Survival and persistence of nonspore-forming biothreat agents in water.

AIMS: To determine whether nonspore-forming biothreat agents can survive and persist in potable water that does not contain a disinfectant. METHODS AND RESULTS: Autoclaved, de-chlorinated Atlanta municipal water was inoculated with eight isolates of bacterial biothreat agents (106 CFU ml⁻¹). The inoculated water samples were incubated at 5, 8 (Francisella tularensis only) or 25°C and assayed for viability by culture and by the presence of metabolic activity as measured by esterase activity (ScanRDI, AES Chemunex). Viability as determined by culture varied from 1 to 30 days, depending upon the organism and the temperature of the water. All organisms were determined viable as measured by esterase activity for the entire 30 days, regardless of the incubation temperature. CONCLUSION: Francisella tularensis was culturable for at least 21 days if held at 8°C. The remaining nonspore-forming bacterial biothreat agents were found to be metabolically active for at least 30 days in water held at 5 or 25°C. SIGNIFICANCE AND IMPACT OF THE STUDY: The data can assist public health officials to determine the safety of drinking water after contamination with a biothreat agent.

Diagnostic utility of cerebrospinal fluid analysis in dogs with suspected idiopathic epilepsy.

BACKGROUND: Idiopathic epilepsy (IE) is the most common cause of repeated seizures in dogs. The International Veterinary Epilepsy Task Force consensus guidelines recommend performing magnetic resonance imaging (MRI) of the brain and cerebrospinal fluid (CSF) analysis as part of a tier II diagnosis of IE, and these procedures have documented risks. The aim of this retrospective study was to identify how often dogs with suspected IE have abnormalities on CSF analysis. METHODS: Dogs aged between 6 months and 6 years that were presented with a history of two or more seizures with at least 24 h between seizure episodes, a normal neurologic examination, no evidence of toxic or metabolic causes, a normal MRI scan (including contrast administration) and CSF analysis were included. RESULTS: Eighty-two dogs were included. Of these, nine dogs (10.9%) had abnormalities on CSF analysis: five of nine dogs (55.5%) had albuminocytologic dissociation, three of nine dogs (33.3%) had mild increases in total nucleated cell count (TNCC), and one of nine dogs (11.1%) had mild increase in both total protein and TNCC. Cytology in dogs with elevated TNCC revealed a mononuclear pleocytosis. One of the nine dogs with abnormal CSF had a seizure within the 24 h before investigations, and six of nine dogs had a seizure within 1 month before investigation. CONCLUSION: CSF analysis can play an important role in the diagnostic investigation of the underlying causes of repeated seizures. However, in dogs with a normal inter-ictal neurological examination and MRI scan, it rarely reveals significant abnormalities, and the risk of performing a CSF tap may outweigh the potential diagnostic gain.

Survey of domestic food handling practices in New Zealand.

The purpose of this survey was to obtain information on the domestic meat and poultry handling practices of New Zealanders in order to support the development of quantitative risk models, as well as providing data to underpin food safety campaigns to consumers. A sample of 1000 New Zealand residents, over 18 years of age, were randomly selected from the electoral roll and asked to participate in a national postal food safety study during 2005. Three hundred and twenty six respondents completed and returned questionnaires containing usable answers, and most of these respondents 'always' prepared the main meal within the household. The majority of meat (84.6%) and poultry (62.9%) purchased by New Zealanders was fresh (rather than frozen), and most consumers (94.4%) claimed that the time taken from food selection to reaching their home was 1 h or less. The majority (approximately 64%) of fresh meat and poultry was frozen in the home and the most favoured method of thawing was at room temperature for up to 12 h. The most common time period for storing cooked or raw meat and poultry in domestic refrigerators was up to 2 days. Most survey respondents preferred their meat and poultry to be cooked either medium or well done. The most popular cooking method for chicken was roasting or baking, while most respondents preferred to pan-fry steak/beef cuts, minced beef or sausages/hamburgers. The potential for undercooking was greatest with pan-fried steak with 19.8% of respondents preferring to consume this meat raw or rare. In answer to questions relating to food handling hygiene practices, 52.2% of respondents selected a hand washing sequence that would help prevent cross contamination. However, it was estimated that 41% and 28% of respondents would use knives and kitchen surfaces respectively in a manner that could allow cross contamination. The data in this survey are self-reported and, particularly for the hygiene questions, respondents may report an answer that they perceive as being correct rather than reflecting their actual behaviour. Nevertheless, the data on food processing, transport, storage and cooking preferences represent useful inputs into the assessment of food safety along the meat and poultry food chains.

Alar reductions in rhinoplasty.

OBJECTIVE: To ascertain if avoiding the vestibular portion of alar reductions during rhinoplasty could improve the cosmetic result of the postoperative nasal sill. DESIGN: Blind, randomized review of base-view photographs (40 patients) 1 year after rhinoplasty. SETTING: A surgical clinic, accredited by the Accreditation Association of Ambulatory Health Care. PARTICIPANTS: A consecutive sample of 40 patients (2 groups) who underwent alar reduction as a part of their rhinoplasty and whose 1-year postoperative photographs were reviewed by 2 facial plastic surgeons and 3 plastic surgeons. MAIN OUTCOME MEASURES: Midway through a 2-year period, the method of alar reduction was changed to include only the cutaneous portion of the nostril. Twenty-two patients had cutaneous-vestibular excisions; 18 patients had cutaneous-only excisions. The surgeon participants reviewed randomized photographs taken 1 year postoperatively and were asked to rate the alar sill for the degree of scarring and notching. RESULTS: Tabulation of the surgeons' ratings revealed significantly less perception of notching and scarring in the alar reduction group with the cutaneous-only excisions. CONCLUSION: Modification of alar reduction to avoid crossing the nostril rim appears to improve the aesthetic result.

Overlay grafting for lateral nasal wall concavities.

One of the most difficult maneuvers in rhinoplasty is achieving a straight dorsum in the patient with a crooked nose. Often this deformity is a result of trauma involving the bony and cartilaginous vaults, resulting in nasal bone fractures and avulsion of the lateral cartilages into the nasal airway. Reduction of nasal bone fractures is fairly straightforward, but the repair of nasal cartilage trauma is more problematic. The cartilage of the nasal vault possesses fibrous attachments, which when disturbed, are difficult to reestablish. Overlay grafts are known to be effective in filling these defects and creating the illusion of a straight nose. In this series, during an 8-year period, 89 grafts were placed over lateral nasal wall concavities during rhinoplasty. Results after a minimum of 1 year follow-up are reviewed, as well as technique, materials, complications, revision rate, and patient satisfaction.

Violence in schools: why--and what can we do about it?

This paper discusses the causes and effects of the violence that occurs in schools. The author explores the notion of need (to be a part of, to belong, and to be connected) as it relates to the tendency toward violence, and conversely, the association between success in school, which allows for the development of positive self-esteem and therein socially acceptable behavior, with a tendency toward nonviolence. The paper explains how behavioral factors common to poor and disadvantaged students, such as a lack of esteem for self and for their educational institution contributes to a failure cycle. The paper also suggests that the development of the affective domain, coupled with sensitivity to culture, good instruction, and an educational environment that nurtures success, leads to an effectively functioning individual with a social, economic, political, and ethnic identity.

The epidemiology and management of upper limb peripheral nerve injuries in modern practice.

This paper reports an epidemiological and clinical study of 813 patients with 1,111 peripheral nerve injuries who were treated for upper limb trauma, which included nerve injury, at two plastic surgery units in south-east England, predominantly between the years 1982 and 1991. The frequency distributions of the levels of nerve injury, and the causes of nerve injury in the sample, are presented, together with the surgical management and timing of nerve repair in these patients. 1,018 clinically suspected nerve injuries in 730 patients (91.6% of nerves, 89.8% of patients) were treated by primary nerve repair, elective delayed nerve repair or primary surgical exploration alone. Divisions of 93 nerves in 83 patients (8.3% of nerves, 10.2% of patients) were treated other than by primary repair or elective delayed repair, due to delayed referral from accident and emergency departments, resulting from missed or uncertain diagnosis at presentation or otherwise unaccounted delay in the initial referral.

Cold intolerance following peripheral nerve injury. Natural history and factors predicting severity of symptoms.

Cold intolerance can be severe and debilitating following injury to the hand. Little is known about its natural history and factors predicting symptom severity. We looked retrospectively at upper limb peripheral nerve injuries over a 12-year period. Information was obtained using a patient questionnaire and patient records. The incidence of cold intolerance was 83%. In 48% the onset of symptoms was within 1 month of the initial injury. At a mean follow-up of 51 months improved symptoms were reported by 21%, while 18% deteriorated. Patients were more likely to develop cold intolerance if they smoked and less likely if they suffered a sharp injury. A score defining the severity of cold induced symptoms, based on the information collected, was calculated for each patient. Significantly increased severity was associated with complete nerve division, median and ulnar nerve division and an associated vessel injury. Symptom improvement was significantly more likely in non-smokers and a deterioration most likely with a high severity score.

Reducing the risk of cartilaginous supratip deformities.

One of the most dramatic results of aesthetic rhinoplastic surgery is that of a pleasing profile. Tip position, a barometer of the acceptable profile, is important to obtain a successful result. However, because of local anesthetic and surgical edema, realization of the final tip position in relation to the supratip dorsum can be deceiving. Postoperative tip drop must be considered when the final intraoperative result is reached. Gender of the patient plays a large part in the tip position desired. Males tend to prefer straighter dorsal profiles. Females often desire a greater difference between the tip and dorsum. Achieving these results can be difficult; therefore, the purpose of this discussion is to quantify, numerically, the difference between immediate postoperative results and one-year results. To quantify these differences, intraoperative measurements of the tip/supratip difference were made in 23 patients. These measurements were then compared with the one-year postoperative results. For female patients, the results indicate a 4 mm to 7 mm intraoperative difference to achieve a 0 mm to 2 mm postoperative difference. In males, the immediate postoperative measurement should be 3 mm to 4 mm in order to obtain a result of 0 mm to 1 mm, the ideal for a male.

Implications of severe trauma to the hand.

Assessment of hand injury should ensure that planning of care is tailored to individual needs. A rehabilitation programme is vital to achieve maximum potential function in the long term. Patients should be prepared for long-term problems.

Transconjunctival blepharoplasty with chemoexfoliation.

Transcutaneous blepharoplasty has been the standard for improving the overall appearance of the lower eyelid, as it addresses skin, muscle, and pseudoherniated orbital fat. Postoperative problems, including poor scarring, scleral show, and even frank ectropion, have led many surgeons to alternate techniques. Transconjunctival blepharoplasty is known to be a reliable method of removing lower eyelid fat, but has been touted as inadequate for those possessing excessive skin and has even been cited as being responsible for increasing lower eyelid wrinkling. Chemoexfoliation, utilizing trichloroacetic acid and phenol, was performed simultaneously with transconjunctival blepharoplasty in 146 patients, whose data are retrospectively reviewed. Excellent results were obtained in lower eyelid skin appearance and pseudoherniated fat in the majority of patients, without an external lower eyelid scar.

Complications of submucous resections of the nasal septum.

We studied retrospectively 263 patients, who had previously undergone submucous resection of their nasal septa. Unsatisfactory septal corrections, perforations, and dorsal saddling were looked for and could be correlated with the skills of the ten surgeons who performed the procedures. Three of the surgeons were attending physicians, while the other seven were resident trainees at different stages of their specialty education. From the total number of the patients, 17 (6.4%) were noted to have persistent septal perforations, 10 (3.8%) had residual deviations of their nasal septa, and 1 (0.4%) had a saddle nose deformity. These findings differed significantly among the different surgeons. The incidence varied from 0% to 30.4% in septal perforations, from 0% to 10.4% in unsatisfactory corrections of the septum, and from 0% to 2.6% in saddle nose. Our findings show that a well-executed submucous resection of the nasal septum by a skilled surgeon yields a low incidence of complications, while in unskilled hands, it may carry a high incidence of complications.