Evaluation of Bacillus anthracis and Yersinia pestis sample collection from nonporous surfaces by quantitative real-time PCR.

AIM: We will validate sample collection methods for recovery of microbial evidence in the event of accidental or intentional release of biological agents into the environment. METHODS AND RESULTS: We evaluated the sample recovery efficiencies of two collection methods - swabs and wipes - for both nonvirulent and virulent strains of Bacillus anthracis and Yersinia pestis from four types of nonporous surfaces: two hydrophilic surfaces, stainless steel and glass, and two hydrophobic surfaces, vinyl and plastic. Sample recovery was quantified using real-time qPCR to assay for intact DNA signatures. We found no consistent difference in collection efficiency between swabs or wipes. Furthermore, collection efficiency was more surface-dependent for virulent strains than nonvirulent strains. For the two nonvirulent strains, collection efficiency was similar between all four surfaces, albeit B. anthracis Sterne exhibited higher levels of recovery compared to Y. pestis A1122. In contrast, recovery of B. anthracis Ames spores and Y. pestis CO92 from the hydrophilic glass or stainless steel surfaces was generally more efficient compared to collection from the hydrophobic vinyl and plastic surfaces. CONCLUSIONS: Our results suggest that surface hydrophobicity may play a role in the strength of pathogen adhesion. The surface-dependent collection efficiencies observed with the virulent strains may arise from strain-specific expression of capsular material or other cell surface receptors that alter cell adhesion to specific surfaces. SIGNIFICANCE AND IMPACT OF THE STUDY: These findings contribute to the validation of standard bioforensics procedures and emphasize the importance of specific strain and surface interactions in pathogen detection.

Premixed insulin preparations in pen syringes maintain glycemic control and are preferred by patients.

OBJECTIVE: To examine the impact on glycemic control of substituting a range of premixed insulins for the standard treatment with patient-mixed insulin combinations. In addition, a pen-type syringe was substituted for the conventional insulin syringe, and the patients' preference was ascertained at the end of the study. RESEARCH DESIGN AND METHODS: Before the study, all patients had maintained a constant insulin dosage for 2 months. For the first month of the study, all patients were encouraged to make any adjustment in insulin dosage required to optimize control. Twenty-seven patients participated in the study. At the end of the first month, patients were randomized either to change to premixed insulins or to continue with self-mixed insulins for 2 months. At the end of the 2-month period, participants changed to the alternative regime for a further 2 months. Glycemic control was measured by assessment of glycosylated hemoglobin levels at the start of the study and after each 2-month period of the study. In addition, during the 1-month run-in period and during both 2-month study periods, a seven-point blood glucose profile was obtained extending from before breakfast to just before retiring for sleep. RESULTS: Glycosylated hemoglobin levels were unchanged throughout the duration of the study. Similarly, there were no systematic changes in individual seven-point blood glucose profiles. The frequency of hypoglycemic reactions was similar on patient-mixed and premixed insulin programs. However, 83% of patients expressed a preference for premixed insulins. A similar percentage regarded pen-type insulin syringes to be preferable to the conventional syringe. CONCLUSIONS: Glycemic control was similar on patient-mixed and premixed insulins, and patients had a marked preference for premixed insulins delivered in a pen-type syringe over conventional insulin therapy. Premixed insulin delivered by a pen-type syringe promises to ease the burden of daily injections for many diabetic patients.

Restraint reduction reduces serious injuries among nursing home residents.

OBJECTIVES: To describe how removing physical restraints affected injuries in nursing home settings. DESIGN: A 2-year prospective study of an educational intervention for physical restraint reduction. SETTING: Sixteen diverse nursing homes with 2075 beds in California, Michigan, New York, and North Carolina. PARTICIPANTS: Study A: 859 residents who were physically restrained at the onset of the intervention on October 1, 1991. Study B: all residents who occupied the 2075 beds in the 16 facilities 3 months before the intervention and 3 months after its completion. INTERVENTION: Educational program for nursing home staff followed by quarterly site consultations to participating nursing homes. MAIN OUTCOME MEASURES: Rate of physical restraint use and injuries. RESULTS: Study A: Serious injuries declined significantly among the 859 residents restrained initially when restraint orders were discontinued (X2 = 6.2, P = .013). Study B: During the intervention period, physical restraint use among the 2075 residents decreased from 41% to 4%, a 90% reduction. The decrease in the percentage of injuries of moderate to serious severity was significant (i.e., 7.5% vs 4.4%, P2-tail = .0004) as was the rate of moderate and serious injuries combined (Rate Ratio = 1.580, P2-tail = .0033). CONCLUSIONS: A substantial decrease in restraint use occurred without an increase in serious injuries. Although minor injuries and falls increased, restraint-free care is safe when a comprehensive assessment is done and restraint alternatives are used.

Phylogeny, ribosomal RNA gene typing and relative abundance of new Pseudomonas species (sensu stricto) isolated from two pinyon-juniper woodland soils of the arid southwest U.S.

Rhizosphere-inhabiting Pseudomonas species interact with plant roots and may be important for plant performance under stressful environmental conditions. A comparison was conducted of culturable Pseudomonas isolates associated with pinyon rhizosphere and between-tree interspace areas in a hot, dry, volcanic cinder field and an adjacent sandy loam soil, in order to identify Pseudomonas species which may be involved in pinyon pine survival under stressful conditions. From a collection of 800 isolates, eleven isolates exhibiting different colony morphology were selected for 16S ribosomal RNA gene sequencing. Phylogenetic analysis of rDNA sequences from the eleven field isolates, forty-six described Pseudomonas species, and thirty-four previously characterized environmental isolates indicated that the isolates from the cinders and sandy loam soil clustered into three groups. The field isolates were distinct from any of the named species or other environmental isolates. Oligonucleotide primer pairs that differentiated three field isolate groups were designed from the 16S rDNA sequences, and eight hundred Pseudomonas field isolates cultured from pinyon rhizospheres and interspaces in the cinders and sandy loam soils were typed into the three groups using PCR assays. The composition of Pseudomonas populations in four environments was significantly different. The relative abundance of the three rDNA-based groups appeared to be affected by both the soil type and the pinyon rhizosphere.

Retrain, don't restrain: the educational intervention of the National Nursing Home Restraint Removal Project.

This article describes an educational program that contributed to a 90% reduction in the use of physical restraints in 16 randomly selected nursing homes over a two-year period. The educational program advocated assessments by a multidisciplinary team to generate individualized, restraint-free interventions. The program consisted of a workshop, telephone and quarterly on-site consultations, regional meetings, a newsletter, and written and audio-visual materials. The workshop and site visits were powerful motivators, and participants also found the video very useful. Most nursing homes can easily adapt components of this project to create their own restraint-removal programs.

rRNA operon copy number reflects ecological strategies of bacteria.

Although natural selection appears to favor the elimination of gene redundancy in prokaryotes, multiple copies of each rRNA-encoding gene are common on bacterial chromosomes. Despite this conspicuous deviation from single-copy genes, no phenotype has been consistently associated with rRNA gene copy number. We found that the number of rRNA genes correlates with the rate at which phylogenetically diverse bacteria respond to resource availability. Soil bacteria that formed colonies rapidly upon exposure to a nutritionally complex medium contained an average of 5.5 copies of the small subunit rRNA gene, whereas bacteria that responded slowly contained an average of 1.4 copies. In soil microcosms pulsed with the herbicide 2,4-dichlorophenoxyacetic acid (2,4-D), indigenous populations of 2,4-D-degrading bacteria with multiple rRNA genes ( = 5.4) became dominant, whereas populations with fewer rRNA genes ( = 2.7) were favored in unamended controls. These findings demonstrate phenotypic effects associated with rRNA gene copy number that are indicative of ecological strategies influencing the structure of natural microbial communities.

Disseminated gonococcal infection due to a beta-lactamase-producing strain of Neisseria gonorrhoeae. A case report.

A ß-lactamase-producing strain of Neisseria gonorrhoeae with nutritional requirements for arginine, hypoxanthine, and uracil was isolated from the knee-joint fluid, the genital tract, and the sexual partner of a woman presenting with gonococcal arthritis.

Taking charge. The role of nursing administrators in removing restraints.

The leadership and commitment of nursing administrators play a pivotal role in minimizing the use of restraints and maintaining a restraint-free environment. This article describes the role of nursing administrators in reducing the use of physical restraints as part of a 2-year, national nursing home restraint-reduction project. It reviews important information about restraint-free care the benefits of restraint-free care, and strategies to reduce the use of restraints in nursing homes, much of which is applicable to settings other than nursing homes.