Gamma spectrometry analysis of radioiodine in charcoal from high volume aerosol samples.

Following accidental releases, gamma spectrometry of impregnated charcoal filters is used to measure gaseous 131I contamination, but is subject to sampling inhomogeneity. In this study two germanium detectors are calibrated using a charcoal multi-gamma standard. Activities in samples spiked with a matrix of 131I aliquots are compared based on measurement, spike known activity, and monte-carlo simulation, and used to test a simple mixing method. Measurement efficiency, and removal of 11% inhomogeneity effect by mixing, was successfully reproduced in GESPECOR calculations.

An automated programme for the optimisation of HPGe detector parameters using an evolutionary algorithm with GESPECOR.

We describe the development of an automated, user-friendly programme which, making use of the GESPECOR gamma spectrometry software to conduct Monte Carlo simulations, yields an optimised model of a HPGe detector by applying suitable optimisation algorithms without requiring any further user intervention. The programme is capable of simultaneously employing multiple experimental FEP efficiency curves for the parameter optimisation process. Application of the optimisation process to a HPGe detector demonstrates that accurate, robust models can be achieved using this approach.

Perinatal determinants of D-dimer levels in a cross-sectional study of low risk pregnant women.

BACKGROUND: To examine perinatal determinants of the antenatal levels of D-dimers. METHODS: Cross-sectional study of 760 low risk pregnant women recruited into five gestational groups. Variables examined in antenatal groups included maternal age, body mass index, parity, smoking, family history venous thromboembolism (VTE) and previous use of the oral contraceptive pill (OCP). Onset of labour and mode of delivery were also examined in the post-natal group. RESULTS: D-dimer levels in group 4 (38-40 + 6) were significantly lower in the women with a history of taking the OCP when compared to those that had not taken it in the past (P = 0.027). In the day 2 post-natal group, the median level of D-dimer was significantly higher in primparous when compared to multiparous women (P = 0.015). The median D-dimer levels were significantly lower in the elective Caesarean section group in comparison to spontaneous onset (P = 0.003) and induction of labour (P = 0.016). When the mode of delivery was examined, the median D-dimer levels were significantly lower in those that had an elective Caesarean section when compared to normal vaginal delivery (P = 0.008) and instrumental vaginal delivery (P = 0.007). Women post elective Caesarean section had a significantly lower D-dimer than those after emergency Caesarean section (P = 0.008). DISCUSSION: There are some significant differences in D-dimer levels when certain perinatal determinants are examined. This work is potentially beneficial to the future diagnosis of VTE in pregnancy as it supports previously published recommended D-dimer levels for the diagnosis of VTE in pregnancy.

Construction and evaluation of a microbiological positive process internal control for PCR-based examination of food samples for Listeria monocytogenes and Salmonella enterica.

PCR assays for food-borne pathogens are widely available but have had more limited application to food testing compared with their use in clinical laboratories. When testing food samples, false negative PCR results can occur and may be due to interference with target-cell lysis necessary for nucleic acid extraction, nucleic acid degradation and/or direct inhibition of the PCR. Therefore, it is essential to include appropriate controls for the application of PCR to the detection of pathogens in food samples. The purpose of this study was to develop and evaluate a novel internal control (IC), capable of monitoring the complete detection procedure, from DNA extraction through to amplification and detection. A 'positive process' IC was developed for the reliable application of real-time PCR assays for the detection of Salmonella enterica or Listeria monocytogenes in enrichment broths. Two novel real-time 5' nuclease PCR assays for the detection of a 77 bp fragment of the green fluorescent protein (gfp) gene and a 91 bp fragment of the iroB gene of S. enterica were developed. These assays were specific and had detection limits of 5+/-0.88 and 15+/-1.03 CFU per PCR for the gfp and iroB genes respectively. The gfp PCR assay was combined with the iroB PCR assay, and also with a previously published real-time 5' nuclease PCR assay for the detection of the hlyA gene of L. monocytogenes. Duplexed assays were optimised such that the target genes were simultaneously amplified at similar sensitivities to single reactions. The gfp gene was cloned into the chromosome of a non-pathogenic strain of Escherichia coli and the modified strain successfully encapsulated in LENTICULE discs. A single disc was added to 1 ml of standard enrichment broths immediately prior to DNA extraction, and used as an IC for the detection of L. monocytogenes and S. enterica by PCR. This method was evaluated using 393 naturally contaminated food or environmental samples, 267 for the detection of Salmonella spp. and 126 for Listeria spp. PCR inhibition was detected in 29 (8%) extracts, although neither pathogens were detected in these broths by culture. S. enterica was detected by PCR in 43 of 45 (96%) broths that were positive by conventional culture. The iroB gene was also detected in a further 2 broths by PCR alone. L. monocytogenes was detected in 6 broths by both PCR and conventional culture, plus an additional 7 by PCR only. Control strategies such as those described here are important tools for the interpretation of PCR assays by improving the reliability of detection of pathogens in food.

An outreach programme for patients with an exacerbation of chronic obstructive pulmonary disease.

Chronic obstructive pulmonary disease is a common clinical condition characterised by airflow obstruction. The clinical course of the disease is characterised by intermittent exacerbations. In Ireland exacerbations of chronic obstructive pulmonary disease are a common cause of admission to acute medical hospitals. The Beaumont Hospital COPD Outreach Programme was designed to provide care at home for patients with an exacerbation of COPD that would otherwise require hospitalisation. Patients recruited to the programme were discharged home within 72 hours of admission and reviewed by the Outreach Team over a two week period. In addition to monitoring clinical progress the Team provided education, smoking cessation and medication advice. Analysis of the outcome of the first 100 patients recruited to the study show that one third of patients admitted to Hospital with an exacerbation of COPD are eligible for this programme and the average length of Hospital stay was 2.6 days. During the fourteen day follow up there was one death (non-respiratory) and six patients were re-admitted to hospital. Forty percent of smokers had abstained from smoking at the end of three months. In summary, the COPD Outreach programme is a safe and effective alternative to acute hospital care for selected patients with exacerbations of COPD.

AIDS & the soul of the physician.

AIDS: Health care providers, especially physicians, are not trained to deal with terminal illness and death. This lack of training makes long-term care of AIDS patients especially difficult for many health professionals. Doctors need to be caring and empathetic, while at the same time guarding against developing a callous attitude as a way to protect themselves emotionally. AIDS treatment is difficult for many to handle, and doctors and caregivers are encouraged to share their feelings or attend workshops and support groups.^ieng

The effect of minimal exercise on fitness in elderly women after hip surgery.

To determine the effect of minimal exercise on functional fitness following total hip replacement in elderly women, 20 women (13 exercisers, 7 controls) who had undergone unilateral or bilateral hip replacement surgery for primary osteoarthritis were studied. An exercise treadmill test with respiratory gas and blood lactate analyses, and a field test of walking speed on a measured course, were administered before and after a twice weekly exercise programme of three months' duration. Markers of cardiorespiratory fitness, including peak achieved oxygen uptake (VO2) and ventilatory and lactate thresholds were measured. Maximum self-selected walking speed was also measured over a flat course. Peak VO2 increased in the exercise group when compared to baseline (P < 0.05) but did not differ from the control group. The exercise group significantly improved their walking speed by 10.1% compared with non-exercising controls (1.41 vs 1.20 m/sec, P < 0.05), and increased VO2 at lactate threshold. The improvements occurred despite the twice weekly exercise sessions being below the recommended frequency of exercise for improving cardiorespiratory fitness. Minimal exercise in elderly women after hip surgery can substantially improve submaximal exercise capacity, as well as walking speed.

Objective verification of tetanus immune status in an apparently non-immune population.

Patients who are not known to be immunised to tetanus are considered to be non-immune. The appropriate treatment is the commencement of active immunisation with a course of three tetanus toxoid inoculations; if the wound is considered to be tetanus-prone, 250 IU of human anti-tetanus immunoglobulin is given concurrently. This study determined the true immune status of 166 patients who were considered to be non-immune on the basis of the available history. The majority (90 of 166) had protective levels of immunoglobulin (greater than 0.06 IU/ml) and further treatment was not indicated. Only two patients were non-immune. The remainder had protective levels (between 0.01 and 0.06 IU/ml) and required a tetanus toxoid booster.

Resuscitation training for cardiac patients and their relatives--its effect on anxiety.

It is feared by many doctors that teaching basic life support (BLS) to high risk cardiac patients or a member of the family increases their anxiety. We trained a group of patients with recurrent ventricular tachycardia in BLS together with a friend or family member. Measurement of anxiety before and three months after training demonstrated a reduction in anxiety in both groups. This suggests that basic life support training can be targeted to high risk groups without fear of increasing anxiety.

Applied hand anatomy: its importance in accident & emergency.

Hand injuries account for 10-20% of an Accident & Emergency department's workload. Early recognition of serious injury is vital to ensure appropriate management. This is only possible with a good working knowledge of hand anatomy. Forty consecutive A&E senior house officers (SHOs) were assessed on their knowledge of basic hand anatomy. The results are discussed as are the implications for undergraduate and post-graduate training.

Ice-skating injuries to the hand.

166 patients with injuries due to ice-skating were seen in the local accident and emergency department over a six-month period; 60% of these involved the upper limb. 28 of the upper limb injuries were closed fractures and 24 were lacerations, almost all to the dorsum of the hand. The use of protective gloves would help to prevent these potentially avoidable injuries. "On-site" first-aid facilities help to reduce the demand on the local accident service.