Increasing hospital admission rates for anorexia nervosa amongst young women in Australia from 1998 to 2018.

OBJECTIVE: This study aims to describe the trends in community incidence, community prevalence, mortality, overnight hospital admission rates and average overnight inpatient length of stay (ALOS) for anorexia nervosa (AN) amongst young females aged 15-29 in Australia, between 1998-2018. METHODS: Hospitalisation and ALOS data was obtained from the Australian Institute of Health and Welfare principal data cubes. Epidemiological data relating to community-level incidence, community-level prevalence, disability adjusted life years (DALY) and mortality were obtained from the Global Health Data Exchange. We analysed the community and hospital rates for AN in 3 female age groups, 15-19, 20-24 and 25-29. RESULTS: Overnight hospital female admission rates for AN have substantially increased over the past two decades, with a higher rate increase between 2008-2018 for 15-29 age groups. The largest absolute increases were seen in the 15-19 female age group. Community prevalence and DALYs increased slightly, whilst community incidence has remained relatively stable. During the study period, mortality rates and the average hospital inpatient length of stay for AN declined for females 15-29 years. CONCLUSION: Overnight hospitalisation rates for AN particularly increased amongst young females (15-29) in Australia over the past decade. Less substantial increases in community incidence, community prevalence and DALYs, and declining mortality were also observed.

Ultrasensitive Detection of Bacillus anthracis by Real-Time PCR Targeting a Polymorphism in Multi-Copy 16S rRNA Genes and Their Transcripts.

The anthrax pathogen Bacillus anthracis poses a significant threat to human health. Identification of B. anthracis is challenging because of the bacterium's close genetic relationship to other Bacillus cereus group species. Thus, molecular detection is founded on species-specific PCR targeting single-copy genes. Here, we validated a previously recognized multi-copy target, a species-specific single nucleotide polymorphism (SNP) present in 2-5 copies in every B. anthracis genome analyzed. For this, a hydrolysis probe-based real-time PCR assay was developed and rigorously tested. The assay was specific as only B. anthracis DNA yielded positive results, was linear over 9 log10 units, and was sensitive with a limit of detection (LoD) of 2.9 copies/reaction. Though not exhibiting a lower LoD than established single-copy PCR targets (dhp61 or PL3), the higher copy number of the B. anthracis-specific 16S rRNA gene alleles afforded ≤2 unit lower threshold (Ct) values. To push the detection limit even further, the assay was adapted for reverse transcription PCR on 16S rRNA transcripts. This RT-PCR assay was also linear over 9 log10 units and was sensitive with an LoD of 6.3 copies/reaction. In a dilution series of experiments, the 16S RT-PCR assay achieved a thousand-fold higher sensitivity than the DNA-targeting assays. For molecular diagnostics, we recommend a real-time RT-PCR assay variant in which both DNA and RNA serve as templates (thus, no requirement for DNase treatment). This can at least provide results equaling the DNA-based implementation if no RNA is present but is superior even at the lowest residual rRNA concentrations.

Drought-inducible expression of Hv-miR827 enhances drought tolerance in transgenic barley.

Drought is one of the major abiotic stresses reducing crop yield. Since the discovery of plant microRNAs (miRNAs), considerable progress has been made in clarifying their role in plant responses to abiotic stresses, including drought. miR827 was previously reported to confer drought tolerance in transgenic Arabidopsis. We examined barley (Hordeum vulgare L. 'Golden Promise') plants over-expressing miR827 for plant performance under drought. Transgenic plants constitutively expressing CaMV-35S::Ath-miR827 and drought-inducible Zm-Rab17::Hv-miR827 were phenotyped by non-destructive imaging for growth and whole plant water use efficiency (WUEwp). We observed that the growth, WUEwp, time to anthesis and grain weight of transgenic barley plants expressing CaMV-35S::Ath-miR827 were negatively affected in both well-watered and drought-treated growing conditions compared with the wild-type plants. In contrast, transgenic plants over-expressing Zm-Rab17::Hv-miR827 showed improved WUEwp with no growth or reproductive timing change compared with the wild-type plants. The recovery of Zm-Rab17::Hv-miR827 over-expressing plants also improved following severe drought stress. Our results suggest that Hv-miR827 has the potential to improve the performance of barley under drought and that the choice of promoter to control the timing and specificity of miRNA expression is critical.

Reciprocal leukemia-stroma VCAM-1/VLA-4-dependent activation of NF-κB mediates chemoresistance.

Leukemia cells are protected from chemotherapy-induced apoptosis by their interactions with bone marrow mesenchymal stromal cells (BM-MSCs). Yet the underlying mechanisms associated with this protective effect remain unclear. Genome-wide gene expression profiling of BM-MSCs revealed that coculture with leukemia cells upregulated the transcription of genes associated with nuclear factor (NF)-κB signaling. Moreover, primary BM-MSCs from leukemia patients expressed NF-κB target genes at higher levels than their normal BM-MSC counterparts. The blockade of NF-κB activation via chemical agents or the overexpression of the mutant form of inhibitor κB-α (IκBα) in BM-MSCs markedly reduced the stromal-mediated drug resistance in leukemia cells in vitro and in vivo. In particular, our unique in vivo model of human leukemia BM microenvironment illustrated a direct link between NF-κB activation and stromal-associated chemoprotection. Mechanistic in vitro studies revealed that the interaction between vascular cell adhesion molecule 1 (VCAM-1) and very late antigen-4 (VLA-4) played an integral role in the activation of NF-κB in the stromal and tumor cell compartments. Together, these results suggest that reciprocal NF-κB activation in BM-MSCs and leukemia cells is essential for promoting chemoresistance in the transformed cells, and targeting NF-κB or VLA-4/VCAM-1 signaling could be a clinically relevant mechanism to overcome stroma-mediated chemoresistance in BM-resident leukemia cells.

Effectiveness of Vitamin D and Alpha-Lipoic Acid in COVID-19 Infection: A Literature Review.

Over three years since the World Health Organization (WHO) declared COVID-19 a pandemic, it is still a global burden. Vaccines against COVID-19, caused by SARS-CoV-2, are available and effective for preventing disease. However, their protective effects are not 100%. Currently, the U.S. Food and Drug Administration (FDA) has only approved a limited number of inpatient treatments for COVID-19, such as remdesivir, baricitinib, and tocilizumab. These medications have indications and contraindications applicable to a select patient population. Finding additional effective therapies that are widely available with limited risk could be vital in optimizing treatment strategies for this viral illness. Some vitamins and supplements have been identified as potential options for managing COVID-19. Vitamin D (VD) deficiency has been associated with respiratory tract infections. Moreover, alpha-lipoic acid (ALA) is a powerful antioxidant and helps reduce inflammatory responses in many pathologic conditions. This review aims to analyze the current evidence regarding the effectiveness of VD and alpha-lipoic acid in COVID-19 infection in both outpatient and hospitalized patients. Relevant randomized controlled trials (RCTs) were identified via the PubMed database from January 1, 2021, to December 31, 2023. Inclusion criteria were as follows: the study design was a randomized controlled trial (RCT), the usage of a constant dose during the intervention period without any additional boluses, and a research ethics committee approved it. Exclusion criteria included a lack of an outcome or apparent intervention, additional boluses, or a single-dose regimen in all the interventional groups. There were 11 studies with a total sample size of 35,717 patients that met the criteria for this review. A total of 10 RCTs examined the efficacy of VD, and one RCT that reviewed the efficacy of ALA was identified. All of the articles investigated the use of VD or ALA during the treatment of COVID-19. The endpoints of each study varied, including length of stay in hospital, viral load, SARS-CoV-2 infection rate, mechanical ventilation, inflammatory markers, clinical symptoms, Sequential Organ Failure Assessment (SOFA) score, and mortality. In 8/10 VD supplementation trials, significant differences were identified between the interventional and placebo groups in the aforementioned parameters. In 2/10 VD supplementation trials, no significant differences were identified. The ALA supplementation RCT found no differences between the interventional and placebo groups in the SOFA score and 30-day all-cause mortality rate. The current literature suggests that VD can potentially reduce the SARS-CoV-2 infection rate, oxygen requirements, inflammatory markers, clinical symptoms, and mortality. Regarding ALA, although there was a suggestion of benefit, it was not statistically significant. Common limitations among the different studies included relatively small sample sizes, different geographical patient locations among studies, and differences in dosages. Trials investigating the effects of higher doses of VD supplementation on SARS-CoV-2 infection should be conducted. More research is needed to define best practices and optimal dosing protocols for the use of VD in COVID-19.

A Case of Erythema Nodosum in a 20-Year-Old Female During the Postpartum Period.

Erythema nodosum (EN) is the most common form of panniculitis and occurs in about one in 100,000 people. EN typically presents as an eruption of tender, erythematous nodules on the anterior aspect of the legs, although the face, trunk, and arms can also be involved. While the majority of cases are idiopathic, a subset of cases occurs in association with various triggers, including infections, medications, tumors, and autoimmune diseases. Rarely can EN develop in relation to pregnancy, which is thought to provide a physiologic background that favors its development. While pregnancy has been associated with EN in a minority of cases, currently, there is a limited amount of data suggesting that EN can develop in the late postpartum period. Herein, we present a case of a 20-year-old female with a six-week history of painful lesions on her lower extremities. A physical exam revealed multiple tender, erythematous nodules on the anterior aspect of the lower extremities, spanning from the knees to the toes. Laboratory workup showed no other identified triggers of EN in our patient besides pregnancy. Management of EN in our patient involved a low dose, six-day course of prednisone (initial dose of 15 mg/day) and ibuprofen for one week, leading to symptomatic improvement. Our case emphasizes the possibility of EN presenting in the late postpartum period. This case underscores the importance of considering EN in the differential diagnoses for women presenting with compatible lesions postpartum.

Persistent Eustachian Valve Causing Abdominal and Pelvic Venous System Dilation in a 44-Year-Old Male: A Case Report.

This case report presents a rare incidence of a persistent Eustachian valve (EV) causing notable venous dilation in the abdominal and pelvic regions of a 44-year-old healthy male. Initially presenting with left flank pain, diagnostic evaluations identified a 4.8-mm calculus in the distal left ureterovesical junction. Incidentally, imaging also revealed unexplained venous distensions, subsequently attributed to a prominent EV obstructing the inferior vena cava (IVC). The EV, an embryological structure in fetal circulation that helps divert blood from the IVC to the left atrium via the foramen ovale, typically regresses postnatally. Its persistence into adulthood is uncommon and often does not necessitate intervention. However, a persistent EV is often associated with other cardiac findings, especially a patent foramen ovale (PFO) of an atrial septal defect (ASD). There were some reports demonstrating that persistent EV may play a role in an increased risk of paradoxical cerebral embolism in such cases. Therefore, the case underscores the importance of considering such embryological remnants in the differential diagnoses of unexplained venous distension and cryptogenic stroke. It also highlighted the need for a personalized approach to management, especially during the preparation phase before interventional procedures, such as an ASD closure, to minimize the risks during the operation. Furthermore, it also contributed to a broader understanding of the clinical implications of persistent embryological structures and emphasized the value of meticulous diagnostic processes in identifying the underlying causes of observed anomalies.

A Novel Process for the Containment of SO2 Emissions from Class C Fly Ash in the Fired Materials by Haüyne Formation.

Class C fly ash has been receiving increasing attention due to the gradual transition of thermal power plants all over the world to the fluidized bed combustion technology with sulfur dioxide emissions capture. This research investigates the utilization of class C fly ash in fired ceramic materials with simultaneous efficient and novel containment of sulfur dioxide emissions in the flue gas during firing. A number of experiments were conducted by addition of sodium water glass with different molar ratios of SiO2:Na2O, sodium carbonate, and different ratios of sodium carbonate to water glass to the class C fly ash to examine the optimal combination and quantity for the creation and formation of the mineral phase haüyne which resulted in reduction and containment of SO2 emissions. Results revealed that a 12% dose of sodium water glass with a low molar ratio of 1.7 (SiO2:Na2O) combined with class C fly ash was more effective in the formation of haüyne and the resulting decrease of SO2 in the flue gas was more substantial. The newly formed mineral phase haüyne was identified by an X-ray diffraction analysis and scanning electron microscopy with energy dispersive X-ray spectroscopy. Outcomes reveal a potential for utilization of class C fly ash in the fired materials by containment of sulfur dioxide into their structure.

Corrosion Resistance of Novel Fly Ash-Based Forsterite-Spinel Refractory Ceramics.

This article aims to investigate the corrosion resistance of novel fly ash-based forsterite-spinel (Mg2SiO4-MgAl2O4) refractory ceramics to various corrosive media in comparison with reactive alumina-based ceramics. Because fly ash is produced in enormous quantities as a byproduct of coal-burning power stations, it could be utilized as an affordable source of aluminum oxide and silicon oxide. Corrosion resistance to iron, clinker, alumina, and copper was observed by scanning electron microscope with an elemental probe. The influence on the properties after firing was also investigated. Fly ash-based and reactive alumina-based mixtures were designed to contain 10%, 15% and 20% of spinel after firing. Raw material mixtures were sintered at 1550 °C for two hours. X-ray diffraction analysis and scanning electron microscopy were used to analyze sintered samples. The apparent porosity, bulk density, modulus of rupture, and refractory and thermo-mechanical properties were also investigated. The experimental results disclosed that the modulus of rupture, thermal shock resistance and microstructure were improved with increasing amounts of spinel in the fired samples. An analysis of the transition zones between corrosive media and ceramics revealed that all mixtures have good resistance against corrosion to iron, clinker, aluminum and copper.

Preparation and Characterization of Glass-Ceramic Foam from Clay-Rich Waste Diatomaceous Earth.

In this study, the potential use of waste diatomaceous earth from the production of diatomaceous earth for filtration purposes, as an alternative raw material for foam glass production, was explored. The chemical and mineralogical composition and the high temperature behavior of waste diatomite were studied to assess its suitability for foam glass production. Glass-ceramic foams were prepared using NaOH solution as a foaming agent, via a hydrate mechanism. The influence of different pretreatments and firing temperatures on the foam's structure, bulk density and compressive strength was investigated. High temperature behavior was studied using TG/DTA analysis and high temperature microscopy. Phase composition was studied using X-ray diffraction analysis. Glass-ceramic foam samples of a high porosity comparable to conventional foam glass products were fabricated. The pretreatment temperature, foaming temperature and sintering holding time were found to have a significant influence on foam properties. With increased pretreatment temperature, pyrogenic carbon from the thermal decomposition of organic matter contained in the raw material acted as an additional foaming agent and remained partially unoxidized in prepared foams. The bulk densities of prepared samples ranged from 150 kg/m3 to 510 kg/m3 and their compressive strengths were between 140 and 1270 kPa.

The Effect of Class C Fly Ash on the Plasticity and Ageing of Ceramic Mixtures Based on Kaolin.

The main aim of the presented article is to describe the behavior of class C fly ash-kaolin plastic doughs during the ageing process. Class C fly ash (CCFA) from the fluidized technology of fuel combustion in a thermal power plant was used as a non-plastic admixture to modify the plasticity in a kaolin-quartz sand mixture (for example, the base of a porcelain mixture). The ageing of plastic ceramic dough determined the effect of the CCFA admixture (0-10-20 wt. %) on the initial water content, plasticity (according to the Pfefferkorn test) and bulk density of a dried green body. The main feature of the CCFA admixture in the kaolin-quartz sand mixture is a solidifying effect. Fly ash increases the initial (mixing) water for the preparation of ceramic dough with constant plasticity (30 mm height of deformed cone Hf, according to the Pfefferkorn test), and Hf increases as the dough ages (the dough solidifies faster and loses its plasticity) with the addition of class C fly ash. The effect of CCFA addition on the plasticity and ageing of kaolin-quartz sand dough is documented on Bigot curves: higher content of fly ash decreases the drying shrinkage of the plastic dough, especially when drying samples that have been aged for 24 h in a plastic wrap (without the possibility of drying). The plastic dough's ageing increases the porosity of the dried green body with increased content of CCFA in the raw materials mixture and increased ageing time.

HDM4 is overexpressed in mantle cell lymphoma and its inhibition induces p21 expression and apoptosis.

In mouse models and cell lines, murine double minute 2 (MDM2) and MDM4 have been shown to synergistically promote proteasome-mediated degradation of p21 and p53. MDM4 also inhibits p53-mediated transcriptional activation of p21. p53 expression results in increased p21 expression, a negative cell-cycle regulatory protein and an inhibitor of cyclin D1. As mantle cell lymphoma is characterized by cyclin D1 overexpression, we assessed for human homolog of MDM4 (HDM4) expression and its effect on p21 in mantle cell lymphoma. Using immunohistochemical methods, in reactive lymph nodes (n=19) germinal center cells strongly expressed HDM4 in the nucleus and the cytoplasm, but mantle zone B-cells were only dimly positive. In mantle cell lymphoma tumors, aberrant HDM4 nuclear expression was observed in 18 of 19 (95%) cases. In contrast, HDM4 in other B-cell non-Hodgkin lymphoma types retained its normal pattern of expression. To further characterize the differential upregulation of HDM4 in mantle cell lymphoma, HDM4 was assessed by quantitative real-time polymerase chain reaction in four mantle cell lymphoma cell lines (Granta 519, Z-138, SP-53, and Mino) and six mantle cell lymphoma tumors. Both the splicing variant HDM4-S, containing only the p53-binding domain, and full length HDM4 were increased compared with normal CD19+ B-cells (P<0.05). Using small interfering RNA to inhibit HDM4 in the SP53 and Mino cell lines showed increased p21 and active caspase-3, the latter indicating increased apoptosis. Our results show that HDM4 is overexpressed in mantle cell lymphoma and, at least in part, exerts its effect by suppressing p21 expression, thereby enhancing cell-cycle progression. Inhibition of HDM4 may serve as a potential approach in the design of therapy for patients with mantle cell lymphoma.

Bromodomain and Extra-Terminal (BET) Domain Protein Inhibitors for Solid Tumor Cancers.

The bromodomain and extraterminal (BET) domain protein family is involved in the process of transcription of genetic information. The BET protein family includes BRD2, BRD3, BRD4, and bromodomain testis-specific protein. BET protein alterations are associated with some solid tumor cancers, including nuclear protein in testis midline carcinoma. BET protein has a role in carcinogenesis and in the regulation of the cell cycle. A number of BET inhibitors have entered clinical trials. This review discusses the results of BET inhibitor clinical trials in solid tumor cancers.

Aurora-A kinase nuclear expression in chronic lymphocytic leukemia.

Aurora-A kinase is a cell-cycle-regulating kinase required for chromosomal segregation. Overexpression of Aurora-A kinase has been shown to correlate with tumor proliferation and chromosomal instability. We investigated Aurora-A kinase expression in peripheral blood and bone marrow of 47 chronic lymphocytic leukemia patients and 20 age-matched hematologically healthy subjects. Western blot analysis showed significantly higher Aurora-A levels in chronic lymphocytic leukemia (42 of 47) compared with lymphocytes of healthy subjects. However, Aurora-A mRNA expression in three chronic lymphocytic leukemia patients was similar to or lower than that of healthy control subjects. In 28 of 42 chronic lymphocytic leukemia patients with elevated Aurora-A kinase expression, one or more chromosomal abnormalities were detected, including trisomy 12 in 9 patients and deletion of the ataxia telangiectasia-mutated gene in 9 patients. Aurora-A was also detected in all (100%) chronic lymphocytic leukemia cases by immunohistochemistry, with a nuclear staining pattern. The larger prolymphocytes and paraimmunoblasts showed stronger Aurora-A kinase expression than did small lymphocytes. In contrast, normal bone marrow reactive lymphocytes were negative for Aurora-A with positive histiocytes and immature myeloid cells. Immunostaining for acetylated histone H3 showed a nuclear pattern in all 38 chronic lymphocytic leukemia cases and double labeling showed coexpression of acetylated histone H3 and Aurora-A. In summary, Aurora-A kinase is overexpressed in chronic lymphocytic leukemia cells. The expression of acetylated histone H3 suggests that Aurora-A kinase may be active (functional). Thus, Aurora-A kinase overexpression in chronic lymphocytic leukemia may be involved in the genesis of chromosomal abnormalities and is a potential target for therapeutic intervention.

Variation in shoot tolerance mechanisms not related to ion toxicity in barley.

Soil salinity can severely reduce crop growth and yield. Many studies have investigated salinity tolerance mechanisms in cereals using phenotypes that are relatively easy to measure. The majority of these studies measured the accumulation of shoot Na+ and the effect this has on plant growth. However, plant growth is reduced immediately after exposure to NaCl before Na+ accumulates to toxic concentrations in the shoot. In this study, nondestructive and destructive measurements are used to evaluate the responses of 24 predominately Australian barley (Hordeum vulgare L.) lines at 0, 150 and 250mM NaCl. Considerable variation for shoot tolerance mechanisms not related to ion toxicity (shoot ion-independent tolerance) was found, with some lines being able to maintain substantial growth rates under salt stress, whereas others stopped growing. Hordeum vulgare spp. spontaneum accessions and barley landraces predominantly had the best shoot ion independent tolerance, although two commercial cultivars, Fathom and Skiff, also had high tolerance. The tolerance of cv. Fathom may be caused by a recent introgression from H. vulgare L. spp. spontaneum. This study shows that the most salt-tolerant barley lines are those that contain both shoot ion-independent tolerance and the ability to exclude Na+ from the shoot (and thus maintain high K+:Na+ ratios).

Immunohistochemical analysis of CBFbeta-SMMHC protein reveals a unique nuclear localization in acute myeloid leukemia with inv(16)(p13q22).

The inv(16)(p13q22) or, less commonly the t(16;16)(p13;q22), is characteristic of acute myeloid leukemia (AML) with abnormal bone marrow eosinophils, also known as AML-M4Eo. This abnormality creates a fusion gene, 5' core binding factor beta (CBF-beta) gene and the 3' MYH11 gene, the latter encoding smooth muscle myosin heavy chain gene (SMMHC). Detection of this abnormality is important for diagnosis and is most commonly done by cytogenetics or molecular methods. In this study, we determined the utility of immunohistochemical and immunofluorescence methods using a rabbit polyclonal antibody (AH107) against the C-terminus of the CBFbeta-SMMHC chimeric protein for diagnosis of AML-M4Eo. Thirty-nine AML-M4Eo cases and 55 cases of other types of AML were evaluated. Immunohistochemical analysis of routinely processed paraffin-embedded bone marrow sections showed that CBFbeta-SMMHC staining is predominantly nuclear in all cases of AML-M4Eo and is not nuclear in other AML types. Four cases of AML-M4Eo double-stained for CBFbeta-SMMHC and CD34 showed the fusion protein in CD34-positive blasts. Indirect immunofluorescence analysis of fresh bone marrow aspirate smears showed that AML-M4Eo blasts have a distinct nuclear microgranular or fine-speckled pattern of staining, with or without faint cytoplasmic staining. By contrast, other types of AML and normal bone marrow specimens were either negative or had a nonspecific pattern of staining. In summary, immunostaining for CBFbeta-SMMHC using either immunohistochemical or immunofluorescense analysis as described here reveals a distinctive pattern of staining for AML-M4Eo. This approach is a specific, reliable, and convenient alternative to cytogenetic and molecular methods for the diagnosis of AML-M4Eo and may be particularly helpful in cases with indeterminate histologic features or in cases in which cytogenetic and molecular studies are either uninformative or not available.

Simulation Testing for Selection of Critical Care Medicine Trainees. A Pilot Feasibility Study.

RATIONALE: Selection of physicians into anesthesiology, intensive care, and emergency medicine training has traditionally relied on evaluation of curriculum vitae, letters of recommendation, and interviews, despite these methods being poor predictors of subsequent workplace performance. OBJECTIVES: In this study, we evaluated the feasibility and face validity of incorporating assessment of nontechnical skills in simulation and personality traits into an existing junior doctor selection framework. METHODS: Candidates short-listed for a critical care residency position were invited to participate in the study. On the interview day, consenting candidates participated in a simulation scenario and debriefing and completed a personality test (16 Personality Factor Questionnaire) and a survey. Timing of participants' progression through the stations and faculty staff numbers were evaluated. Nontechnical skills were evaluated and candidates ranked using the Ottawa Crisis Resource Management Global Rating Scale (Ottawa GRS). Nontechnical skills ranking and traditional selection method ranking were compared using the concordance correlation coefficient. Interrater reliability was assessed using the concordance correlation coefficient. MEASUREMENTS AND MAIN RESULTS: Thirteen of 20 eligible participants consented to study inclusion. All participants completed the necessary stations without significant time delays. Eighteen staff members were required to conduct interviews, simulation, debriefing, and personality testing. Participants rated the simulation station to be acceptable, fair, and relevant and as providing an opportunity to demonstrate abilities. Personality testing was rated less fair, less relevant, and less acceptable, and as giving less opportunity to demonstrate abilities. Participants reported that simulation was equally as stressful as the interview, whereas personality testing was rated less stressful. Assessors rated both personality testing and simulation as acceptable and able to provide additional information about candidates. The Ottawa GRS showed moderate interrater concordance. There was moderate concordance between rankings based on traditional selection methods and Ottawa GRS rankings (ρ = 0.52; 95% confidence interval, -0.02 to 0.82; P = 0.06). CONCLUSIONS: A multistation selection process involving interviews, simulation, and personality testing is feasible and has face validity. A potential barrier to adoption is the high number of faculty required to conduct the process.

Emergence of fluoroquinolones as the predominant risk factor for Clostridium difficile-associated diarrhea: a cohort study during an epidemic in Quebec.

BACKGROUND: Since 2002, an epidemic of Clostridium difficile-associated-diarrhea (CDAD) associated with a high case-fatality rate has involved >30 hospitals in the province of Quebec, Canada. In 2003, a total of 55% of patients with CDAD at our hospital had received fluoroquinolones in the preceding 2 months. It has been suggested that massive use of proton pump inhibitors might have facilitated this epidemic. METHODS: To delineate the risk of CDAD associated with specific classes of antibiotics and whether this is modulated by concomitant use of proton pump inhibitors and other drugs altering gastric acidity or gastrointestinal motility, we conducted a retrospective cohort study of patients hospitalized in a teaching hospital in Sherbrooke, Canada, during the period of January 2003 through June 2004. We obtained data on 7421 episodes of care corresponding to 5619 individuals. Patients were observed until they either developed CDAD or died or for 60 days after discharge from the hospital. Adjusted hazard ratios (AHRs) were calculated using Cox regression. RESULTS: CDAD occurred in 293 patients. Fluoroquinolones were the antibiotics most strongly associated with CDAD (AHR, 3.44; 95% confidence interval [CI], 2.65-4.47). Almost one-fourth of all inpatients received quinolones, for which the population-attributable fraction of CDAD was 35.9%. All 3 generations of cephalosporins, macrolides, clindamycin, and intravenous beta-lactam/beta-lactamase inhibitors were intermediate-risk antibiotics, with similar AHRs (1.56-1.89). Proton pump inhibitors (AHR, 1.00, 95% CI, 0.79-1.28) were not associated with CDAD. CONCLUSIONS: Administration of fluoroquinolones emerged as the most important risk factor for CDAD in Quebec during an epidemic caused by a hypervirulent strain of C. difficile.

Auditing Operating Room Recycling: A Management Case Report.

Much waste arises from operating rooms (ORs). We estimated the practical and financial feasibility of an OR recycling program, weighing all waste from 6 ORs in Melbourne, Australia. Over 1 week, 237 operations produced 1265 kg in total: general waste 570 kg (45%), infectious waste 410 kg (32%), and recyclables 285 kg (23%). The achieved recycling had no infectious contamination. The achieved recycling/potential recycling rate was 285 kg/517 kg (55%). The average waste disposal costs were similar for general waste and recycling. OR recycling rates of 20%-25% total waste were achievable without compromising infection control or financial constraints.