Phenotypic and genotypic characterization of antibiotic resistance in military hospital-associated bacteria from war injuries in the Eastern Ukraine conflict between 2014 and 2020.

BACKGROUND: Infections from the recent conflict in Ukraine have been poorly investigated. AIM: To describe the phenotypic and genotypic mechanisms of antibiotic resistance in pathogens associated with war injuries in the Ukraine conflict. METHODS: This report describes a retrospective multi-centre microbiological survey conducted in four Ukrainian military hospitals between 2014 and 2020. The phenotypes of 813 organisms obtained from 1061 tests of 162 patients were analysed. Fifty-two isolates underwent whole-genome sequencing. FINDINGS: Resistance was highest in Acinetobacter baumannii, with 92.5% ((48/52) 95% confidence interval (CI) 81.8-97.9) resistant to fluoroquinolones, 83.0% ((43/52) 95% CI 70.2-91.9) resistant to aminoglycosides, and 67.9% ((37/52) 95% CI 53.7-80.1) resistant to carbapenems. In contrast, resistance to carbapenems was 55.6% ((30/52) 95% CI 41.4-69.1) in Pseudomonas aeruginosa, 42.9% in Escherichia coli ((12/28) 95% CI 24.5-62.8), and 32.8% in Klebsiella pneumoniae ((20/34) 95% CI 21.3-46.0). Multi-drug-resistant strains harboured an abundance of antibiotic resistance genes. K. pneumoniae co-produced class A and D ß-lactamases, in one case with blaNDM-1 and rmtC 16S rRNA methyltransferase. A. baumannii carried class A and D ß-lactamases but not metallo-ß-lactamases; in four isolates, carbapenemases were present with the RmtASE gene armA. P. aeruginosa harboured a wide range of class A and D ß-lactamases along with metallo-ß-lactamases, as well as the RmtB4 RmtASE gene. Gram-positive cocci were generally sensitive to the tested antibiotics. CONCLUSION: The incidence of resistance among the studied pathogens was higher than that in Ukrainian civilian hospitals and European countries. The discovery of P. aeruginosa, A. baumannii, and K. pneumoniae co-producing carbapenemases and RmtASEs is of particular importance, and hospitals should be vigilant for their emergence.

Measurements of δ13C in CH4 and using particle dispersion modeling to characterize sources of Arctic methane within an air mass.

A stratified air mass enriched in methane (CH4) was sampled at ~600 m to ~2000 m altitude, between the north coast of Norway and Svalbard as part of the Methane in the Arctic: Measurements and Modelling campaign on board the UK's BAe-146-301 Atmospheric Research Aircraft. The approach used here, which combines interpretation of multiple tracers with transport modeling, enables better understanding of the emission sources that contribute to the background mixing ratios of CH4 in the Arctic. Importantly, it allows constraints to be placed on the location and isotopic bulk signature of the emission source(s). Measurements of δ13C in CH4 in whole air samples taken while traversing the air mass identified that the source(s) had a strongly depleted bulk δ13C CH4 isotopic signature of -70 (±2.1)‰. Combined Numerical Atmospheric-dispersion Modeling Environment and inventory analysis indicates that the air mass was recently in the planetary boundary layer over northwest Russia and the Barents Sea, with the likely dominant source of methane being from wetlands in that region.

A new atomization cell for trace metal determinations by tungsten coil atomic spectrometry.

A new metallic atomization cell is used for trace metal determinations by tungsten coil atomic absorption spectrometry and tungsten coil atomic emission spectrometry. Different protecting gas mixtures are evaluated to improve atomic emission signals. Ar, N(2), CO(2) and He are used as solvents, and H(2) and C(2)H(2) as solutes. A H(2)/Ar mixture provided the best results. Parameters such as protecting gas flow rate and atomization current are also optimized. The optimal conditions are used to determine the figures of merit for both methods and the results are compared with values found in the literature. The new cell provides a better control of the radiation reaching the detector and a small, more isothermal environment around the atomizer. A more concentrated atomic cloud and a smaller background signal result in lower limits of detection using both methods. Cu (324.7 nm), Cd (228.8 nm) and Sn (286.3 nm) determined by tungsten coil atomic absorption spectrometry presented limits of detection as low as 0.6, 0.1, and 2.2 µg L(-1), respectively. For Cr (425.4 nm), Eu (459.4 nm) and Sr (460.7 nm) determined by tungsten coil atomic emission spectrometry, limits of detection of 4.5, 2.5, and 0.1 µg L(-1) were calculated. The method is used to determine Cu, Cd, Cr and Sr in a water standard reference material. Results for Cu, Cd and Cr presented no significant difference from reported values in a 95% confidence level. For Sr, a 113% recovery was obtained.

Cellular and molecular characterization of a feline insulinoma.

BACKGROUND: Insulinoma is an autonomous insulin-secreting islet cell neoplasm that is rarely diagnosed in cats. The clinical and pathological aspects of feline insulinoma have been described previously, but the molecular characteristics of these tumors have not been investigated. OBJECTIVES: The study objectives were to characterize peptide hormone production and determine expression of selected genes involved in glucose metabolism and insulin secretion in a feline insulinoma. METHODS: Immunohistochemistry and RT-PCR were used to examine hormone and gene expression, respectively, by insulinoma cells. RESULTS: Immunohistochemistry examination indicated that the tumor cells expressed insulin, chromogranin A, and somatostatin but not glucagon or pancreatic polypeptide. The tumor expressed several genes characteristic of pancreatic beta cells (beta cells) including insulin (INS), glucose transporter 2 (GLUT2), and glucokinase (GCK). The tumor also expressed hexokinase 1 (HK1), a glycolytic enzyme not normally expressed in beta cells. GCK expression was higher in the insulinoma than in normal pancreas from the same cat. The GCK : HK1 ratio was >20-fold higher in insulinoma tissue than in normal pancreas. CONCLUSIONS AND CLINICAL IMPORTANCE: The feline insulinoma produced several peptide hormones and expressed genes consistent with a beta-cell phenotype. The pattern of hexokinase gene expression in tumor cells differed from that of normal pancreas. These findings suggest insulinoma cells may have an increased sensitivity to glucose that could contribute to the abnormal insulin secretory response observed at low serum glucose concentrations.

An inductively coupled plasma carbon emission detector for aqueous carbohydrate separations by liquid chromatography.

An inductively coupled plasma atomic emission spectrometer is used to detect carbon-containing compounds following separation by high-performance liquid chromatography. A calcium form ligand exchange column with distilled and deionized water as the mobile phase is used to separate carbohydrates. The eluting species are detected by monitoring the carbon atomic emission line at 193.09 nm. The mass detection limits using a photomultiplier tube for sucrose and glucose are 50 ng, while that for fructose is 60 ng. The carbon emission detector should provide the same detection limit for any compound with a similar mass percent of carbon, whether or not the compound exhibits appreciable absorption characteristics. While the carbon emission detector will universally detect any organic compound, it will discriminate against species with high molar absorptivity that may be present at low concentration. Such species may act as interferences in chromatograms generated with conventional UV-visible absorption detectors. To demonstrate the utility of the carbon emission detector, three sugars (glucose, fructose, sucrose) are determined in apple, crangrape, and orange juice.

A review of expectancy theory and alcohol consumption.

Research is reviewed on the association between alcohol outcome expectancies and consumption which has led many to argue that manipulating expectancies might be a route to manipulating consumption for problem prevention and treatment. Studies indirectly and directly evaluating this latter position are reviewed. Expectancies predicting treatment outcome: two studies have shown that the more positive expectancies held at treatment, the poorer is treatment outcome, but five other studies have failed to find this. Three related studies have shown that the more negative expectancies held at treatment, the better the treatment outcome. This evaluation provides evidence inconsistent with the main position for positive expectancy and limited support for negative. Expectancy manipulations and ad libitum consumption: three studies in the laboratory have shown that increasing positive expectancies through word priming increases subsequent consumption and two studies have shown that increasing negative expectancies decreases it. A single study in the field showed a similar relationship. This evaluation provides evidence consistent with the main position but is limited by measuring consumption changes over only 1-2 hours. Prevention programmes with expectancy components: seven projects are reviewed in which positive expectancies were targeted, but only two report an expectancy change analysis and in both cases the expectancy change did not relate to subsequent consumption. This evaluation provides evidence inconsistent with the main position. Expectancy challenge: two related studies are reviewed in which positive expectancy challenges reduce subsequent consumption but changes in expectancy were not evaluated as predictors of consumption change. Two studies are reviewed which found a reduction in positive expectancy following expectancy challenge but no reduction in consumption. One study is reviewed in which when negative expectancy was increased in treatment there was a better treatment outcome at 3 months follow-up than when it was not. This evaluation provides evidence inconsistent with the main position for positive expectancy and limited consistent evidence for negative. It is concluded that the research has still to be done that securely links expectancy manipulations with subsequent changes in consumption, and fulfils the early promise from association studies.

Tungsten coil devices in atomic spectrometry: absorption, fluorescence, and emission.

In this work, tungsten coil (W-Coil) devices are used as atomizers for electrothermal atomization atomic absorption spectrometry (ETAAS), electrothermal atomization laser excited atomic fluorescence spectrometry (ETA-LEAFS), and electrothermal vaporization inductively coupled plasma atomic emission spectrometry (ETV-ICP-AES). For most cases in ETAAS and ETA-LEAFS, limits of detection (LODs) using the W-Coil are within a factor of ten of those observed with commercial graphite furnace systems. LOD for Cd by W-Coil AAS is 10 pg, while LODs for As, Se, Cr, Sb and Pb by W-Coil LEAFS are 950, 320, 1400, 330, and 160 fg, respectively. The compact W-Coil device makes it an ideal atomizer for portable atomic spectrometry instrumentation, especially when coupled with a miniature charge coupled device spectrometer. Alternatively, the atomizer can be used as an inexpensive, modular add-on to an existing commercial ICP-AES system; and the thermal separation of Pb with interference elements Al, Mn, and Fe is demonstrated.

Desire for alcohol and outcome expectancies as measures of alcohol cue-reactivity in social drinkers.

AIMS: To assess the responsiveness of questionnaire measures of desire to drink and alcohol outcome expectancies. DESIGN: A subjective alcohol cue-reactivity paradigm (alcohol cue: sight, smell, taste) was used with a 2 x 2 between-subject design (n = 88), drink type (soft/alcoholic) and order of assessment (desire-expectancy/expectancy-desire). Covariance analysis controlled for quantity of recent alcohol consumption. SETTING: A quiet alcohol research suite. PARTICIPANTS: Eighty-eight male and female social drinking students, recruited for a 'taste preference' survey. MEASURES: Three composite measures using questionnaire totals and subscales: of desire (DAQ), positive expectancy (AEQ) and negative expectancy (NAEQ). Timeline Follow-back procedure for recent consumption. FINDINGS: Subjective cue-reactivity was found for the DAQ total score and the subscales 'strong intentions and desires' and 'negative reinforcement'. Expectancies did not demonstrate alcohol cue-reactivity. CONCLUSION: The DAQ and subscales are sensitive measures of alcohol cue-reactivity in social drinkers. Potential uses of the subjective cue-reactivity procedure with multi-factorial representations of cue reaction are identified.

The effects of alcohol cues and an alcohol priming dose on a multi-factorial measure of subjective cue reactivity in social drinkers.

RATIONALE: Exploring subjective alcohol cue reactivity in non-clinical samples should assist understanding in clinical samples where additional problems muddy the water. However, exploration is stalled through using insensitive, single-item representations. OBJECTIVE: The effect of alcohol cues and a priming dose of alcohol on a new multi-factorial representation of cue reactivity is sought (DAQ, Desire for Alcohol Questionnaire). METHODS: Prime and Cue exposure are variables in a standard 2x2 between subjects design set within a stooge taste-evaluation experiment. The DAQ was administered after a Prime and Cue exposure phase. RESULTS: Main effects for Cue exposure but not Prime were found for the DAQ total and the subscales Mild desires (positively reinforcing items) and Strong desires/intentions but not Negative reinforcement (negatively reinforcing items) and Controllability; however, there was no interaction. CONCLUSION: The DAQ is a sensitive measure of subjective cue reactivity in social drinkers and its potential in the evaluation of pharmacological interventions is proposed.

Retained fecalith after laparoscopic appendectomy.

An intraabdominal abscess developed from a retained fecalith following laparoscopic appendectomy. We discuss the prevention and management of retained fecaliths in light of the numerous reports of retained gallstones.

Simultaneous determination of Cu, Cd and Pb in drinking-water using W-Coil AAS.

An inexpensive, multi-element, W-coil atomic absorption spectrometer has been developed. Atomization occurs on W-coils extracted from commercially available slide projector bulbs. The system has minimal power requirements, 120 ACV and 15 A. A small, computer controlled CCD spectrometer is used as the detector. A multi-element Cu, Cd and Pb hollow cathode lamp is used as the source. 20 mul volumes are deposited on the coil and atomized at 6.7 A or approximately 2200 degrees C. Cu, Cd and Pb were simultaneously determined in tap water, drinking water and a quality control sample. The instrument detection limits are 0.8, 0.2 and 3.0 mug/l for Cu, Cd and Pb, respectively.

Development of a digital micromirror spectrometer for analytical atomic spectrometry.

A digital micromirror device (DMD) has been incorporated into a novel spectrometer for use in analytical atomic spectrometry. The device can be taken from a commercial computer projector. A protective glass window covering the DMD chip limits the viewable wavelengths to the visible range. The DMD is used to project an image of the light source onto the exit plane of a flat-field spectrograph. A single photomultiplier tube is used for detection. The high switching rate of the micromirrors (15 µs) enables rapid full-spectrum capture, wavelength-modulation, source-modulation, fast narrow-wavelength window scans, and rapid-wavelength "jumping." Calcium, sodium, and potassium have been determined in several standard reference materials (tomato leaves, bovine liver, rice flour, total diet) by flame atomic absorption and emission spectrometry. Absorption sensitivities for each element are near the 0.02 µg/mL level, and detection limits for both absorption and emission are near the 0.01 µg/mL level. Elemental recoveries were within 10% of certified values for most reference materials.

Changes in alcohol expectancies during treatment relate to subsequent abstinence survivorship.

When negative alcohol expectancies are measured appropriately they form at least as secure associations with measures of consumption as has been demonstrated by mainstream expectancy research for positive alcohol expectancies and they can be usefully used to represent a component of motivation to restrain consumption or recover in dependent drinkers. A study is reported in which (i) negative outcome expectancies assessed at admission to treatment reliably predicted number of days to first drink; (ii) the same relationship is discovered for discharge measures (iii) and, although the change is negative expectancies between admission and discharge does not, itself, predict the number of days to first drink, it does when the corresponding admission measure is also taken into account. The same predictive relationships were not found for positive expectancies. Implications for planning treatment are discussed in terms of treatment enhancement rather than treatment matching.

A comparison of positive and negative alcohol expectancy and value and their multiplicative composite as predictors of post-treatment abstinence survivorship.

Within social learning theory, positive alcohol expectancies represent motivation to drink and negative expectancies, motivation to restrain. It is also recognized that a subjective evaluation of expectancies ought to moderate their impact, although the evidence for this in social drinkers is problematic. This paper addresses the speculation that the moderating effect will be more evident in clinical populations. This study shows that (i) both expectancy and value reliably, independently and equally predict clients' abstinence survivorship following discharge from a treatment programme (and that this is almost entirely confined to the negative rather than positive terms). When (ii) expectancy evaluations are processed against expectancy through multiplicative composites (i.e. expectancy x value), their predictive power is only equivalent to either expectancy or value on its own. However (iii) when the multiplicative composite is assessed following the statistical guidelines advocated by Evans (1991) (i.e. within the same model as its constituents, expectancy and value) the increase in outcome variance explained by its inclusion is negligible and casts doubt upon its use in alcohol research. This does not appear to apply to value, however, and its possible role in treatment is discussed.

Blood lead levels in North Carolina painters.

1. Blood lead levels were examined in 127 housepainters in North Carolina between April and September, 1993. Each participant filled out a questionnaire and gave a blood sample. The questionnaire covered the individual's work history, concentrating on paint-removal activities and personal protection, and also covered potential nonoccupational sources of lead exposure. Blood samples were analysed for lead content using atomic absorption spectroscopy. 2. The geometric mean blood lead level was 0.33 mumol L-1 (6.8 micrograms dL-1). No blood lead samples were found to exceed the occupational standard of 1.93 mumol L-1 (40 micrograms dL-1). The three highest samples had levels between 0.97 and 1.45 mumol L-1 (20 and 30 micrograms dL-1); this represented 2.4% of the study sample. 3. No statistical association was found between blood lead levels in these painters and their painting activities, including using dust masks for personal protection. 4. Current painting practices in this group of North Carolina painters do not appear to elevate blood lead levels above the occupational standard.

Negative alcohol expectancy predicts post-treatment abstinence survivorship: the whether, when and why of relapse to a first drink.

Using survival analysis, the association was explored between positive and negative alcohol expectancies measured on admission to a non-residential alcohol dependence treatment unit and post-treatment relapse to a first drink (first slip). A reliable association between negative alcohol expectancy (but not positive) and relapse was found. The active negative alcohol expectancies were distal rather than proximal: proximal expectancies surround consumption ('same day' expectancies) and distal expectancies relate to the 'next-day' following consumption or those longer term expectancies coming from 'continued drinking'. Only the 'next day' component of distal expectancies formed a reliable association with relapse. The use to which negative alcohol expectancy as measured by the Negative Alcohol Expectancy Questionnaire might be put is discussed in terms of (i) a bottom-up representation of motivation for recovery to help treatment match and (ii) a provisor of detailed, client-specific information for structuring motivational interventions.

Social drinkers' negative alcohol expectancy relates to their satisfaction with current consumption: measuring motivation for change with the NAEQ.

Negative alcohol expectancy (NAE) reliably discriminates between social drinkers who are satisfied with their current consumption and those who are not (even when the variable, consumption, is controlled). Positive alcohol expectancy does not. A role for NAE as representing motivation for change in social drinkers is suggested.

Negative and positive alcohol expectancies as predictors of abstinence after discharge from a residential treatment program: a one-month and three-month follow-up study in men.

Male alcohol dependent clients (N = 53), who were given the Alcohol Expectancy Questionnaire and the Negative Alcohol Expectancy Questionnaire upon admission to a residential alcohol treatment program, were successfully followed-up 1 month and 3 months after discharge to assess their compliance with the treatment goal of total abstinence. At 1 month, neither demographic variables nor alcohol expectancies were associated with outcome consumption. At 3 months, however, the demographic variable, age, total negative expectancy (but not total positive) and the two subscales, global positive expectancy and continued-drinking negative expectancy (representing longer term expected negative consequences), were. The potential importance of negative alcohol expectancy in drinking decisions and the limitations of the study were identified.

A prospective comparison of the status of the deep venous system after treatment with intracaval interruption versus anticoagulation.

The safety and efficacy of caval interruption has been well demonstrated. Likewise, comparisons of caval interruption and anticoagulation have shown similar rates of mean and long term clinical outcome. One concern that continues to be voiced is whether or not anticoagulation enhances venous recovery and function. The present study compares outcome by impedance plethysmography, Duplex scanning and clinical sequelae at six months after the acute illness and treatment with either caval interruption or anticoagulation. The results show no significant differences between the two treatment groups.

Empirical evidence shows that measuring users' opinions is not a satisfactory way of evaluating computer-assisted learning in nurse education.

Users' opinions have been one of the cornerstones of the evaluation of both CAL, in general, and CAL packages, in particular, in nurse education. This paper reports on two experiments that reliably show student nurses' opinions of their current computer-use are formed more by the change from a previously-used computing facility rather than the actual features that the current one possesses. The use of such opinions as a valid evaluation measure within nursing CAL is, consequently, weakened. The evaluation context in which these experiments are conducted derives from the highly-researched multidisciplinary area of Human-Computer Interaction (HCI), and the experiments are introduced and discussed with respect to the HCI concepts of computer-use and usability which examine the interactions taking place at the human-computer interface. Graphical hypertext and the doctrine of functionality are also introduced and discussed, for these aspects have considerable implications for computer-use and the process of planning and choosing computer-use facilities within nurse education.