Evaluating Disaster Damages and Operational Status of Health-Care Facilities During the Emergency Response Phase of Hurricane Maria in Puerto Rico.

On September 20, 2017, Hurricane Maria made landfall on Puerto Rico as a category 4 storm, resulting in serious widespread impact across the island, including communication and power outages, water systems impairment, and damage to life-saving infrastructure. In collaboration with the Puerto Rico Department of Health, the Public Health Branch (PHB), operating under the Department of Health and Human Services Incident Response Coordination Team, was tasked with completing assessments of health-care facilities in Puerto Rico to determine infrastructure capabilities and post-hurricane capacity. Additionally, in response to significant data entry and presentation needs, the PHB leadership worked with the Puerto Rico Planning Board to develop and test a new app-based infrastructure capacity assessment tool. Assessments of hospitals were initiated September 28, 2017, and completed November 10, 2017 (n = 64 hospitals, 97%). Assessments of health-care centers were initiated on October 7, 2017, with 186 health-care centers (87%) assessed through November 18, 2017. All hospitals had working communications; however, 9% (n = 17) of health-care centers reported no communication capabilities. For the health-care centers, 114 (61%) reported they were operational but had sustainment needs. In conclusion, health-care facility assessments indicated structural damage issues and operational capacity decreases, while health-care centers reported loss of communication capabilities post-Hurricane Maria.

Potential for development of haemophilia link nurse role within UK hospitals.

Link nurses are practising nurses with an expressed interest in a given specialty, with formal links to clinical nurse specialists and other specialist staff. The role involves attending meetings to discuss ideas and new developments, and relaying findings to other ward nurses to improve their practice. Such nurses are common in many specialties such as diabetes and tissue viability. In haemophilia, the role has the potential to enhance the care of haemophilia patients on general hospital wards. In April 2012, a focus group of five haemophilia nurses was convened to discuss their experiences of 'link nurse' programmes within district general hospitals and the potential value of developing the haemophilia link nurse role, and to consider the materials needed to support such role development. It was agreed to test whether other haemophilia nurses perceived such a need by means of a short five-item questionnaire devised by the group and made available to all members of the UK's Haemophilia Nurse's Association via Survey-Monkey. Final responses from 59 haemophilia nurses across the UK have been analysed. Most nurses agreed that there was value in the development of a haemophilia link nurse role within UK hospitals and thought their trusts would support it. While barriers and potential downsides were acknowledged, this was seen as a useful way of sharing information and knowledge with colleagues from different specialties and of raising awareness of bleeding disorders among the general nursing community. Haemophilia nurses should coordinate the development of a Haemophilia Link Nurse training and education pack.

Mycoplasma gallisepticum in pheasants and the efficacy of tylvalosin to treat the disease.

Infectious sinusitis, a common condition seen in adult pheasants, is primarily caused by Mycoplasma gallisepticum. The aims of the present study were to investigate the pathogenicity of M. gallisepticum in 14-day-old pheasants and evaluate the macrolide antibiotic tylvalosin (TVN) as a treatment for infectious sinusitis. The minimum inhibitory concentration of TVN for five isolates of M. gallisepticum taken from pheasants confirmed their susceptibility to TVN (range: 0.002 to 0.008 µg/ml). One of the isolates (G87/02) was inoculated intranasally into 72 pheasants (two groups of 36) at 14 days of age. Eight days later, when 18/72 (25%) of the pheasants showed clinical signs, one group was treated with 25 mg TVN/kg bodyweight daily in drinking water for three consecutive days. An uninfected, unmedicated control group (n=12) was also included. In contrast to the uninfected control group, a range of clinical signs typical of infectious sinusitis with varying severity was observed in challenged birds and M. gallisepticum was re-isolated from the infraorbital sinus and the eye/conjunctiva at necropsy, 22 days post challenge. In comparison with untreated birds, medication with TVN significantly reduced clinical signs and the re-isolation/detection of M. gallisepticum (P≤0.0021). The daily liveweight gain of treated birds was significantly increased in comparison with untreated birds (P=0.0002), and similar to daily liveweight gains observed in the uninfected control group. In conclusion, TVN at 25 mg/kg bodyweight daily for three consecutive days in drinking water was efficacious in the treatment of M. gallisepticum infection induced by challenging 14-day-old pheasants.

A survey of the prevalence of Giardia in dogs presented to Canadian veterinary practices.

Fecal samples (1216) were collected from dogs presented to 15 veterinary practices across Canada and tested for Giardia by ELISA for group-specific antigen. If positive, the presence of Giardia was confirmed by microscopy. Eighty-eight submissions tested positive by ELISA and microscopy. The overall prevalence rate of Giardia was 7.2%.

Phosphorylation of Wzc, a tyrosine autokinase, is essential for assembly of group 1 capsular polysaccharides in Escherichia coli.

Wzc proteins are tyrosine autokinases. They are found in some important bacterial pathogens of humans and livestock as well as plant-associated bacteria, and are often encoded within gene clusters determining synthesis and assembly of capsular and extracellular polysaccharides. Autophosphorylation of Wzc(cps) is essential for assembly of the serotype K30 group 1 capsule in Escherichia coli O9a:K30, although a genetically unlinked Wzc(cps)-homologue (Etk) can also participate with low efficiency. While autophosphorylation of Wzc(cps) is required for assembly of high molecular weight K30 capsular polysaccharide, it is not essential for either the synthesis of the K30 repeat units or for activity of the K30 polymerase enzyme. Paradoxically, the cognate phosphotyrosine protein phosphatase for Wzc(cps), Wzb(cps), is also required for capsule expression. The tyrosine-rich domain at the C terminus of Wzc(cps) was identified as the site of phosphorylation and autophosphorylation of Wzc requires a functional Walker A motif. Intermolecular transphosphorylation of Wzc(cps) was detected in strains expressing a combination of mutant Wzc(cps) derivatives. The N- and C-terminal domains of Wzc(cps) were expressed independently to mimic the situation found naturally in Gram-positive bacteria. In this format, both domains were required for phosphorylation of the Wzc(cps) C terminus, and for capsule assembly. Regulation by a post-translational phosphorylation event represents a new dimension in the assembly of bacterial cell-surface polysaccharides.

The comparison of an aqueous preparation of tilmicosin with tylosin in the treatment of Mycoplasma gallisepticum infection of turkey poults.

A virulent strain of Mycoplasma gallisepticum (MG) was used to infect groups of 40 2-day-old poults kept in separate pens of 10 each. Of the six groups, three were treated with separate concentrations of tilmicosin, one was treated with tylosin, one remained untreated, and a final group was not infected and not treated. Mortality, clinical signs, and gross lesions were significantly less (P < 0.001) in the uninfected and infected medicated groups than in the infected unmedicated group. Also, the mean body weight gain of poults surviving to the end of the experiment was greater (P < 0.005) in the uninfected and infected medicated groups. MG was not recovered from the uninfected birds, and, among the infected poults, it was recovered from significantly fewer (P < 0.05) poults in the medicated groups. Serologic results were negative for the uninfected group, and there were fewer positive reactors for the infected medicated than the infected unmedicated group. In consideration of these results, tilmicosin should prove to be a useful addition to the antimicrobials in the treatment of MG infection in poults.

Prevalence of work related musculoskeletal disorders in active union carpenters.

OBJECTIVES: To determine the prevalence and risk factors for work related musculoskeletal disorders among union carpenters. METHODS: A detailed questionnaire on musculoskeletal symptoms and work history was administered to 522 carpenters. The symptom questions assessed if carpenters experienced pain, numbness, or tingling in a particular body region. A subset of this group then received a physical examination of the upper extremities and knees. RESULTS: The study group was primarily white (94.9%) and male (97.8%) with a mean age of 42.3 years. The highest prevalence of work related musculoskeletal disorders cases by carpentry specialty ranged from 20%-24% for those doing drywall or ceiling, finishing or framing, and the building of concrete forms. Generally, as duration of employment increased, the prevalence of symptoms increased. An adjusted logistic regression analysis showed that the group with the longest (> or = 20 years) duration of employment in carpentry was significantly associated with work related musculoskeletal disorders of the shoulders (odds ratio (OR) 3.2, 95% confidence interval (95% CI) 1.1 to 8.9), hands or wrists (OR 3.1, 95% CI 1.1 to 8.4), and knees (OR 3.5, 95% CI 1.3 to 9.2). Also, analyses showed that carpenters who reported that they had little or no influence over their work schedule had significant increases of work related musculoskeletal disorders of the shoulders, hips, and knees with ORs of 1.9 (95% CI 1.1 to 3.2), 2.9 (95% CI 1.1 to 7.2), and 2.3 (95% CI 1.2 to 4.1), respectively. Feeling exhausted at the end of day was also a significant risk factor for work related musculoskeletal disorders of the knee (OR 1.8, 95% CI 1.1 to 3.1). Upper extremity disorders were the most prevalent work related musculoskeletal disorders reported among all carpenters. Drywall or ceiling activities involve a considerable amount of repetitive motion and awkward postures often with arms raised holding heavy dry walls in place, whereas form work is notable for extensive lumbar flexion and had the two highest rates of work related musculoskeletal disorders. The psychosocial element of job control was associated with both upper and lower extremity disorders. These union carpenters, who were relatively young, already were experiencing considerable work related physical problems. CONCLUSION: This study supports the need for vigilant ergonomic intervention at job sites and early ergonomic education as an integral part of apprenticeship school training to ensure that carpenters remain fit and healthy throughout their working lifetime.

In vitro and in vivo comparisons of valnemulin, tiamulin, tylosin, enrofloxacin, and lincomycin/spectinomycin against Mycoplasma gallisepticum.

The minimum inhibitory concentrations (MICs) for valnemulin, tiamulin, enrofloxacin, tylosin, and lincomycin/spectinomycin were determined for a virulent strain of Mycoplasma gallispeticum (MG). At the initial reading, the lowest MICs were seen with valnemulin and tiamulin, followed by tylosin, enrofloxacin, and a relatively high MIC for lincomycin/spectinomycin. At the final reading, at 14 days, a similar pattern was obtained, with valnemulin giving the lowest MIC (< 0.008 mg/ml). The same strain of MG was used to infect groups of 20 2-day-old chicks in two separate experiments. In both, several concentrations of valnemulin and tiamulin and one each of tylosin and enrofloxacin were administered to separate groups in the drinking water. In the second experiment, one group of chicks was given lincomycin/spectinomycin. Each experiment had one infected unmedicated group and an uninfected unmedicated group. Mortality, clinical signs, and gross lesions, in both experiments, were significantly less (P < 0.001) in the uninfected and infected medicated groups (except for the two lowest dosages of valnemulin, lincomycin, and spectinomycin) than in the infected unmedicated groups. Also, the mean body weight gain was greater in the uninfected and infected medicated groups. Among the infected birds, MG was recovered from fewer chicks in the infected medicated groups except for the lowest two dosages of valnemulin. Serologic results were negative for the uninfected groups, and there were fewer positive reactors for the infected medicated groups except for the group treated with lincomycin/spectinomycin. Valnemulin should prove to be a useful addition to the antimicrobials in the control of MG infection in chickens.

An ergonomic evaluation of a patient handling device: the elevate and transfer vehicle.

This study evaluated a Patient Handling Device (PHD) called the Elevate and Transfer Vehicle (ETV). The ETV works on the principle of leverage to transfer a patient from one seated position to another. Three types of product evaluation were used: expert appraisal; user trials; and performance tests. Expert appraisal was conducted by a panel of 11 people including an ergonomist, an industrial designer, two engineers, including one employed as an academic in a School of Mechanical, Manufacturing and Medical Engineering, and seven health professionals. The experts evaluated the ETV using a checklist and group discussions. They generally agreed that the advantages of the ETV tested were it's simplicity, the convenient position to adjust clothing for toileting and the need for only one carer. They noted comfort, security of straps, centre of gravity and manoeuvrability as the main areas for improvement. User trials consisted of nine male and nine female volunteer users assigned to carer/patient pairs. Following a training period, each user subjectively evaluated the ETV by structured interview. User trial results indicated ease of use, prevention of back injuries in carers and minimal body contact were advantages of the ETV. The main problems with using the ETV appeared to be the inadequate 'prop' and straps, the 'jolt' and lack of dignity for the patient. Several critical performance tests were conducted to determine compliance to Australian Standards for design. Areas of non-compliance included strength of frame and static stability. The findings suggest that most of the identified problems of the ETV could be overcome with minor design improvements. The general consensus of participants was to keep the design simple, maintain fast transfers and maintain the position of the patient to enable ease of clothing adjustment for toileting.

Nested case-control study of hand and wrist work-related musculoskeletal disorders in carpenters.

Unionized carpenters (n = 522) participated in a telephone interview regarding their jobs and musculoskeletal symptoms. From this group, a nested case-control study was conducted on 25 symptomatic carpenters who met a hand or wrist work-related musculoskeletal disorder (WMD) case definition and on 35 asymptomatic carpenters who were of similar age, sex, height, and weight. The purpose of the study was to determine if questionnaire symptom data could be used to estimate the prevalence of hand/wrist WMDs. To test this hypothesis, a subset of subjects underwent physical examination and electrodiagnostic testing to determine if these symptom-derived cases had findings of carpal tunnel syndrome or other hand or wrist musculoskeletal disorders. Standardized upper extremity physical examinations and unilateral ulnar and median nerve conduction studies were administered. Physical examination findings of CTS were significantly increased among WMD cases. Mean median sensory and motor distal latencies were significantly longer (P < 0.05) and median sensory amplitudes smaller in cases compared to controls. Median relative to ulnar sensory and motor latencies also were longer in cases. A median mononeuropathy at the wrist was found in 78% of the cases. These findings suggest that symptom-derived WMD data are useful in estimating estimating the prevalence of CTS among carpenters.

Screen based keyboard operation: the adverse effects on the neural system.

The effect of screen based keyboard (SBK) operation on extensibility of the neural system was investigated using the radial nerve upper limb tension test (Butler 1991). Twenty-five female subjects (aged 17-55 years) including 15 SBK operators and 10 non-SBK operators who acted as a control were examined. Mean glenohumeral abduction in the upper limb tension test in the control group was 40 degrees. In the SBK operators, it was 27 degrees (right side) and 30 degrees (left side). Statistical analysis showed a significant difference between the groups. Results indicate that the normal mechanics of the neural system may be affected by SBK operation and that neural tension warrants consideration in the prevention and management of work related neck and upper limb disorders.

Clinical privileges program for pharmacists.

A clinical privileges program for pharmacists is described. In 1985 and 1989 the Department of Veterans Affairs (VA) issued circulars defining policy on clinical privileges for pharmacists at its medical centers. Pharmacists at one large VA medical center responded by developing a clinical privileges program. Bylaws under which medical staff members are granted clinical privileges were used as a model for the pharmacist program. A pharmacist seeking privileges prepares an application detailing his or her background and the practice areas involved in the request; the applicant also drafts a quality assurance protocol. The application is reviewed by a pharmacist clinical privileges review board (PCPRB). The PCPRB uses the quality assurance plan to verify that adequate measures are in place to meet standards of care. If a question of patient safety arises, the board meets to review the pharmacist's activities. Each pharmacist who is granted privileges must have a physician sponsor. Since the first meeting of the PCPRB in 1990, clinical privileges have been requested by all 24 clinical pharmacy specialists at the center. No pharmacist has been denied privileges, although the board has required additional training or improved quality assurance protocols for many. Acceptance of the program by the medical staff has been good. A clinical privileges program at a VA medical center offers pharmacists the opportunity to practice pharmaceutical care.

Anatomy of a statewide trauma registry.

The Pennsylvania Trauma Systems Foundation has existed for five years. A concept that in 1984 seemed like a futuristic dream has been accomplished. Standards for trauma center accreditation have been developed, and trauma centers are accredited in a fair, unbiased, and systematic manner. Pennsylvania's voluntary system could not have succeeded without the full support of the hospital, medical, and nursing communities. Trauma centers are not edifices alone; the commitment of the institutions and their personnel was phenomenal. Pennsylvania has the largest and most comprehensive trauma registry in terms of complete data compliance in the United States. Data collected have been used for quality assurance, the accreditation process, and trauma prevention and research. The commitment by medical record professionals to develop and maintain individual hospital trauma registries as well as the PTSF trauma registry has been enormous. The future of trauma system development in Pennsylvania lies in the data collection system and the research in trauma systems and trauma care that is generated from the database.

Development of a statewide trauma registry.

In October 1986, the Pennsylvania Trauma Systems Foundation (PTSF) developed a statewide registry. Development concentrated on four major issues: 1) data elements; 2) patient selection; 3) confidential mandatory involvement for trauma centers; and 4) reporting/analysis. The overall compliance of the trauma centers was 81.5%. Documentation of prehospital run times and admission trauma scores were 21% and 70%, respectively. PTSF patients 55 years or older (27.9%) had twice the mortality as younger patients. Falls accounted for 76% of injuries to elderly patients. Finally, 42.6% of survivors had moderate to severe disabilities. Defining the "major trauma patient" is extremely difficult. A registry must have uniform quality data without undue costs. To obtain such data, maintenance of an active registry must be viewed as important as medical care, if organized trauma systems are to remain cost effective.

Salmonella infections in patients with acquired immunodeficiency syndrome.

Salmonella infections occurred in six patients with acquired immunodeficiency syndrome (AIDS) and one patient with probable AIDS. The immune system defects increase the susceptibility of patients with AIDS to salmonella infections. Recognition of salmonellosis in patients with AIDS is important because of a high propensity of this organism to invade the bloodstreams of these patients, and because, unlike other infections in patients with AIDS, this infection can be easily treated.

Pseudomonas mesophilica infections in humans.

Reported here is the case of a patient with metastatic adenocarcinoma of the lung who had bacteremia involving Pseudomonas mesophilica. Of the common laboratory media tested at 35 degrees C, buffered charcoal yeast extract agar and nutrient agar provided the best growth; however, other media supported growth at lower temperatures. Since blood cultures are routinely subcultured onto chocolate agar and then incubated at 35 degrees C, awareness of the characteristics of P. mesophilica and of the isolation techniques as outlined may enhance the recovery of this and related bacterial species.

Mycobacterium xenopi infection in a patient with acquired immunodeficiency syndrome.

A case of Mycobacterium xenopi infection in a patient with acquired immunodeficiency syndrome (AIDS) is described and the clinical experience of others in the United States with this organism is reviewed. Disseminated infection by this organism appears to occur only in the immunocompromised host. Because M xenopi has been found in hot water systems by others and is an organism more susceptible to the traditional antituberculosis antibiotics, recognition and distinction of this organism from the more resistant and difficult to treat Mycobacterium avium-intracellulare in the patients with AIDS may be important.

Association between polyneuritis and multiple sclerosis.

We report two cases in which multiple sclerosis and inflammatory polyneuritis occurred separately, and suggest that this association supports the idea that the two conditions may have an aetiological link.