Quantitative assessment of spicule length in Heligmosomoides spp. (Nematoda, Heligmosomidae): distinction between H. bakeri, H. polygyrus and H. glareoli.

Nematode spicules play a vital role in the reproductive activity of species that possess them. Our primary objective was to compare the lengths of spicules of the laboratory mouse (Mus musculus) ­ maintained isolate H. bakeri ­ with those of H. polygyrus from naturally infected wood mice (Apodemus sylvaticus). On a more limited scale, we also included H. glareoli from bank voles (Myodes glareolus), a species reputed to possess longer spicules than either of the 2 former species. In total, we measured 1264 spicules (H. bakeri, n = 614; H. polygyrus n = 582; and H. glareoli, n = 68). There was a highly significant difference between the spicule lengths of the Nottingham-maintained H. bakeri (mean = 0.518 mm) and H. polygyrus (0.598 mm) from 11 different localities across the British Isles. A comparison of the spicules of H. bakeri maintained in 4 different laboratories in 3 continents revealed a range in the mean values from 0.518 to 0.540 mm, while those of worms from Australian wild house mice were shorter (0.480 mm). Mean values for H. polygyrus from wood mice from the British Isles ranged from 0.564 to 0.635 mm, although isolates of this species from Norway had longer spicules (0.670 mm). In agreement with the literature, the spicules of H. glareoli were considerably longer (1.098 mm). Since spicules play a vital role in the reproduction of nematode species that possess them, the difference in spicule lengths between H. bakeri and H. polygyrus adds to the growing evidence that these 2 are quite distinct species and likely reproductively isolated.

Litigation in pediatric otorhinolaryngology: Lessons in improving patient care.

OBJECTIVE(S): Medico-legal claims involving children place a substantial financial burden on health services and have a profound emotional and psychological impact on clinicians. Our objective was to analyze both the common causes and cost of litigation in pediatric otorhinolaryngology. METHODS: A retrospective review of all clinical negligence claims within pediatric otolaryngology (0-17 years inclusive) in NHS (National Health Service) England held by the clinical negligence service 'NHS Resolution between' 4/2013 and 4/2020. RESULTS: There were 100 claims in pediatric otorhinolaryngology accounting for an estimated potential total cost of just under £49 million with an average of 14 claims per year. Over half (52%) of claims were related to an operation with cause codes "Operator Error/Intra-Op Problem", "Diathermy Injury" and "Failure to Warn - Consent" most cited. The most common operation cited in a claim was tonsillectomy with an average cost per claim of £47,084. There were 21 claims coded as either "failure to diagnose" or "failure to treat" in relation to cholesteatoma, with an average cost per claim of £61,086. CONCLUSION: This is the largest study to date analyzing the reasons and potential cost of clinical negligence claims within pediatric otolaryngology. Many learning opportunities exist to reduce patient morbidity, mortality and improve the patient experience through litigation data analysis.

Investigations into Enhancing Yersinia pestis Cells Viability following Environmental Sampling for Forensic Analysis.

Following an intentional or accidental bio-warfare agent (BWA) release, environmental sample analysis is absolutely critical to determine the extent of contamination. When dealing with nonspore forming BWA (e.g., Yersinia pestis), retention of cell viability is central to such analyses. Even though significant advances have been achieved in DNA sequencing technologies, a positive identification of BWAs in environmental samples must be made through the ability of cells to form colony-forming units upon culturing. Inability to revive the cells between collection and analysis renders such studies inconclusive. Commercial kits designed to preserve the viability of pathogens contained within clinical samples are available, but many of them have not been examined for their ability to preserve samples containing suspected BWAs. The study was initiated to examine the applicability of commercial solutions aiding in retention of Y. pestis viability in samples stored under nonpermissive temperatures, that is, 40 and 37°C. While none of the tested solutions sustained cell viability at 40°C, the results show five out of 17 tested preservatives were capable of supporting viability of Y. pestis at 37°C.

Validation of the Professional Identity and Values Scale Among an Athletic Trainer Population.

CONTEXT: Forming a professional identity is a process by which an individual achieves an awareness of his or her own self-concept in the context of the profession. Identity in relation to an individual's profession includes the ability to articulate one's role as a professional and professional philosophy. Professional identity has been studied extensively in other fields, but currently no professional identity scales have been validated within the athletic training profession. OBJECTIVE: To validate the Professional Identity and Values Scale (PIVS) among an athletic trainer population. DESIGN: Cross-sectional study. SETTING: Web-based questionnaire. PATIENTS OR OTHER PARTICIPANTS: Athletic trainers employed in National Collegiate Athletic Association Division I, II, III, or National Association of Intercollegiate Athletics colleges or universities (n = 299, 56.5% female, 43.5% male). The average age of the participants was 33.6 ± 8.3 years, and they had 10.3 ± 7.6 years of experience. MAIN OUTCOME MEASURE(S): Participants were asked to complete a demographic questionnaire and the 32-item PIVS. The variables included demographics and the PIVS (Professional Orientation and Values subscale [18 items] and the Professional Development subscale [14 items]). RESULTS: Exploratory factor analysis reduced the survey from 32 to 20 items and revealed 6 factors. Three factors emerged from the Professional Development subscale and emphasized professional insecurities during the early career stages, the importance of mentors during the intermediate stages, and self-confidence and awareness during the later stages of professional development. An additional 3 factors emerged from the Professional Orientation and Values subscale: (1) patient care and advocacy, (2) professional engagement and collaboration, and (3) personal wellness and values. A Cronbach α of 0.80 indicated good internal consistency. CONCLUSIONS: A modified PIVS is a valid and reliable measure of professional identity among athletic trainers employed in the collegiate setting.

Evaluation of Commercial-off-the-Shelf Materials for the Preservation of Bacillus anthracis Vegetative Cells for Forensic Analysis.

Environmental surface sampling is crucial in determining the zones of contamination and overall threat assessment. Viability retention of sampled material is central to such assessments. A systematic study was completed to determine viability of vegetative cells under nonpermissive storage conditions. Despite major gains in nucleic acid sequencing technologies, initial positive identification of threats must be made through direct culture of the sampled material using classical microbiological methods. Solutions have been developed to preserve the viability of pathogens contained within clinical samples, but many have not been examined for their ability to preserve biological agents. The purpose of this study was to systematically examine existing preservation materials that can retain the viability of Bacillus anthracis vegetative cells stored under nonpermissive temperatures. The results show effectiveness of five of seventeen solutions, which are capable of retaining viability of a sporulation deficient strain of B. anthracis Sterne when stored under nonrefrigerated conditions.

Strongyloidiasis in Ontario: Performance of diagnostic tests over a 14-month period.

BACKGROUND: We evaluated the performance of stool microscopy, serology, and real time PCR (qPCR) for the diagnosis of strongyloidiasis at our reference laboratory. METHODS: Using a convenience sample of specimens submitted between April 1, 2014 and May 31, 2015, positivity rates and performance characteristics were calculated. RESULTS: During the enrolment period, 17,933 stool specimens were examined for O&P, 14 of which were positive for Strongyloides larvae. For stool specimens serially positive for larvae, mean duration of larval shedding was 12.7 days following the initial positive specimen, while for sputum and urine, it was 12 and 2 days, respectively. During the enrolment period, 3258 specimens were processed for Strongyloides serology, 200 of which were reactive (6.1%), 210 indeterminate (6.5%), and 2848 non-reactive (87.4%). qPCR was positive in 11 of 12 (91.7%) stool specimens containing larvae, and negative in all stool specimens without larvae by microscopy. There was no cross-reactivity of Strongyloides-specific qPCR to other stool protozoa or helminths. CONCLUSIONS: In the absence of immunosuppression, larval burden in strongyloidiasis is low, limiting the utility of microscopy, and favoring serologic testing. However, false negative serology can occur in those with hyperinfection necessitating a combined diagnostic approach. qPCR was insufficiently sensitive to replace microscopy for detection of larvae.

Implementing Health and Safety Policy Changes at the High School Level From a Leadership Perspective.

CONTEXT: Although consensus statements and recommendations from professional organizations aim to reduce the incidence of injury or sudden death in sport, nothing is mandated at the high school level. This allows states the freedom to create and implement individual policies. An example of a recommended policy is heat acclimatization. Despite its efficacy in reducing sudden death related to heat stroke, very few states follow the recommended guidelines. OBJECTIVE: To retroactively examine why and how 3 states were able to facilitate the successful creation and adoption of heat-acclimatization guidelines. DESIGN: Qualitative study. SETTING: High school athletic associations in Arkansas, Georgia, and New Jersey. PATIENTS OR OTHER PARTICIPANTS: Eight men and 3 women (n = 11; 6 athletic trainers; 2 members of high school athletic associations; 2 parents; 1 physician) participated. Participant recruitment ceased when data saturation was reached. DATA COLLECTION AND ANALYSIS: All phone interviews were digitally recorded and transcribed verbatim. A grounded-theory approach guided analysis and multiple analysts and peer review were used to establish credibility. RESULTS: Each state had a different catalyst to change (student-athlete death, empirical data, proactivity). Recommendations from national governing bodies guided the policy creation. Once the decision to implement change was made, the states displayed 2 similarities: shared leadership and open communication between medical professionals and members of the high school athletic association helped overcome barriers. CONCLUSIONS: The initiating factor that spurred the change varied, yet shared leadership and communication fundamentally allowed for successful adoption of the policy. Our participants were influenced by the recommendations from national governing bodies, which align with the institutional change theory. As more states begin to examine and improve their health and safety policies, this information could serve as a valuable resource for athletic trainers in other states and for future health and safety initiatives.

"They Were Really Looking for a Male Leader for the Building": Gender, Identity and Leadership Development in a Principal Preparation Program.

This study utilized a comparative case study analysis to investigate how gender influenced the experiences of participants in a leadership development program (principal preparation program) designed to lead public K-12 schools identified as requiring turnaround. We closely focused on two participants, a man and a woman, and compared the ways each participant made meaning of his/her experiences as developing leaders in the program. Although both participants conceptualized effective leadership in similar communally-oriented ways, the way they came to construct their identities as leaders varied greatly. These differences were largely influenced by different and, what appeared to be, gendered feedback occurring during the program and when participants entered the job market.

The experiences of female athletic trainers in the role of the head athletic trainer.

CONTEXT: Very few women have leadership positions in athletic training (ie, head athletic training positions) in intercollegiate athletics. Research exists on the barriers to attaining the role; however, our understanding about the experiences of those currently engaged in the role is limited. OBJECTIVE: To examine the experiences of female head athletic trainers as they worked toward and attained the position of head athletic trainer. DESIGN: Qualitative study. SETTING: National Collegiate Athletic Association Division I setting. PATIENTS OR OTHER PARTICIPANTS: Eight female athletic trainers serving in the role of head athletic trainer participated in our study. The mean age of the participants was 45 ± 12 years, with 5 ± 1.5 years of experience in the role of head athletic trainer and 21 ± 10 years of experience as athletic trainers. DATA COLLECTION AND ANALYSIS: We conducted phone interviews with the 8 participants following a semistructured format. Interviews were transcribed verbatim and analyzed following a general inductive approach as described by Thomas. To establish credibility, we used a peer reviewer, member checks, and multiple-analyst triangulation. RESULTS: Six major themes emerged from our analysis regarding the experiences of female head athletic trainers. Opportunities to become a head athletic trainer, leadership qualities, and unique personal characteristics were discussed as factors leading to the assumption of the role of the head athletic trainer. Where women hold back, family challenges, and organizational barriers speak to the potential obstacles to assuming the role of head athletic trainer. CONCLUSIONS: Female head athletic trainers did not seek the role, but through persistence and encouragement, they find themselves assuming the role. Leadership skills were discussed as important for success in the role of head athletic trainer. Life balancing and parenting were identified as barriers to women seeking the role of head athletic trainer.

Familial tumoral calcinosis.

INTRODUCTION: Tumoral calcinosis is a rare condition characterised by progressive, ectopic, periarticular deposits of calcium. These tumour-like growths often infiltrate muscle and tendon, usually presenting as multiple masses or as a painless, solitary mass. Our case report will focus on familial tumoral calcinosis, an autosomal recessive metabolic disorder generally observed in patients within the first two decades of life. CASE PRESENTATION: Our case report introduces two Sudanese siblings from consanguineous parents who presented with simultaneous recurrent multiple soft tissue swellings. CONCLUSION: The cases discussed highlight the main features of familial tumoral calcinosis and indicate the need for improved clinical guidance on the investigations, treatment and genetic screening of familial tumoral calcinosis.

The secondary school football coach's relationship with the athletic trainer and perspectives on exertional heat stroke.

CONTEXT: Prior researchers have examined the first-aid knowledge and decision making among high school coaches, but little is known about their perceived knowledge of exertional heat stroke (EHS) or their relationships with an athletic trainer (AT). OBJECTIVE: To examine secondary school football coaches' perceived knowledge of EHS and their professional relationship with an AT. DESIGN: Qualitative study. SETTING: Web-based management system. PATIENTS OR OTHER PARTICIPANTS: Thirty-eight secondary school head football coaches (37 men, 1 woman) participated in this study. Their average age was 47 ± 10 years old, and they had 12 ± 9 years' experience as a head football coach. DATA COLLECTION AND ANALYSIS: Participants responded to a series of online questions that were focused on their perceived knowledge of EHS and professional relationships with ATs. Data credibility was established through multiple-analyst triangulation and peer review. We analyzed the data by borrowing from the principles of a general inductive approach. RESULTS: Two dominant themes emerged from the data: perceived self-confidence of the secondary school coach and the influence of the AT. The first theme highlighted the perceived confidence, due to basic emergency care training, of the coach regarding management of an emergency situation, despite a lack of knowledge. The second theme illustrated the secondary school coach's positive professional relationships with ATs regarding patient care and emergency procedures. Of the coaches who participated, 89% (34 out of 38) indicated positive interactions with their ATs. CONCLUSIONS: These secondary school coaches were unaware of the potential causes of EHS or the symptoms associated with EHS, and they had higher perceived levels of self-confidence in management abilities than indicated by their perceived knowledge level. The secondary school football coaches valued and understood the role of the AT regarding patient and emergency care.

Undergraduate athletic training students' influences on career decisions after graduation.

CONTEXT: Career opportunities for athletic training students (ATSs) have increased substantially over the past few years. However, ATSs commonly appear to be opting for a more diversified professional experience after graduation. With the diversity in available options, an understanding of career decision is imperative. OBJECTIVE: To use the theoretical framework of socialization to investigate the influential factors behind the postgraduation decisions of senior ATSs. DESIGN: Qualitative study. SETTING: Web-based management system and telephone interviews. PATIENTS OR OTHER PARTICIPANTS: Twenty-two ATSs (16 females, 6 males; age = 22 ± 2 years) who graduated in May 2010 from 13 different programs accredited by the Commission on Accreditation of Athletic Training Education. DATA COLLECTION AND ANALYSIS: All interviews were transcribed verbatim, and the data were analyzed inductively. Data analysis required independent coding by 2 athletic trainers for specific themes. Credibility of the results was confirmed via peer review, methodologic triangulation, and multiple analyst triangulation. RESULTS: Two higher-order themes emerged from the data analysis: persistence in athletic training (AT) and decision to leave AT. Faculty and clinical instructor support, marketability, and professional growth were supporting themes describing persistence in AT. Shift of interest away from AT, lack of respect for the AT profession, compensation, time commitment, and AT as a stepping stone were themes sustaining the reasons that ATSs leave AT. The aforementioned reasons to leave often were discussed collectively, generating a collective undesirable outlook on the AT profession. CONCLUSIONS: Our results highlight the importance of faculty support, professional growth, and early socialization into AT. Socialization of pre-AT students could alter retention rates by providing in-depth information about the profession before students commit in their undergraduate education and by helping reduce attrition before entrance into the workforce.

The professional socialization of collegiate female athletic trainers: navigating experiences of gender bias.

CONTEXT: Female athletic trainers (ATs) experience gender discrimination in the workplace due to stereotypical gender roles, but limited information is available regarding the topic. OBJECTIVE: To understand the challenges and obstacles faced by young female ATs working in National Collegiate Athletic Association Division I athletics. DESIGN: Exploratory study using semistructured interviews. SETTING: Division I clinical setting. PATIENTS OR OTHER PARTICIPANTS: A total of 14 female ATs were included in the study, using both criterion and snowball-sampling techniques. Their mean age was 27 ± 2 years, with 5 ± 2 years of overall clinical experience. Criteria included employment at the Division I clinical setting, being a full-time assistant AT, and at least 3 years of working experience but no more than 9 years to avoid role continuance. DATA COLLECTION AND ANALYSIS: Analysis of the interview data followed inductive procedures as outlined by a grounded theory approach. Credibility was established by member checks, multiple-analyst triangulation, and peer review. RESULTS: Clear communication with both coaches and players about expectations and philosophies regarding medical care, a supportive head AT in terms of clinical competence, and having and serving as a role model were cited as critical tools to alleviate gender bias in the workplace. CONCLUSIONS: The female ATs in this study stressed the importance of being assertive with coaches early in the season with regard to the AT's role on the team. They reasoned that these actions brought forth a greater perception of congruity between their roles as ATs and their gender and age. We suggest that female athletic training students seek mentors in their field while they complete their coursework and practicums. The ATs in the current study indicated that a mentor, regardless of sex, helped them feel empowered to navigate the male-centric terrain of athletic departments by encouraging them to be assertive and not second-guess their decisions.

National Collegiate Athletic Association Division I football players' perceptions of women in the athletic training room using a role congruity framework.

CONTEXT: Previous researchers have demonstrated that male and female athletes feel more comfortable with treatment by a same-sex athletic trainer for sex-specific injuries and conditions. OBJECTIVE: To address football players' comfort with care provided by same-sex and opposite-sex athletic trainers for sex-specific and non-sex-specific injuries and conditions through the lens of role congruity theory. DESIGN: Cross-sectional study for the quantitative data and qualitative study for the qualitative data. SETTING: Two National Collegiate Athletic Association Division I Football Bowl Series university football programs. PATIENTS OR OTHER PARTICIPANTS: Male football players within the 2 university programs. DATA COLLECTION AND ANALYSIS: We replicated existing methods and an existing survey to address male football players' comfort levels. Additionally, an open-ended question was used to determine male football players' perceptions of female athletic trainers. Paired-samples t tests were conducted to identify differences between the responses for the care given by a male athletic trainer and for the care given by a female athletic trainer. Three categories were analyzed: general medical conditions, psychological conditions, and sex-specific injuries. The qualitative data were coded and analyzed using content analysis. RESULTS: Male football players were more comfortable with treatment by a male athletic trainer (mean = 3.61 +/- 1.16) for sex-specific injuries and conditions than they were with treatment by a female athletic trainer (mean = 2.82 +/- 1.27; P < .001). No significant results were found for comfort with overall psychological conditions, although a female athletic trainer was preferred over a male athletic trainer for the treatment of depression (mean = 3.71 +/- 1.07 versus mean = 3.39 +/- 1.16, respectively; P < .001). Qualitative data provided support for role congruity theory. CONCLUSIONS: Both quantitative and qualitative evidence were provided for the support of role congruity theory.

Current knowledge, attitudes, and practices of certified athletic trainers regarding recognition and treatment of exertional heat stroke.

CONTEXT: Previous research has indicated that despite awareness of the current literature on the recommended prevention and care of exertional heat stroke (EHS), certified athletic trainers (ATs) acknowledge failure to follow those recommendations. OBJECTIVE: To investigate the current knowledge, attitudes, and practices of ATs regarding the recognition and treatment of EHS. DESIGN: Cross-sectional study. SETTING: Online survey. PATIENTS OR OTHER PARTICIPANTS: We obtained a random sample of e-mail addresses for 1000 high school and collegiate ATs and contacted these individuals with invitations to participate. A total of 498 usable responses were received, for a 25% response rate. MAIN OUTCOME MEASURE(S): The survey instrument evaluated ATs' knowledge and actual practice regarding EHS and included 29 closed-ended Likert scale questions (1 = strongly disagree, 7 = strongly agree), 2 closed-ended questions rated on a Likert scale (1 = lowest value, 9 = greatest value), 8 open-ended questions, and 7 demographic questions. We focused on the open-ended and demographic questions. RESULTS: Although most ATs (77.1%) have read the current National Athletic Trainers' Association position statement on heat illness, only 18.6% used rectal thermometers to assess core body temperature to recognize EHS, and 49.7% used cold-water immersion to treat EHS. Athletic trainers perceived rectal thermometers as the most valid temperature assessment device when compared with other assessment devices (P

Validation of the TaqMan Influenza A Detection Kit and a rapid automated total nucleic acid extraction method to detect influenza A virus in nasopharyngeal specimens.

This study describes the validation of the TaqMan Influenza A Detection Kit v2.0 combined with an automated nucleic acid extraction method. The limit of detection of this assay was determined by probit regression (95% confidence interval) to be 2 influenza A/PR/8/34 (H1N1) virus particles per microlitre. One hundred and eleven specimens previously tested using the Seeplex RV assay and viral culture methods were tested using the TaqMan Influenza A Detection Kit. Compared to the aggregate gold-standard, the sensitivity and specificity of the TaqMan Influenza A Detection Kit were 100% (35/35) and 97% (74/76), respectively. Because of its accuracy, quick turn-around-time and lyophilized bead form, the TaqMan Influenza A Detection Kit, combined with the NucliSense easyMAG automated extraction method, constitutes a reliable protocol for influenza A diagnosis.

Parotitis in a child infected with triple-reassortant influenza A virus in Canada in 2007.

Swine H3N2 influenza virus designated A/Ontario/1252/2007 was isolated from a child with parotitis. Diagnosis was confirmed by viral isolation and serological assays. A/Ontario/1252/2007 was related to H3N2 triple reassortants that emerged in swine in the United States in 1998. Three of five tested household members were also seropositive for A/Ontario/1252/2007.

Characterization of culture-positive adenovirus serotypes from respiratory specimens in Toronto, Ontario, Canada: September 2007-June 2008.

This study describes the prevalence of culture-positive adenovirus serotypes in culture-positive respiratory specimens sent to the Central Public Health Laboratory, Toronto, Ontario, Canada for the period September 2007-June 2008. Total nucleic acid was extracted from virus cultures using an automated extraction method followed by polymerase chain reaction and Sanger sequencing of the adenovirus hexon gene hypervariable region 7. 73% of specimens (n = 70) were from patients < or = 4 years of age. Of the 96 adenovirus isolates, the most common identified serotypes were serotype 3 (n = 44, 46%), serotype 2 (n = 25, 26%), serotype 1 (n = 17, 18%), and serotype 21 (n = 5, 5%). Adenovirus serotype 14 was not found in this study group. The leading serotype, Ad3, was identified throughout the duration of the study period. Molecular methods allow for the determination of circulating adenovirus serotypes and be used to document the spread of highly virulent adenoviral serotypes into a region.