution of 1 seed lot to multiple growers corresponded to the distribution of cases. Distribution of a second seed lot from the same European wholesaler corresponded to the location of the fall outbreak, which was characterized by a similar demographic profile. The PFGE pattern of fall outbreak isolates and confiscated sprouts and seeds was indistinguishable from the Oregon and British Columbia outbreak and differed from background isolates.

CONCLUSIONS

The SN-contaminated alfalfa seeds were distributed to multiple growers across North America in 1995 and resulted in a protracted international outbreak scattered over many months. Current sprouting methods are inadequate to protect consumers from such events. Alfalfa sprouts may be an elusive but important vehicle for salmonellosis and other enteric infections.

Loloatins A-D, cyclic decapeptide antibiotics produced in culture by a tropical marine bacterium

Loloatins A (1) to D (4), a family of new cyclic decapeptide antibiotics, have been isolated from laboratory cultures of a tropical marine bacterium recovered from the Great Barrier Reef in Papua New Guinea. The structures of loloatins A-D were elucidated via a combination of spectroscopic analyses and chemical degradation. Loloatins A-D exhibit in vitro antimicrobial activity against methicillin-resistant Staphyloccoccus aureus, vancomycin-resistant enterococci, and drug-resistant Streptococcus pneumoniae.

High-throughput assay for G2 checkpoint inhibitors and identification of the structurally novel compound isogranulatimide

Treatment of cancer cells lacking p53 function with G2 checkpoint inhibitors sensitizes them to the toxic effects of DNA damage and has been proposed as a strategy for cancer therapy. However, few inhibitors are known, and they have been found serendipitously. We report the development of a G2 checkpoint inhibition assay that is suitable for high-throughput screening and its application to a screen of 1300 natural extracts. We present the isolation of a new G2 checkpoint inhibitor, the structurally novel compound isogranulatimide. In combination with gamma-irradiation, isogranulatimide selectively kills MCF-7 cells lacking p53 function.

Determination of aspirin and salicylic acid in transdermal perfusates

A high-performance liquid chromatographic (HPLC) method has been developed for the simultaneous determination of aspirin and salicylic acid in transdermal perfusates. The compounds were separated on a C8 Nucleosil column (5 microm, 250x4.6 mm) using a mobile phase containing a mixture of water-acetonitrile-orthophosphoric acid (650:350:2, v/v/v) and a flow-rate of 1 ml/min. The transdermal samples were in phosphate-buffered saline (PBS) and could be injected directly onto the HPLC system. The method was reproducible with inter-day R.S.D. values of no greater than 3.46 and 2.60% for aspirin and salicylic acid, respectively. The method was linear over the concentration range 0.2-5.0 microg/ml and had a limit of detection of 0.05 microg/ml for both compounds. For certain samples, it was necessary to ensure that no transmembrane leakage of the aspirin prodrugs had occurred. In these cases, a gradient was introduced by increasing the acetonitrile content of the mobile phase after the salicylic acid had eluted. The method has been applied to the determination of aspirin and salicylic acid in PBS following in vitro application of the compounds to mouse skin samples.

Determination of aspirin and salicylic acid in human plasma by column-switching liquid chromatography using on-line solid-phase extraction

A column-switching liquid chromatographic method is described for the simultaneous determination of aspirin and salicylic acid in human plasma. Blood samples are taken into chilled tubes containing a fluoride anticoagulant, and the plasma is isolated by centrifugation. Following a simple acidification step, a 200 microL aliquot of the sample is injected directly onto the HPLC system. The C-18 extraction column is washed with acidified water for 2 min, after which time the compounds are removed by back-flushing directly onto the analytical column (C-8 Nucleosil, 5 microns, 250 mm x 4.6 mm). The flow rate through both columns is 1 mL/min, and the analytes are quantified by measurement of their UV absorbance at 225 nm. The mobile phase is a mixture of water-methanol-acetonitrile-orthophosphoric acid (650:200:150:1 v/v/v/v). The method is linear in the concentration ranges 0.10-5.00 micrograms/mL for aspirin and 0.25-15.00 micrograms/mL for salicylic acid. Both compounds have a limit of quantitation of 0.10 microgram/mL and a limit of detection of 0.04 microgram/mL. Extensive stability tests have been carried out, and validation studies reveal the method to be reproducible and repeatable. Excellent recoveries from plasma obviate the need for an internal standard. The procedure is easier to execute and requires less sample handling than methods currently described in the literature. It has been successfully applied to the investigation of the levels of aspirin and salicylic acid in a healthy, nonfasting volunteer following a 600 mg oral dose of aspirin.

The preparation of a molecular imprinted polymer to 7-hydroxycoumarin and its use as a solid-phase extraction material

A molecular imprinted polymer (MIP) was prepared to 7-hydroxycoumarin (7-OHC). A number of preparation parameters were examined by ultraviolet (UV) spectroscopy, including the amount of solvent used for reaction, equilibration time, selectivity and capacity of material. The polymer which showed the most selectivity for 7-OHC was then packed into cartridges and used as a solid-phase extraction sorbent. An extraction procedure was then developed from first principles. The cartridges were examined for selectivity of 7-OHC over some other members of the coumarin family. 7-OHC was then extracted from urine using this solid-phase extraction (SPE) method, and its concentration determined using capillary zone electrophoresis (CZE). The method was found to be linear over the range 10-50 micrograms ml-1. Inter- and Intra-assay precision studies were performed to validate the method.

Genetic analysis of the Rhizobium meliloti nifH promoter, using the P22 challenge phage system

In several genera of bacteria, the sigma54-RNA polymerase holoenzyme (E sigma54) is a minor form of RNA polymerase that is responsible for transcribing genes whose products are involved in diverse metabolic processes. E sigma54 binds to the promoters of these genes to form a closed promoter complex. An activator protein is required for the transition of this closed promoter complex to an open complex that is transcriptionally competent. In this study, the P22-based challenge phage system was used to investigate interactions between E sigma54 and the Rhizobium meliloti nifH promoter. Challenge phages were constructed in which the R. meliloti nifH promoter replaced the binding site for the Mnt protein, a repressor of the phage P22 ant gene. When a Salmonella typhimurium strain that overexpressed sigma54 was infected with these challenge phages, E sigma54 bound to the nifH promoter and repressed transcription of the ant gene as seen by the increased frequency of lysogeny. Following mutagenesis of challenge phages that carried the R. meliloti nifH promoter, mutant phages that could form plaques on an S. typhimurium strain that overexpressed sigma54 were isolated. These phages had mutations within the nifH promoter that decreased the affinity of the promoter for E sigma54. The mutations were clustered in seven highly conserved residues within the -12 and -24 regions of the nifH promoter.

Massetolides A-H, antimycobacterial cyclic depsipeptides produced by two pseudomonads isolated from marine habitats

Massetolides A-H (1-8), novel cyclic depsipeptides, and the known compound viscosin (9) have been isolated from cultures of two Pseudomonas sp. isolated from a marine alga and a marine tube worm, respectively. Massetolide A (1) and viscosin (9) exhibit in vitro antimicrobial activity against Mycobacterium tuberculosis and Mycobacterium avium-intracellulare. Precursor-directed biosynthesis has been used to generate unnatural massetolides 11-13 incorporating nonprotein amino acids.

High-performance liquid chromatographic determination of taurine in human plasma using pre-column extraction and derivatization

Plasma samples (100 microliters) were treated with 150 microliters of acetonitrile and centrifuged at 5800 g for 10 min and 50 microliters of 10 mM borate buffer (pH 9.2) were added to the supernatant solution. This was followed by the addition of a 50 microliters aliquot of 5 mM fluorescamine in acetonitrile and immediate vortex mixing. A 20 microliters sample was injected on to a reversed-phase HPLC system using a Bondclone C-18 10 microns analytical column (300 mm x 3.9 mm). The mobile phase was tetrahydrofuran-acetonitrile-phosphate buffer (15 mM, pH 3.5) (4:24:72, v/v/v). The taurine derivative was detected by measuring the UV absorbance of 385 nm. Platelet-poor plasma samples were spiked with known amounts of taurine and inter- and intra-assay calibration curves were obtained. The method was applied to the determination of taurine in platelet-rich plasma.

Comparison of two extraction methods for determination of propranolol and furosemide in human plasma by mixed-mode chromatography

An isocratic high performance liquid chromatographic method is described for the determination of the beta-adrenergic blocking drug, propranolol, and the diuretic, furosemide, in human plasma. The two compounds and the internal standard were extracted from plasma using a two-step extraction technique. Propranolol and pindolol (internal standard) were first extracted from alkaline plasma into diethyl ether; this was followed by extraction of furosemide into acidified ether: hexane (65:35). The two extracts were then combined and evaporated under nitrogen, and the reconstituted residues were analysed on a C18/SCX reversed-phase/cation exchange column with a mobile phase of acetonitrile: 0.1 M sodium acetate pH 4 (33:67). The drugs and the internal standard were detected by UV absorption at 230 nm. The drugs were also extracted from plasma by a column-switching technique utilizing a ten-port valve. The drug compounds were retained on a C18 pre-column. A comparison of RSD for within-batch (intra-assay) and between-batch (inter-assay) runs for both methods was carried out, the liquid/liquid extraction method giving better recovery values. The calibration graphs were linear from 25-300 ng ml-1 for furosemide and 50-400 ng ml-1 for propranolol. Recovery values were > 90.0% by liquid/liquid extraction and > 76.0% by column switching.

Determination of cimetidine in human plasma by high-performance liquid chromatography following liquid-liquid extraction

A new method is described for the determination of cimetidine in human plasma. The drug and internal standard (ranitidine) were separated on a Nucleosil C18 5 microns (25 x 4.6 mm I.D.) column using a mobile phase of acetonitrile-phosphate buffer, pH 6.2 (25:75, v/v) containing 2.5 g/l heptane sulphonic acid. The mobile phase was delivered at a flow-rate of 0.9 ml/min, detection was by ultraviolet absorption at 228 nm and concentrations were calculated on the basis of peak areas. The drugs were extracted from alkaline plasma into ethyl acetate using a salting out procedure which involved the addition of 100 ml of a saturated solution of K2CO3 to each 250-microliters plasma aliquot. The method was validated over the concentration ranges 50-3000 ng/ml and 100-7000 ng/ml for two separate studies. Mean coefficients of variation were less than 6% for both intra- and inter-assay in both studies and recoveries varied between 71 and 81%. The method was successfully applied to the determination of cimetidine in plasma for a pharmacokinetic study.

Absorbed dose in the skin from beta emitters in medical and laboratory containers

The International Commission on Radiation Protection have recently recommended an annual dose limit for the skin of radiation workers of 500 mSv at a depth of 20-100 microns averaged over any 1 cm2 regardless of the area exposed. It has previously been shown by the authors that beta dose rates on the outer surfaces of typical laboratory containers (vials, test tubes) or on medical syringes can exceed 100 mSv h-1 for radionuclide concentrations of the order of 1 MBq g-1, depending on container diameter, wall thickness and material and the beta particle energy spectrum. Since the fingers are frequently in contact with such containers it is of some importance to extend these dose calculations to depths below the skin surface, taking into consideration the anatomy of skin on the fingers. Using an extension of a Monte Carlo method previously described, dose rates have been calculated for the clinically useful radionuclides 90Y, 32P, 198Au, 153Sm and 131I. For polypropylene syringes the beta dose rates at a depth of 270 microns (a typical basal cell depth in the fingers) range from 77 to 135 mGy h-1 per MBq g-1 for 90Y (maximum energy 2.27 MeV) and approximately zero to 0.62 mGy h-1 per MBq g-1 for 131I (maximum energy 0.61 MeV). These results emphasize the importance of adequate finger protection when using high energy beta emitters and especially for clinicians who typically inject specific activities of the order of 100 MBq g-1 of 32P; in such cases annual permissible dose rates are exceeded in a matter of minutes. It is recommended that a minimum of 5 mm perspex finger protection be used for 90Y and 32P.

Determination of ivermectin in bovine plasma by column-switching LC using on-line solid-phase extraction and trace enrichment

Ivermectin is a potent avermectin anthelmintic, derived from the soil organism Streptomyces avermitilis. Because of its potency, it is administered in very low doses (200 micrograms kg-1), giving rise to plasma levels in the ppb region, and hence sensitive methods are required for its determination in biological samples. A method is described for the determination of ivermectin in bovine plasma, based on a commercially available C18 column employing a mobile phase composed of acetonitrile-water-isopropanol (40:40:35, v/v/v). Extraction from plasma is carried out on-line using coupled-column technology; switching between the extraction and analytical columns is achieved using a six-port column-switching valve. The method is linear over the range 2-100 ng ml-1 (r = 0.9994) and has a limit of detection of 0.8 ng ml-1 (signal-to-noise ratio = 3). Reproducibility of the method, expressed as the overall mean relative standard deviation, is 6.7% (intra-assay) and 3.8% (inter-assay). The mean recovery of the drug from plasma is 76.4%. The method is simple and economical in its execution and is sufficiently reproducible to obviate the need for an internal standard.

Simultaneous determination of salbutamol and terbutaline at overdose levels in human plasma by high performance liquid chromatography with electrochemical detection

A multidimensional column chromatographic method involving electrochemical detection using a carbon fibre microelectrode flow cell was optimized and successfully applied to the simultaneous determination of salbutamol and terbutaline in plasma at overdose levels. This method performs, in a single step, an efficient extraction and clean-up of salbutamol and terbutaline from human plasma. The calibration graphs over three days were linear over the calibration range 20-100 ng/mL plasma with a limit of detection of 1 ng and 0.8 ng/mL plasma for salbutamol and terbutaline, respectively. The intra- and inter-assay coefficients of variation were less than 8% and the recoveries ranged from 94 to 96%. The accuracy of the assay, which was defined as the percentage difference between the mean concentration found and the theoretical concentration, was 7% or better. The proposed method combines the advantages of being simple, reproducible and selective in the presence of other sympathomimetic and commonly ingested drugs and is suitable for routine analyses to obtain valuable information about the clinical effects and treatment of overdose with these drugs. The whole procedure takes ca. 10 min and compares favourably with detection at a conventional glassy carbon electrode.

Characterization of a DNA probe for detection of Mycobacterium tuberculosis complex in clinical samples by polymerase chain reaction

We cloned and sequenced a DNA fragment from Mycobacterium tuberculosis for use in the identification of members of the M. tuberculosis complex. The DNA probe for culture confirmation had a sensitivity and a specificity of 100%. By using primers developed from this probe, the polymerase chain reaction detected 20 mycobacteria by ethidium bromide staining. This polymerase chain reaction system demonstrated 98% sensitivity and 100% specificity for detection of the M. tuberculosis complex in 200 sputum specimens.

Evaluation of the Autoscan Walkaway system for rapid identification and susceptibility testing of gram-negative bacilli

We evaluated the performance of the Autoscan Walkaway (W/A) system (MicroScan, Sacramento, Calif.) in conjunction with the fluorometric Neg Combo panels for rapid identification and susceptibility testing of gram-negative bacilli. Fermentative and nonfermentative gram-negative bacilli were tested in parallel with the W/A system and the Cathra Repliscan replicator (C/R) system (Cathra, St. Paul, Minn.). Conventional biochemical testing and agar dilution testing were used to resolve the identification and susceptibility testing discrepancies. Of 495 clinical isolates tested, 445 (90%) were correctly identified by the W/A system and 483 (98%) were correctly identified by the C/R system. Repeat testing by using updated versions of the W/A system's computer identification software failed to demonstrate improved identification accuracy. For susceptibility testing, the W/A system demonstrated 5.6% total interpretative category errors, including only 0.9% major and very major errors. The comparative C/R system produced only 1% errors overall, including 0.2% major and very major errors. Although the W/A system is highly automated and is capable of producing results rapidly, our findings suggest that additional identification and susceptibility testing refinements are needed before the system will be suitable for routine use.

Analysis of terbutaline in human plasma by high-performance liquid chromatography with electrochemical detection using a micro-electrochemical flow cell

A high-performance liquid chromatographic method is described for the determination of terbutaline in human plasma in the range 1-35 ng/ml. Detection was achieved using a carbon fibre micro-electrochemical detector and a column-switching system. The microelectrode cell has advantages over conventional glassy carbon electrode-based detection systems in that it is easy to prepare, flexible in its operation and suffers less trouble from problems such as air bubbles and leaks. Furthermore, it has a better detection limit for terbutaline (0.8 ng/ml) to that obtained using a conventional glassy carbon electrode flow detector (2 ng/ml). Sample clean-up was by on-line solid-phase extraction with column switching, providing a method which was sensitive and reproducible, where the mean overall coefficient of variation was 5.60% and drug recovery in excess of 86% at the concentration levels studied.

Sodium hypochlorite disinfection of irreversible hydrocolloid impression material

Alginate impression material is one of the most frequently used in dentistry. However, this material is susceptible to dimensional distortion during disinfection because of its hydrophilic nature. This study examined the effects of alginate disinfection using a sodium hypochlorite spray or impression immersion. Spray disinfection of an alginate impression did not cause dimensional differences of the poured stone casts when compared with casts from water-rinsed controls. Immersion disinfection created dimensional distortion of the anterior, posterior, and interarch model segments. Both the spray and immersion treatments equally decreased the surface detail reproducibility. The antimicrobial effects of the spray treatment were similar to those of the immersion treatment, while mere water rinsing resulted in inadequate disinfection.

Thermal properties of a methyl methacrylate-based orthodontic bonding adhesive

Methyl methacrylate-based (MMA-based) bonding resins have been used in orthodontics because they offer easy removal of both the bonded bracket and the residual adhesive at case completion. However, these materials are not cross-linked, and the brackets bonded with this type of product may undergo drifting when subjected to temperatures slightly higher than those in the mouth. This research investigated the influence of heat on the debonding characteristics of a MMA-based bonding resin compared with those of a BIS-GMA-based system. The temperature of initial bracket movement, as well as of final bracket displacement, was noted for a variety of applied loads (141, 226, 425, 934, and 1727 gm) with stainless steel brackets bonded to etched bovine enamel. The results showed that the MMA-based material underwent a glass transition near 47 degrees C in which the initiation of bracket drift resulted on the tooth surface. This temperature proved independent of the applied load. Further heating resulted in the release of heat from the resin as a result of further curing. The extent of bracket drift associated with this secondary heat release was dependent on the applied load. The debonding temperature of the BIS-GMA-based system was three to six times greater than that of the MMA-based product. Practitioners should be aware that brackets bonded with MMA-based resins have the potential for drifting when subjected to temperatures within the normal range of hot fluids consumed by their patients. Bracket drift could result in deactivation of orthodontic force and could prolong the treatment time.

Comparison of a direct fecal Shiga-like toxin assay and sorbitol-MacConkey agar culture for laboratory diagnosis of enterohemorrhagic Escherichia coli infection

A direct fecal Shiga-like toxin assay (DSLTA) was used to prospectively screen 9,449 unselected stool samples, received at the British Columbia Provincial Health Laboratories and the Metropolitan Laboratories of Vancouver, for Shiga-like toxin I and Shiga-like toxin II. The results were compared with results of routine stool culture on sorbitol-MacConkey agar (SMAC) for Escherichia coli O157:H7. Of 80 specimens positive by either method, 59 (74%) and 74 (93%) were positive by SMAC and DSLTA, respectively; 53 (66%) were positive by both methods, 21 (26%) were positive by DSLTA only, and 6 (7%) were positive by SMAC only. On further screening, Shiga-like toxin-producing E. coli were detected in 8 (38%) of the 21 stools positive by DSLTA only, including serotypes O157:H7 (1 stool), O26:K60 (5 stools), O128:K67 (1 stool), and O103:H2 (1 stool). For the remaining 13 stools in which no SLTEC was found but DSLTA was positive, clinical information revealed that 11 of 12 patients had diarrheal illnesses, and 4 of these 11 had bloody diarrhea or hemolytic-uremic syndrome. Stools positive only by SMAC were collected earlier in the illness than stools positive by DSLTA, suggesting that free fecal toxin levels may be too low to detect at this time. Overall we found that DSLTA detected 19% more positive specimens than SMAC and that Shiga-like toxin-producing E. coli serotypes other than E. coli O157:H7 are causing disease in the province of British Columbia, Canada.

Biochemical characteristics and plasmids of clinical and environmental Plesiomonas shigelloides

The biochemical characteristics of 68 clinical and 5 environmental Plesiomonas shigelloides isolates were determined. The reactions for ONPG, phenylalanine deaminase, motility, lactose fermentation and salicin fermentation were different from previously published findings. The reactions of the clinical and environmental isolates were very similar. The isolates were also tested for the presence of plasmids, and 40% of the strains were found to harbor between one and seven plasmids. The findings of this study will be useful for the identification and characterization of this recently recognized enteric pathogen.

High-performance liquid chromatographic determination of nifedipine, nicardipine and pindolol using a carbon fibre flow-through amperometric detector

The electrochemical properties of the calcium-channel blockers, nifedipine and nicardipine, and the beta-blocking agent, pindolol, have been exploited for the determination of their concentrations in plasma samples. High-performance liquid chromatography (HPLC) separation was carried out on a cyanopropyl modified column and the drugs were detected in a flow-through carbon fibre microelectrode cell. The chromatographic system was coupled to a column-switching arrangement in order to perform on-line solid-phase extraction of the drugs from spiked human plasma. Preliminary investigations showed the response of the method to be linear over a range of 20-500 ng ml-1 in plasma with a limit of detection of approximately 15 ng ml-1 for each compound.

Clinical comparison of isolator and BACTEC 660 resin media for blood culture

The 10-ml Isolator system (E.I. du Pont de Nemours & Co., Inc., Wilmington, Del.) was compared with the BACTEC 16A-17A nonradiometric resin system (Johnston Laboratories, Inc., Towson, Md.) for isolation of organisms from 6,839 paired blood cultures. Equal volumes of blood (6 to 10 ml for each Isolator and 3 to 5 ml for each BACTEC bottle) were cultured in parallel in the two systems, and 600 isolates that were judged to be clinically significant by chart review were recovered during the study. The BACTEC resin system detected 510 (85%) and the Isolator system detected 435 (72%) of the clinically significant isolates (P less than 0.001). Of 45 polymicrobial blood cultures, the BACTEC system detected 32 (71%) and the Isolator system detected 21 (47%) (P less than 0.05). Of 253 gram-negative bacilli isolated during the study, 30% were detected only in the BACTEC system and 16% were detected only in the Isolator system (P less than 0.001), and of 56 nonfermentative or fastidious gram-negative bacilli detected, 46% were recovered only in the BACTEC system, while 14% were detected only in the Isolator system (P less than 0.001). Of 86 streptococci isolated during the study, 30% were detected only in the BACTEC system, and 4% were detected only in the Isolator system (P less than 0.001). Recoveries of anaerobic bacteria, staphylococci, and yeasts were equivalent in the two systems. Organisms judged to be contaminants were detected in approximately 1% of the cultures in each system. The results suggest that use of resin media renders the BACTEC nonradiometric system equivalent or superior to the Isolator system for detection of clinically significant organisms in blood cultures.

High-performance liquid chromatographic method for the comparison of tanning capacity of tannic acid batches used in the manufacture of pregnancy testing kits

A high-performance liquid chromatographic (HPLC) method was developed for the quantitative comparison of various batches of tannic acid from the same manufacturer used to aid the binding of human chorionic gonadotropin to sheep erythrocytes in the manufacture of pregnancy testing kits. The tannic acids were separated by reversed-phase HPLC on a C18 column using gradient elution with aqueous methanolic eluents at low pH. A portion of the chromatogram corresponding to the compounds involved in the tanninisation process was integrated and a linear relationship was established between this peak area and tannic acid concentration. The correlation coefficient was greater than 0.993 even in the absence of an internal standard. Tanning capacity was evaluated on the basis of the amount of tannic acid which remained following incubation with a known quantity of erythrocytes. The application of this procedure to three batches of tannic acid is demonstrated.

Evaluation of drug-free plasma profiles by high-performance liquid chromatography following on-line solid-phase extraction

The effect of varying the type of column and eluent composition on drug-free plasma profiles was investigated. The study was based on a C18 and a CN column; methanol and acetonitrile were the organic modifiers used. The plasma profiles were evaluated quantitatively by measuring the number of interfering peaks greater than 8 . 10(-4) absorbance units in the area of interest along the chromatogram. Results were subjected to statistical treatment using a three-factor analysis of variance design. The three factors were the column, the type of organic modifier and either the percentage organic modifier, the pH or the ionic strength. Analysis of the data revealed that significant effects were seen with changing eluent composition, particularly with regard to the percentage of organic modifier, and that the observed effects were strongly dependent on the type of column and the type of organic modifier under consideration.

Urease-positive, Kanagawa-negative Vibrio parahaemolyticus from patients and the environment in the Pacific Northwest

We previously reported the occurrence of Vibrio parahaemolyticus in patients and the environment in the Pacific Northwest. The present studies compare the biochemical characteristics, Kanagawa hemolysin reactions, and plasmid profiles of 13 patient and 221 environmental isolates of the organism. Classical biochemical testing of the isolates revealed similar reactions for the clinical and environmental strains, and analysis in agarose gels revealed that 13 to 15% of the isolates had plasmids. The strains were tested for production of Kanagawa hemolysin on Wagatsuma agar, and 1.4% of environmental isolates and 23% of clinical isolates were positive. Clinical isolates from locally acquired extraintestinal infections were urease negative and Kanagawa hemolysin negative, isolates from locally acquired gastroenteritis cases were urease positive and Kanagawa negative, and isolates from traveler's diarrhea were urease negative and Kanagawa positive. Eight percent of the local environmental isolates were also urease positive and Kanagawa hemolysin negative. These findings suggest that expression of the Kanagawa hemolysin is not essential for the pathogenesis of V. parahaemolyticus infections. In addition, our findings suggest that V. parahaemolyticus gastroenteritis in the Pacific Northwest is associated with a urease-positive, Kanagawa-negative biotype of the organism.

Antimicrobial susceptibility of Plesiomonas shigelloides from patients with diarrhea

Antimicrobial susceptibility testing was performed on 72 fecal isolates of Plesiomonas shigelloides from patients with diarrhea by using a standard agar dilution technique. All isolates were obtained from a single geographic location. Based on the in vitro activities demonstrated in this study, norfloxacin, ciprofloxacin, and trimethoprim may be effective as oral agents in the treatment of P. shigelloides diarrheal disease. For the parenteral treatment of extraintestinal infection, netilmicin and the cephalosporins had the best in vitro activity.

Retention characteristics in high-performance liquid chromatography of basic drugs and plasma extracts on an alumina column

The retention characteristics of 35 drugs on an alumina column using buffered aqueous methanolic mobile phases have been investigated. It has been shown that the effect of pH on retention depends on the pKa of the drug and the type of buffer ion used; that there is an inverse relation between ionic strength and solute retention; and that a decrease in the amount of methanol in the mobile phase causes the drugs to be held longer on the column. The chromatographic system was also coupled to an on-line column-switching assembly to facilitate extraction of the drugs from plasma, and results are presented which indicate that the alumina column lends itself well to this convenient method of plasma clean-up.

Clinical features, epidemiology, and treatment of Plesiomonas shigelloides diarrhea

Recent studies have suggested that Plesiomonas shigelloides is a cause of diarrhea. The present study addresses the clinical features, epidemiology, and response to antimicrobial therapy of P. shigelloides diarrhea. Thirty cases of P. shigelloides infection were defined by isolation of the organism from stool specimens, and 30 age-matched control patients were identified by detection of other enteric pathogens. Clinical and epidemiological information was obtained by interviewing the referring physicians and the patients. Of the P. shigelloides-infected patients, 71% had a history of recent tropical travel, but 29% acquired their infections locally in association with the consumption of seafood or untreated water or both. Seventy-eight percent of the P. shigelloides-infected patients had findings suggestive of colitis, and P. shigelloides-infected patients had a history of tropical travel, acute illness, abdominal pain, and prolonged symptoms significantly more often than did the control patients. Antimicrobial therapy significantly reduced the duration of illness in patients with Plesiomonas diarrhea. These results suggest that P. shigelloides is a significant cause of both locally acquired and traveler's diarrhea that may respond to antimicrobial therapy.

A comparison of silica and alumina columns for high-performance liquid chromatographic separations of basic drugs and plasma constituents following on-line solid-phase extraction with column switching

A comparison has been made of a silica and an alumina column with respect to retention behaviour in high-performance liquid chromatography of pure drug solutions and plasma profiles following on-line solid-phase extraction. Using methanol-ammonium nitrate buffer (80:20, v/v) as eluent, it was found that these systems lend themselves well to the column switching technique. Increasing the pH of the mobile phase produced similar shifts in retention for basic drugs on both columns, but fewer plasma interferents are retained on the alumina column as compared to the silica column under the same operating conditions.

Comparison of blood agar, ampicillin blood agar, MacConkey-ampicillin-Tween agar, and modified cefsulodin-Irgasan-novobiocin agar for isolation of Aeromonas spp. from stool specimens

The performance of four media for the isolation of Aeromonas strains from stool specimens, the importance of ampicillin-susceptible Aeromonas strains in the selection of culture media, and the usefulness of beta-hemolysis in screening blood-containing media for Aeromonas strains were evaluated in two phases. In the first phase, 36 of 1,672 stool specimens yielded Aeromonas isolates. Ninety-seven percent of the isolates were detected on blood agar containing 20 micrograms of ampicillin per ml (ABA), and 47% were detected on MacConkey agar containing 100 micrograms of ampicillin per ml and 1% Tween 80. In the second phase of the study, 43 of 1,924 stool specimens yielded Aeromonas isolates. Fifty-one percent of the isolates were detected on blood agar and on modified cefsulodin-Irgasan-novobiocin agar, and 84% were detected on ABA. The combination of ABA and modified cefsulodin-Irgasan-novobiocin agar provided 100% recovery of the Aeromonas isolates encountered. All of the Aeromonas isolates detected on blood agar were also detected on ABA, and 89% of the Aeromonas isolates detected on these media were beta-hemolytic. These results suggest that ABA is superior to the other media evaluated for the isolation of Aeromonas strains from stool specimens, but optimal recovery of the organism may require the use of more than one medium. The results also suggest that the occurrence of ampicillin-susceptible strains is not a limitation on the use of ABA, but at least 10% of Aeromonas isolates will be missed if beta-hemolysis is used to screen ABA plates for these organisms.

Temporal relationship of Vibrio parahaemolyticus in patients and the environment

We prospectively compared the occurrence of Vibrio parahaemolyticus in patients and the environment in the Pacific Northwest. Inpatient and outpatient stool and wound specimens and water samples from 10 estuarine sites were cultured for V. parahaemolyticus over a period of 3 years. V. parahaemolyticus infections were detected in 13 patients (8 with gastroenteritis; 5 with wound infections), and all of the infections were found in outpatients in physicians' offices. Ten of the infections were locally acquired, and three occurred in patients returning from tropical travel. V. parahaemolyticus was isolated from 11 to 33% of the environmental samples, and each sampling site yielded the organism at some time during the study. V. parahaemolyticus was found in the environment only during the summer months, when water temperatures were greater than or equal to 17 degrees C and salinities were less than or equal to 13% (parts per thousand), and locally acquired infections were detected only when the organism was present in large numbers in the environment. We conclude that V. parahaemolyticus causes locally acquired gastroenteritis and wound infections, as well as traveler's diarrhea, in the Pacific Northwest, that patients with V. parahaemolyticus infections are likely to be seen in physicians' offices rather than hospitals, that locally acquired V. parahaemolyticus infections occur only when the organism is present in the environment, and that the organism is likely to be present during the summer months, when warm, low-salinity water conditions prevail in the coastal marine environment.