Advancing indocyanine green fluorescence flap perfusion assessment via near infrared signal quantification.

Introduction: Intraoperative indocyanine green fluorescence angiography (ICGFA) perfusion assessment has been demonstrated to reduce complications in reconstructive surgery. This study sought to advance ICGFA flap perfusion assessment via quantification methodologies. Method: Patients undergoing pedicled and free flap reconstruction were subjected to intraoperative ICGFA flap perfusion assessment using either an open or endoscopic system. Patient demographics, clinical impact of ICGFA and outcomes were documented. From the ICGFA recordings, fluorescence signal quality, as well as inflow/outflow milestones for the flap and surrounding (control) tissue were computationally quantified post hoc and compared on a region of interest (ROI) level. Further software development intended full flap quantification, metric computation and heatmap generation. Results: Fifteen patients underwent ICGFA assessment at reconstruction (8 head and neck, 6 breast and 1 perineum) including 10 free and 5 pedicled flaps. Visual ICGFA interpretation altered on-table management in 33.3% of cases, with flap edges trimmed in 4 and a re-anastomosis in 1 patient. One patient suffered post-operative flap dehiscence. Laparoscopic camera use proved feasible but recorded a lower quality signal than the open system.Using established and novel metrics, objective ICGFA signal ROI quantification permitted perfusion comparisons between the flap and surrounding tissue. Full flap assessment feasibility was demonstrated by computing all pixels and subsequent outputs summarisation as heatmaps. Conclusion: This trial demonstrated the feasibility and potential for ICGFA with operator based and quantitative flap perfusion assessment across several reconstructive applications. Further development and implementation of these computational methods requires technique and device standardisation.

Species portfolio effects dominate seasonal zooplankton stabilization within a large temperate lake.

Portfolio effects (PEs) in ecology refer to the suite of phenomenon where the temporal variation of aggregate ecosystem properties (i.e., abundance) is lower than that of their ecosystem components. An example of this is where differential responses of species to environmental variation generate stability at higher levels of ecological organization (e.g., local community, metapopulation, metacommunity). Most of the research examining such PEs has focused on spatial or interannual variation of ecosystems; however, as global change continues to alter seasonality and ecosystem functioning, understanding the underlying food web structures that help maintain stability at multiple spatial and temporal scales is critical to managing ecological systems. Recent advances investigating diversity-stability relationships has led to the development of frameworks that incorporate a metacommunity perspective which allows for the partitioning of PEs across organizational scales (i.e., local community, metapopulation, cross-community, metacommunity) from local population dynamics (total). This partitioning yields insights into the mechanisms that generate observed PEs in nature. Here, we employed one of these recently developed frameworks on a temporally (1986-1999, 2008-2019) and spatially (five sampling stations, local communities) extensive data set of zooplankton abundance (e.g., density) within a large temperate lake to investigate how temporal (seasonal) and spatial (among site) PEs influence stability within the zooplankton metacommunity. We found that seasonal asynchrony of different zooplankton species within local communities and across communities generated the vast majority of stabilization, while spatial (i.e., metapopulation) dynamics were more synchronous and contributed little to overall system stability. Furthermore, significantly positive diversity-asynchrony relationships at the total, local- and cross-community scales were found as asynchrony was positively correlated with local Shannon diversity. Last, a comparison of PEs over the time periods, during which significant local and global changes (i.e., climate warming, invasive species) have occurred suggests that PEs may be eroding, as increasingly synchronous dynamics and declining diversity in recent years have led to a rise in metacommunity variability. We end by arguing for the critical importance of understanding seasonally driven stabilizing mechanisms as local and global changes threaten to fundamentally alter seasonal signals with potentially strong implications for the structures that lend stability to ecosystems.

Phenotype, genotype and glycaemic variability in people with activating mutations in the ABCC8 gene: response to appropriate therapy.

AIMS: To examine the phenotypic features of people identified with ABCC8-maturity-onset diabetes of the young (MODY) who were included in the adult 'Mater MODY' cohort and to establish their response to sulfonylurea therapy. METHODS: Ten participants with activating ABCC8 mutations were phenotyped in detail. A 2-hour oral glucose tolerance test was performed to establish glycaemic tolerance, with glucose, insulin and C-peptide measurements taken at baseline and 30-min intervals. Insulin was discontinued and sulfonylurea therapy initiated after genetic diagnosis of ABCC8-MODY. A blinded continuous glucose monitoring sensor was used to establish glycaemic control on insulin vs a sulfonylurea. RESULTS: The mean age at diagnosis of diabetes was 33.8 ± 11.1 years, with fasting glucose of 18.9 ± 11.5 mmol/l and a mean (range) HbA1c of 86 (51,126) mmol/mol [10.0 (6.8,13.7)%]. Following a genetic diagnosis of ABCC8-MODY three out of four participants discontinued insulin (mean duration 10.6 ± 1.69 years) and started sulfonylurea treatment. The mean (range) HbA1c prior to genetic diagnosis was 52 (43,74) mmol/mol (6.9%) and the post-treatment change was 44 (30,57) mmol/mol (6.2%; P=0.16). Retinopathy was the most common microvascular complication in this cohort, occurring in five out of 10 participants. CONCLUSIONS: Low-dose sulfonylurea therapy resulted in stable glycaemic control and the elimination of hypoglycaemic episodes attributable to insulin therapy. The use of appropriate therapy at the early stages of diabetes may decrease the incidence of complications and reduce the risks of hypoglycaemia associated with insulin therapy.

Anestesia libre de opioides en hemicolectomía abierta derecha extendida. Reporte de un caso y revisión / Opiod Free Anesthesia (OFA) for Open extended right colectomy. A case report and review

Opioid free anesthesia (OFA) is defined as an anesthesiologic technique where opioids are not used in the intraoperative and postoperative period. Although the mainstay of intra-operative analgesia may be opioids, current challenges are focus on reducing them and preventing the adverse effects of opioids, by rationalizing and even suspending their perioperative use, specifically at risk populations such as Obstructive Sleep Apnea Syndrome (OSAHS), obesity, Chronic Obstructive Pulmonary Disease (COPD) and cancer surgery. We present this case of OFA in a susceptible patient with complications from the use of opioids undergoing an extended right hemicolectomy. Multimodal analgesia was performed with a thoracic peridural and subanesthetic doses of intravenous agents including dexmedetomidine, ketamine and propofol, accompanied by short and long-lasting local periglotic anesthetics. The patient had given an intraand postoperative analgesia without presenting any adverse events, good recovery, early deambulation and extubation.

La anestesia libre de opioides (OFA) es una técnica anestésica donde no hay administración de opioides, tanto en el intraoperatorio como en el postoperatorio. Aunque una de las bases de la analgesia intraoperatoria podrían ser los opioides, los desafíos actuales están enfocados en reducir su uso perioperatorio, previniendo sus efectos adversos, racionalizando y limitando su empleo específicamente en poblaciones de riesgo como síndrome de apnea obstructiva del sueño (SAHOS), obesidad, enfermedad pulmonar obstructiva crónica (EPOC) y cirugía oncológica. Presentamos este caso de OFA en un paciente susceptible de complicaciones por uso de opioides sometido a una hemicolectomía derecha extendida. Se realizó analgesia multimodal con peridural torácica y dosis subanestésicas de agentes endovenosos como dexmedetomidina, ketamina y propofol, acompañado de anestésicos locales periglóticos de corta y larga duración. Se otorgó una adecuada analgesia intra y postoperatoria, el paciente no tuvo eventos adversos, presentando una buena recuperación, deambulación y extubación precoz.

Set-up error validation with EPID images: Measurements vs Egs_cbct simulation.

AIM: In this study, the egs_cbct code's ability to replicate an electronic portal imaging device (EPID) is explored. BACKGROUND: We have investigated head and neck (H&N) setup verification on an Elekta Precise linear accelerator. It is equipped with an electronic portal imaging device (EPID) that can capture a set of projection images over different gantry angles. METHODS AND MATERIALS: Cone-beam computed tomography (CBCT) images were reconstructed from projection images of two different setup scenarios. Projections of an Anthropomorphic Rando head phantom were also simulated by using the egs_cbct Monte Carlo code for comparison with the measured projections.Afterwards, CBCT images were reconstructed from this data. Image quality was evaluated against a metric defined as the image acquisition interval (IAI). It determines the number of projection images to be used for CBCT image reconstruction. RESULTS: From this results it was established that phantom shifts could be determined within 2 mm and rotations within one degree accuracy using only 20 projection images (IAI = 10 degrees). Similar results were obtained with the simulated data. CONCLUSION: In this study it is demonstrated that a head and neck setup can be verified using substantially fewer projection images. Bony landmarks and air cavities could still be observed in the reconstructed Rando head phantom. The egs_cbct code can be used as a tool to investigate setup errors without tedious measurements with an EPID system.

Medicine on the margins. An innovative GP training programme prepares GPs for work with underserved communities.

We describe and evaluate the North Dublin City General Practitioner Training Programme (NDCGP), which was designed to educate doctors to work with the underserved. People who are marginalised have poorer health and less access to healthcare than the general population. Furthermore, these groups have significantly lower numbers of GPs per capita of population. Few GP training programmes are located in such communities, despite GPs tending to work in the areas where they trained. An evaluation of NDCGP training programme was conducted by sending a self-administered questionnaire to all graduates of the programme (2013-17). Thirty-seven graduates (88%) responded to the questionnaire. Thirty-six (97%) were either working as GPs in an area of deprivation or their work included services to a marginalised group. These 36 (97%) respondents indicated that continuing to serve deprived communities was in their long-term plans. The training provided trainees with the knowledge, understanding and a specific skill set to equip them to work with the underserved. Through teaching and exposure placements, trainees' confidence and empathy had increased and their prejudice and fear towards underserved patients had decreased. Conclusion: The NDCGP Training Programme achieved its aims. Replication of this model of education should be considered elsewhere.

Cornalean affinities, phylogenetic significance, and biogeographic implications of Operculifructus infructescences from the Late Cretaceous (Campanian) of Mexico.

IN ENGLISH: Premise of the Study Cretaceous Cornales provide a crucial record of the early history of asterids. Most lineages of the order are well represented in the fossil record, but South African families of Curtisiaceae and Grubbiaceae remain poorly understood. Seventy-three specimens of a fossil infructescence belonging to the genus Operculifructus Estrada-Ruiz & Cevallos-Ferriz emend. Hayes & Smith from the Late Cretaceous (Campanian) El Gallo Formation, Baja California, Mexico bear previously undescribed characters that suggest a relationship to Grubbiaceae. Methods Microstructures of the fossils were examined through light microscopy and x-ray microcomputed tomography (microCT) scanning. Modern Grubbia tomentosa (Thunb.) Harms fruits were scanned for comparison to the fossil material. Phylogenetic analyses using the 77 fruit characters of Atkinson () were performed to test relationships of the fossil to major lineages of the order. Several analyses applied topological constraints to the extant taxa, based on various genetically supported hypotheses of relationship within Cornales. Key Results Novel structures of Operculifructus newly observed here include (1) anatropous ovules, (2) drupaceous fruits, (3) an epigynous disc, (4) and a stylar canal in the center of the disc aligned with the micropylar protrusion of the seed. Phylogenetic analysis consistently resolves Operculifructus as sister to Grubbiaceae. Conclusions Operculifructus provides direct evidence for the occurrence of Grubbiaceae in the Late Cretaceous, much older than previous Eocene evidence. The phylogeny of Atkinson () indicates that the new phylogenetic position recovered for Operculifructus also establishes the presence of the most basal drupaceous cornalean fruits in North America by the Campanian. RESUMEN EN ESPAÑOL Hipótesis de la Investigación Cornales cretácicos representan un registro esencial en la historia de los astéridos. Casi todos los linajes del orden están bien representados en el registro fósil, pero las familias africanas sureñas Curtisiaceae y Grubbiaceae permanecen pobremente entendidas. Setenta y tres ejemplares de una infrutescencia fósil perteneciente al género Operculifructus Estrada-Ruiz & Cevallos-Ferriz emend. Hayes & Smith de la formación campaniana (Cretácico Tardío) El Gallo, Baja California, México, poseen caracteres no descritos previamente y sugieren una relación con Grubbiaceae. Metodología Microestructuras de los fósiles fueron examinadas con microscopio de luz y microtomografía computarizada (micro-CT) de rayos X. Frutos actuales de Grubbia tomentosa (Thunb.) Harms fueron escaneados para su comparación con el material fósil. Se realizaron análisis filogenéticos usando los 77 caracteres de frutos de Atkinson () para probar las relaciones de los fósiles con los linajes principales del orden. En algunos análisis se aplicaron restricciones topológicas a los taxa actuales basándose en varias hipótesis, soportadas genéticamente, de las relaciones dentro de Cornales. Resultados Centrales (Cruciales) Las estructuras novedosas de Operculifructus, recientemente observadas aquí, incluyen (1) óvulos anátropos; (2) frutos drupáceos; (3) disco epígino; y (4) un canal estilar en el centro del disco alineado con la protuberancia micropilar de la semilla. Los análisis filogenéticos consistentemente dan como resultado que Operculifructus es hermano de Grubbiaceae. Conclusiones Operculifructus proporciona evidencia directa de la presencia de Grubbiaceae en el Cretácico Tardío, mucho antes que la previa evidencia en el Eoceno. La filogenia de Atkinson () indica que la nueva posición filogenética recuperada para Operculifructus también resalta la presencia de frutos drupáceos cornaleanos más basales en Norteamérica durante el Campaniano.

EUV spectral analysis of ns-laser produced bismuth plasmas at 8-17 nm.

Extreme ultraviolet (EUV) spectra from laser produced bismuth plasmas were recorded in the 8-17 nm spectral region using a Nd:YAG laser with a pulse length of 8 ns operating at a range of laser power densities. Due to the broad-band emission at 8-17 nm, bismuth plasmas show promise as sources of quasicontinuous radiation in the extreme ultraviolet. When varying the incident laser power density, ionic populations of Bi ions at different power densities were estimated by the collisional-radiative (CR) model for explanation of changes in the spectral profile. Comparison of experimental spectra with atomic structure calculations using the Hartree-Fock with configuration interaction (HFCI) code of Cowan was performed in order to identify most of the features in the spectra.

C-reactive protein as a predictor of anastomotic leak in the first week after anterior resection for rectal cancer.

AIM: Anastomotic leak (AL) after anterior resection results in increased morbidity, mortality and local recurrence. The aim of this study was to assess the ability of C-reactive protein (CRP) to predict AL in the first week after anterior resection for rectal cancer. METHOD: A retrospective review of a prospectively maintained database that included all patients undergoing anterior resection between January 2008 and December 2013 was performed. The ability of CRP to predict AL was assessed using area under the receiver-operating characteristics (AUC) curves. The severity of AL was defined using the International Study Group of Rectal Cancer (ISREC) grading system. RESULTS: Two-hundred and eleven patients were included in the study. Statistically significant differences in mean CRP values were found between those with and without an AL on postoperative days 5, 6 and 7. A CRP value of 132 mg/l on postoperative day 5 had an AUC of 0.75, corresponding to a sensitivity of 70%, a specificity of 76.6%, a positive predictive value of 16.3% and a negative predictive value of 97.5%. Multivariable analysis found that a CRP of > 132 mg/l on postoperative day 5 was the only statistically significant patient factor that was linked to an increased risk of AL (HR = 8.023, 95% CI: 1.936-33.238, P = 0.004). CONCLUSION: Early detection of AL may minimize postoperative complications. CRP is a useful negative predictive test for the development of AL following anterior resection.

Concomitant cervical fractures without neurological symptoms: a case report.

BACKGROUND: Non-contiguous spinal fractures are rare and most frequently occur in a fall from a height, or high energy trauma such as a road traffic accident (Reid, J Trauma 27:980-986, 1987). Cervical spine fractures tend to occur at two levels, one-third of injuries occur at the level of C2, and one-half of injuries occur at the level of C6 or at C7 (Wittenberg, Spine 27:254-257, 2002). The most devastating and fatal cervical spine injuries occur in upper cervical levels, either at craniocervical junction C1 or C2. CASE REPORT: The case we present is of a young man involved in a road traffic accident in Ireland who had a concomitant non-displaced C2 vertebral body fracture and a C6-C7 fracture dislocation. The patient had no neurological symptoms. CONCLUSION: Following concurrent ACDF at C6/7 and peg screw fixation of C2 through the same incision the patient made a full recovery.

Comparative outcomes of total parenteral nutrition use in patients aged greater or less than 80 years of age.

OBJECTIVES: Total-parenteral-nutrition (TPN) can act as a bridge to enteral nutrition. The current study aims to explore the outcomes of TPN use in older adults which are at present poorly defined. DESIGN, SETTING AND PARTICIPANTS: Data on 172 patients who received TPN between January-December 2011 were prospectively recorded and examined. RESULTS: Mean age was 62.7 ± 16.8 years (12.8% ≥ 80 years). Those ≥ 80 years were less often male (31.8% Vs 57.3%, P=0.038) and had no history of hepatic dysfunction (0.0% Vs 16.7%, P=0.025). In those ≥ 80 years the indication was more often suspected ileus (40.9% Vs 13.3%, P=0.004). Patients ≥ 80 years developed hypertriglyceridaemia less frequently (7.7% Vs 36.2%, P=0.031). There was no difference in the duration of TPN administration, the rate of TPN line sepsis, serum electrolyte derangement or glycaemic control. Change in serum albumin over the course of treatment did not differ (≥ 80 Vs <80 years, -0.28 ± 0.62 mg/dL Vs -2.00 ± 1.57 mg/dL, P=0.323). CONCLUSIONS: These data suggest TPN use is safe in patients aged ≥ 80 years and advanced age alone should not preclude TPN use.

CO2 laser pulse shortening by laser ablation of a metal target.

A repeatable and flexible technique for pulse shortening of laser pulses has been applied to transversely excited atmospheric (TEA) CO(2) laser pulses. The technique involves focusing the laser output onto a highly reflective metal target so that plasma is formed, which then operates as a shutter due to strong laser absorption and scattering. Precise control of the focused laser intensity allows for timing of the shutter so that different temporal portions of the pulse can be reflected from the target surface before plasma formation occurs. This type of shutter enables one to reduce the pulse duration down to ~2 ns and to remove the low power, long duration tails that are present in TEA CO(2) pulses. The transmitted energy is reduced as the pulse duration is decreased but the reflected power is ~10 MW for all pulse durations. A simple laser heating model verifies that the pulse shortening depends directly on the plasma formation time, which in turn is dependent on the applied laser intensity. It is envisaged that this plasma shutter will be used as a tool for pulse shaping in the search for laser pulse conditions to optimize conversion efficiency from laser energy to useable extreme ultraviolet (EUV) radiation for EUV source development.

Monte carlo electron source model validation for an Elekta Precise linac.

PURPOSE: Electron radiation therapy is used frequently for the treatment of skin cancers and superficial tumors especially in the absence of kilovoltage treatment units. Head-and-neck treatment sites require accurate dose distribution calculation to minimize dose to critical structures, e.g., the eye, optic chiasm, nerves, and parotid gland. Monte Carlo simulations can be regarded as the dose calculation method of choice because it can simulate electron transport through any tissue and geometry. In order to use this technique, an accurate electron beam model should be used. METHODS: In this study, a two point-source electron beam model developed for an Elekta Precise linear accelerator was validated. Monte Carlo data were benchmarked against measured water tank data for a set of regular and circular fields and at 95, 100, and 110 cm source-to-skin-distance. EDR2 Film dose distribution data were also obtained for a paranasal sinus treatment case using a Rando phantom and compared with corresponding dose distribution data obtained from Monte Carlo simulations and a CMS XiO treatment planning system. A partially shielded electron field was also evaluated using a solid water phantom and EDR2 film measurements against Monte Carlo simulations using the developed source model. RESULTS: The major findings were that it could accurately replicate percentage depth dose and beam profile data for water measurements at source-to-skin-distances ranging between 95 and 110 cm over beam energies ranging from 4 to 15 MeV. This represents a stand-off between 0 and 15 cm. Most percentage depth dose and beam profile data (better than 95%) agreed within 2%/2 mm and nearly 100% of the data compared within 3%/3 mm. Calculated penumbra data were within 2 mm for the 20 x 20 cm2 field compared to water tank data at 95 cm source-to-skin-distance over the above energy range. Film data for the Rando phantom case showed gamma index map data that is similar in comparison with the treatment planning system and the Monte Carlo source model. The gamma index showed good agreement (2%/2 mm) between the Monte Carlo source model and the film data. CONCLUSIONS: Percentage depth dose and beam profile data were in most cases within a tolerance of 2%/2 mm. The biggest discrepancies were in most cases recorded in the first 6 mm of the water phantom. Circular fields showed local dose agreement within 3%/3mm. Good agreement was found between calculated dose distributions for a paranasal sinus case between Monte Carlo, film measurements and a CMS XiO treatment planning system. The electron beam model can be easily implemented in the BEAMnrc or DOSXYZnrc Monte Carlo codes enabling quick calculation of electron dose distributions in complex geometries.

What has happened to people affected by thalidomide 50 years on?

INTRODUCTION: There have been reports of thalidomide-affected people suffering a deterioration in their disability over time [1, 2]. This study assessed changes in disabilities among thalidomide-affected people in the Irish population. METHODS: A questionnaire, assessing musculo-skeletal health, quality-of-life, general health and illness intrusiveness was sent to 26 people affected by thalidomide in the Republic of Ireland. RESULTS: Seventeen (65%) responded. Six (35%) respondents were not working as a result of their disability. Eleven (65%) reported a worsening of their disability over time, with nine of them reporting the deterioration as moderate to severe. The impact of this decline was measured by respondents in terms of ability to perform daily tasks, emotional health and finances (due to extra costs related to clothing, transport, housing alterations and heating). CONCLUSION: There is a need to continually review the physical, psychological and social needs of thalidomide survivors in order to ensure optimum care is made available.

There's a hole in the bucket: an analysis of the impact of the medical card review process on patient entitlement to free health care.

In 2001 the frequency of reviewing medical-card eligibility was increased. This study assessed the impact of this policy change on patient entitlement to free health care. Data on reasons for patient removal from a GP's General Medical Services (GMS) list during a two and a half year period was analysed. During this period, 1489 (89% CI 87-91%) patients from the practice list were removed for non-return of review forms. Forty patients randomly selected from patients deleted from the list in 2006 were interviewed. Sixty percent said they had not received a review form and 91% (CI 82-100%) believed they were entitled to a medical card. In the period without medical card cover, cost prevented 11% (CI 1-21%) of those who felt they were eligible from accessing medical care while 26% (CI 12-40%) paid 'out-of-pocket'. This study shows that a bureaucratic policy change has negatively affected access to health care.

'Breaking up is hard to do': perspectives of general practitioners and patients towards removals from GP lists.

BACKGROUND: The numbers of removals of patients from General Practitioner lists in Ireland is increasing and is a cause for some concern. AIMS: To examine the views of both general practitioners and patients toward removals of patients from general practitioner lists. METHODS: Questionnaire survey to general practitioners in North Inner City Dublin who had removed patients from their list over a 1-year period (n = 45) and to the patients they had removed (n = 86). Follow up semi structured interviews were carried out with five general practitioners and ten patients. RESULTS: For doctors, the decision to remove a problematic patient from their list is generally a positive experience, providing relief and being associated with certainty in both the decision and the process. For the patient, being removed from a GP's list is a negative experience, stressful and confusing. CONCLUSIONS: There is a need for the development of a clear responsive, transparent and supportive system for removing patients from a GP list.

[Neonatal meningitis caused by atypical Streptococcus pneumoniae: case report and review]. / Meningitis neonatal por Streptococcus pneumoniae atípico: Reporte de un caso y revisión.

Streptococcus pneumoniae is a rarely recognized cause of neonatal sepsis and/or meningitis, but it is associated with substantial morbidity and mortality. Traditionally, S. pneumoniae is identified in the laboratory by demonstrating susceptibility to optochin. However, the emergence of optochin-resistant organisms makes definite identification difficult when only phenotypic tests are taken as markers. We present the case of a severe early-onset neonatal meningitis due to an atypical strain of S. pneumoniae. Laboratory methods utilized to certify this species diagnosis are discussed.

Meningitis neonatal por Streptococcus pneumoniae atípico: Reporte de un caso y revisión / Neonatal meningitis caused by atypical Streptococcus pneumoniae: Case report and review

Streptococcus pneumoniae is a rarely recognized cause of neonatal sepsis and/or meningitis, but it is associated with substantial morbidity and mortality. Traditionally, S. pneumoniae is identified in the laboratory by demonstrating susceptibility to optochin. However, the emergence of optochin-resistant organisms makes definite identification difficult when only phenotypic tests are taken as markers. We present the case of a severe early-onset neonatal meningitis due to an atypical strain of S. pneumoniae. Laboratory methods utilized to certify this species diagnosis are discussed.

Streptococcus pneumoniae es una causa infrecuente de infección en el recién nacido y se caracteriza por gran capacidad invasora (sepsis, meningitis) y alta mortalidad. Tradicionalmente, esta bacteria se diagnostica en base a su susceptibilidad a optoquina. Sin embargo, la emergencia de cepas de S. pneumoniae resistentes a optoquina (atípicas) dificulta el diagnóstico sin utilizar varias pruebas diagnósticas, incluyendo las de biología molecular. Se describe el caso de una neonata con infección invasora causada por una cepa de S. pneumoniae atípico y se discuten los métodos empleados para certificar el diagnóstico de esta especie.

Factors affecting influenza vaccine uptake among health care workers.

BACKGROUND: In 2000, the UK Departments of Health recommended influenza immunization to employees directly involved in patient care. Uptake of this immunization had tended to be variable and usually low. AIMS: To assess personal and organizational factors associated with influenza immunization uptake among Health Care Workers (HCWs). METHODS: A cross-sectional survey of all HCWs within the Health and Social Care Trusts in Northern Ireland and a parallel-group study of nursing staff within Elderly Care using self-administered questionnaires. RESULTS: Of 203 nurses working in elderly care units 76(37%) were immunized and 127(63%) declined. Almost 70% of those not immunized perceived themselves to be 'healthy' and gave this reason for declining immunization. Nurses were more likely to be immunized by a factor of four if they believed there was benefit for healthy HCWs, three if they felt at-risk of contracting influenza and nine on a recommendation from the occupational health (OH) unit. Fifteen OH units participated in a survey of HCWs at the time of immunization. Five thousand two hundred and thirty (9.7%) HCWs were immunized. Increased uptake was correlated with immunization in area of work (r=0.74, P=0.02) and when provided out of hours (r=0.83; P<0.001) and by a factor of two with individual targeting of availability (P<0.001) and when individuals had been previously immunized (P<0.001). CONCLUSION: Uptake of influenza immunization is low. Attitudes to one's health and to the value of influenza immunization affect the uptake as does the delivery of the immunization programme.

Sickness absence due to influenza.

In addition to its recognized health effects, influenza has socio-economic consequences, most notably sickness absence and associated work disruption. It may account for 10-12% of all sickness absence from work. Data on the impact of influenza on work are limited. Most research has assessed the impact of an intervention, usually influenza immunization. Within the available literature, there are five randomized controlled trials in the workplace that have assessed the effectiveness of influenza immunization as an intervention: two in the general working population and three in the health sector. If the benefit desired is a reduction in sickness absence as a cost-effective measure, the likely outcome is a modest gain in years when incidence of influenza is increased in the community. There are some distinctive factors in the health care industry: health care workers may exhibit different absence behaviour, they may be more exposed to infection at work and they may pose a risk as a source of nosocomial infection. From the occupational health perspective, how do we best inform employers currently? The cost-effectiveness case has not been absolutely proven. More research appears necessary, including assessment of those factors that influence uptake of influenza immunization. In the interim, a targeted approach to certain job categories may be the way forward.