Abscess drain migration into the colon following laparoscopic cholecystectomy.

Percutaneous abscess drainage is a procedure commonly performed by interventional radiologists to provide source control on infections using CT or ultrasound guidance. The interventionalist has many different sizes and shapes of catheters to treat abscesses of varying sizes and locations, but the general approach to each abscess is similar: provide a percutaneous route for purulence, bacteria, necrotic tissue, and other debris to escape the body. While generally considered a low-risk procedure, adverse events can occur due to operator error or other means. We present a unique case of an abscess drain placed into a right upper quadrant abscess that formed following laparoscopic cholecystectomy that perforated and entered the colon. Astute physicians, both in the emergency department and the radiology reading room, were able to rapidly rule out more common post-operative complications and make the correct diagnosis, likely preventing dangerous sequelae from developing in this patient.

Faster Serotonin Clearance in CA3 Region of Hippocampus and Antidepressant-like Effect of Decynium-22 in Juvenile Mice Are Putatively Linked to Increased Plasma Membrane Monoamine Transporter Function: Implications for Efficacy of Antidepressants in Juveniles.

Selective serotonin reuptake inhibitors (SSRIs) are less efficacious in treating depression in children than in adults. SSRIs block serotonin uptake via the high-affinity, low-capacity serotonin transporter. However, the low-affinity, high-capacity organic cation transporter 3 (OCT3) and plasma membrane monoamine transporter (PMAT) are emerging as important players in serotonin uptake. We hypothesized that OCT3 and/or PMAT are functionally upregulated in juveniles, thereby buffering SSRIs' ability to enhance serotonergic neurotransmission. Unlike in adult mice, we found the OCT/PMAT blocker, decynium-22, to have standalone antidepressant-like effects in juveniles. Using in vivo high-speed chronoamperometry, we found that juveniles clear serotonin from the CA3 region of the hippocampus ~2-fold faster than adult mice. Cell density did not differ between ages, suggesting that faster serotonin clearance in juveniles is unrelated to faster diffusion through the extracellular matrix. Western blot and immunohistochemistry showed that juvenile mice have modestly greater expression of PMAT than adults, whereas OCT3 expression in the CA3 region of the hippocampus was similar between ages. Together, these data suggest that faster serotonin clearance and antidepressant-like effects of decynium-22 in juvenile mice may be due to functionally upregulated PMAT. Faster serotonin clearance via PMAT in juveniles may contribute to reduced therapeutic efficacy of SSRIs in children relative to adults.

Factors Affecting Outcomes in Geriatric Traumatic Subdural Hematoma in a Neurosurgical Intensive Care Unit.

BACKGROUND AND OBJECTIVE: Geriatric patients (age ≥65 years) who sustain a traumatic brain injury have an increased risk of poor outcomes and higher mortality compared with younger cohorts. We aimed to evaluate the risk factors for discharge outcomes in a geriatric traumatic subdural hematoma population, stratified by age and pretraumatic medical comorbidities. This was a single-center retrospective cohort study of geriatric patients (N = 207). METHODS: Patient charts were evaluated for factors including patient characteristics, comorbidities, injury-related and seizure-related factors, neurosurgical intervention, and patient disposition on discharge. RESULTS: Bivariate and multivariate analyses showed that age was nonpredictive of patient outcomes. Underlying vasculopathic comorbidities were the primary determinant of posttraumatic seizure, surgical, and discharge outcomes. Multifactor analysis showed that patients who went on to develop status epilepticus (n = 11) had a higher frequency of vasculopathic comorbidities with strong predictive power in poor patient outcomes. CONCLUSIONS: Our findings suggest a need to establish unique prognostic risk factors based on patient outcomes that guide medical and surgical treatment in geriatric patients.

Topological atlas of the hypothalamus in adult rhesus monkey.

The prosomeric model explains the embryological development of the central nervous system (CNS) shared by all vertebrates as a Bauplan. As a primary event, the early neural plate is patterned by intersecting longitudinal plates and transverse segments, forming a mosaic of progenitor units. The hypothalamus is specified by three prosomeres (hp1, hp2, and the acroterminal domain) of the secondary prosencephalon with corresponding alar and basal plate parts, which develop apart from the diencephalon. Mounting evidence suggests that progenitor units within alar and basal plate parts of hp1 and hp2 give rise to distinct hypothalamic nuclei, which preserve their relative invariant positioning (topology) in the adult brain. Nonetheless, the principles of the prosomeric model have not been applied so far to the hypothalamus of adult primates. We parcellated hypothalamic nuclei in adult rhesus monkeys (Macaca mulatta) using various stains to view architectonic boundaries. We then analyzed the topological relations of hypothalamic nuclei and adjacent hypothalamic landmarks with homology across rodent and primate species to trace the origin of adult hypothalamic nuclei to the alar or basal plate components of hp1 and hp2. We generated a novel atlas of the hypothalamus of the adult rhesus monkey with developmental ontologies for each hypothalamic nucleus. The result is a systematic reinterpretation of the adult hypothalamus whose prosomeric ontology can be used to study relationships between the hypothalamus and other regions of the CNS. Further, our atlas may serve as a tool to predict causal patterns in physiological and pathological pathways involving the hypothalamus.

State-Wide Genomic and Epidemiological Analyses of Vancomycin-Resistant Enterococcus faecium in Tasmania's Public Hospitals.

From 2015 onwards, the number of vancomycin-resistant Enterococcus faecium (VREfm) isolates increased in Tasmania. Previously, we examined the transmission of VREfm at the Royal Hobart Hospital (RHH). In this study, we performed a state-wide analysis of VREfm from Tasmania's four public acute hospitals. Whole-genome analysis was performed on 331 isolates collected from screening and clinical specimens of VREfm. In silico multi-locus sequence typing (MLST) was used to determine the relative abundance of broad sequence types (ST) across the state. Core genome MLST (cgMLST) was then applied to identify potential clades within the ST groupings followed by single-nucleotide polymorphic (SNP) analysis. This work revealed that differences in VREfm profiles are evident between the state's two largest hospitals with the dominant vanA types being ST80 at the RHH and ST1421 at Launceston General Hospital (LGH). A higher number of VREfm cases were recorded at LGH (n = 54 clinical, n = 122 colonization) compared to the RHH (n = 14 clinical, n = 67 colonization) during the same time period, 2014-2016. Eleven of the clinical isolates from LGH were vanA and belonged to ST1421 (n = 8), ST1489 (n = 1), ST233 (n = 1), and ST80 (n = 1) whereas none of the clinical isolates from the RHH were vanA. For the recently described ST1421, cgMLST established the presence of individual clusters within this sequence type that were common to more than one hospital and that included isolates with a low amount of SNP variance (≤16 SNPs). A spatio-temporal analysis revealed that VREfm vanA ST1421 was first detected at the RHH in 2014 and an isolate belonging to the same cgMLST cluster was later collected at LGH in 2016. Inclusion of isolates from two smaller hospitals, the North West Regional Hospital (NRH) and the Mersey Community Hospital (MCH) found that ST1421 was present in both of these institutions in 2017. These findings illustrate the spread of a recently described sequence type of VREfm, ST1421, to multiple hospitals in an Australian state within a relatively short time span.

Emergence of Vancomycin-Resistant Enterococcus faecium at an Australian Hospital: A Whole Genome Sequencing Analysis.

In 2015, a marked increase in vancomycin-resistant Enterococcus faecium (VREfm) isolation was detected at the Royal Hobart Hospital, Australia. The primary objective of this work was to examine the dynamics of VREfm transmission using whole genome data mapped to public health surveillance information. Screening and clinical isolates of VREfm from patients were typed for the specific vancomycin-resistance locus present. Of total isolates collected from 2014-2016 (n = 222), 15.3% and 84.7% harboured either the vanA or the vanB vancomycin-resistance locus, respectively. Whole-genome sequencing of 80 isolates was performed in conjunction with single-nucleotide polymorphic (SNP) analysis and in silico multi-locus sequence typing (MLST). Among the isolates sequenced, 5 phylogenetic clades were identified. The largest vanB clade belonged to MLST sequence type ST796 and contained clinical isolates from VREfm infections that clustered closely with isolates from colonised patients. Correlation of VREfm genotypes with spatio-temporal patient movements detected potential points of transmission within the hospital. ST80 emerged as the major vanA sequence type for which the most likely index case of a patient cluster was ascertained from SNP analyses. This work has identified the dominant clones associated with increased VREfm prevalence in a healthcare setting, and their likely direction of transmission.

Poor pay must be addressed.

The government's response to an online petition calling for fair pay for nurses is disgusting (news, 16 November). Ministers should come to a trust unexpectedly - without the trust suddenly having enough staff just for the visit. Only then will they appreciate how nurses try to manage a ward with patients all with differing diagnoses, helped only by agency and bank staff who may not know the hospital, let alone the ward.

Childhood abuse and suicidal ideation in a cohort of pregnant Peruvian women.

BACKGROUND: Childhood abuse is a major global and public health problem associated with a myriad of adverse outcomes across the life course. Suicide is one of the leading causes of mortality during the perinatal period. However, few studies have assessed the relationship between experiences of childhood abuse and suicidal ideation in pregnancy. OBJECTIVE: We sought to examine the association between exposure to childhood abuse and suicidal ideation among pregnant women. STUDY DESIGN: A cross-sectional study was conducted among 2964 pregnant women attending prenatal clinics in Lima, Peru. Childhood abuse was assessed using the Childhood Physical and Sexual Abuse Questionnaire. Depression and suicidal ideation were assessed using the Patient Health Questionnaire-9 scale. Logistic regression procedures were performed to estimate adjusted odds ratios and 95% confidence intervals adjusted for potential confounders. RESULTS: Overall, the prevalence of childhood abuse in this cohort was 71.8% and antepartum suicidal ideation was 15.8%. The prevalence of antepartum suicidal ideation was higher among women who reported experiencing any childhood abuse compared to those reporting none (89.3% vs 10.7%, P < .0001). After adjusting for potential confounders, including antepartum depression and lifetime intimate partner violence, those with history of any childhood abuse had a 2.9-fold (2.90, adjusted odds ratio; 95% confidence interval, 2.12-3.97) increased odds of reporting suicidal ideation. Women who experienced both physical and sexual childhood abuse had much higher odds of suicidal ideation (adjusted odds ratio, 4.04; 95% confidence interval, 2.88-5.68). Women who experienced any childhood abuse and reported depression had 3.44-fold (3.44, adjusted odds ratio; 95% confidence interval, 1.84-6.43) increased odds of suicidal ideation compared with depressed women with no history of childhood abuse. Finally, the odds of suicidal ideation increased with increased number of childhood abuse events experienced (P value for linear trend < .001). CONCLUSION: Maternal history of childhood abuse was associated with increased odds of antepartum suicidal ideation. It is important for clinicians to be aware of the potential increased risk of suicidal behaviors among pregnant women with a history of childhood physical and sexual abuse.

Misdiagnosis and missed diagnoses in foster and adopted children with prenatal alcohol exposure.

OBJECTIVE: The purpose of this article is to assess the rate of misdiagnosis and missed diagnoses of fetal alcohol spectrum disorders (FASD) among a population of foster and adopted youth referred to a children's mental health center. METHODS: Data were collected from a sample of 547 children who underwent a comprehensive multidisciplinary diagnostic evaluation. Utilizing current diagnostic criteria, children were diagnosed, as appropriate, with fetal alcohol syndrome, partial fetal alcohol syndrome, alcohol-related neurodevelopmental disorder, or alcohol-related birth defects. Changes in rates of alcohol exposure-related diagnoses and cooccurring mental health disorders pre- and postassessment were analyzed by using McNemar's test for dependent proportions. RESULTS: Among 156 children and adolescents who met criteria for a diagnosis within the fetal alcohol spectrum, 125 had never been diagnosed as affected by prenatal alcohol exposure, a missed diagnosis rate of 80.1%. Of the 31 who had been recognized before referral as affected by prenatal alcohol exposure, 10 children's FASD diagnoses were changed within the spectrum, representing a misdiagnosis rate of 6.4%. The remaining 21 (13.5%) children's diagnoses stayed the same. There also were significant changes in the rate of mental health diagnosis, and learning disorders, communication disorders, and intellectual disability, objective signs of neurocognitive damage, were not recognized in a significant number of children with FASD. CONCLUSIONS: Within this clinical sample, 86.5% of youth with FASD had never been previously diagnosed or had been misdiagnosed. These high rates of missed diagnoses and misdiagnosis have significant implications for intervention and therapeutic services.

Mental Health Disorders among Children within Child Welfare who have Prenatal Substance Exposure: Rural vs. Urban Populations.

This study analyzed differences in mental health diagnoses among Illinois child welfare-involved youth who have had prenatal substance exposure. Results indicate that youth from the rural area had a significantly higher rate of co-occurring mental health disorders. A multiple regression analysis revealed five significant predictors: living in a rural area, a history of neglect, having Fetal Alcohol Syndrome or an alcohol-related neurodevelopmental disorder, and age. These results have implications for adapting existing treatment models.

Australian graduating nurses' knowledge, intentions and beliefs on infection prevention and control: a cross-sectional study.

BACKGROUND: In recent year, national bodies have been actively addressing the increasing concern on the spread of healthcare-associated infections (HAIs). The current study measures the knowledge, intentions and beliefs of third-year Australian nursing students on key infection prevention and control (IPC) concepts. METHODS: A cross-sectional study of final-year undergraduate nursing students from Schools of Nursing at six Australian universities was undertaken. Students were asked to participate in an anonymous survey. The survey explored knowledge of standard precautions and transmission based precautions. In addition intentions and beliefs towards IPC were explored. RESULTS: 349 students from six universities completed the study. 59.8% (95% CI 58.8-60.8%) of questions were answered correctly. Significantly more standard precaution questions were correctly answered than transmission-based precaution questions (p < 0.001). No association was found between self-reported compliance with IPC activities and gender or age. Certain infection control issues were correlated with the percentage of correctly answered transmission-based precaution questions. The participants were most likely to seek infection control information from an infection control professional. CONCLUSION: Knowledge on transmission-based precautions was substandard. As transmission-based precautions are the foundation of IPC for serious organisms and infections, education institutions should reflect on the content and style of educational delivery on this topic.

A major reduction in hospital-onset Staphylococcus aureus bacteremia in Australia-12 years of progress: an observational study.

BACKGROUND: Staphylococcus aureus bacteremia (SAB) is a serious cause of morbidity and mortality. This longitudinal study describes significant reductions in hospital-onset SAB (HO-SAB) in Australian hospitals over the past 12 years. METHODS: An observational cohort study design was used. Prospective surveillance of HO-SAB in 132 hospitals in Australia was undertaken. Aggregated data from all patients who acquired HO-SAB was collected (defined as 1 or more blood cultures positive for S. aureus taken from a patient who had been admitted to hospital for >48 hours). The primary outcome was the incidence of HO-SAB, including both methicillin-resistant (MRSA) and methicillin-susceptible (MSSA) S. aureus strains. RESULTS: A total of 2733 HO-SAB cases were identified over the study period, giving an aggregate incidence of 0.90 per 10 000 patient-days (PDs) (95% confidence interval [CI], .86-.93). There was a 63% decrease in the annual incidence, from 1.72 per 10 000 PDs in 2002 (95% CI, 1.50-1.97) to 0.64 per 10 000 PDs (95% CI, .53-.76) in 2013. The mean reduction per year was 9.4% (95% CI, -8.1% to -10.7%). Significant reductions in both HO-MRSA (from 0.77 to 0.18 per 10 000 PDs) and HO-MSSA (from 1.71 to 0.64 per 10 000 PDs) bacteremia were observed. CONCLUSIONS: There was a major and significant reduction in incidence of HO-SAB caused by both MRSA and MSSA in Australian hospitals since 2002. This reduction coincided with a range of infection prevention and control activities implemented during this time. It suggests that national and local efforts to reduce the burden of healthcare-associated infections have been very successful.

Neurocognitive habilitation therapy for children with fetal alcohol spectrum disorders: an adaptation of the Alert Program®.

OBJECTIVE: This study evaluated the effectiveness of neurocognitive habilitation, a group therapy intervention for foster and adoptive caregivers and their children who were prenatally exposed to alcohol. METHOD: Participants were recruited from clients seeking evaluation for fetal alcohol syndrome (FAS) and alcohol-related neurodevelopmental disorder (ARND) and were randomly assigned to treatment and no-treatment control groups. Forty children participated in the treatment program and were compared with 38 control participants using the Behavior Rating Inventory of Executive Function (BRIEF) and the Roberts Apperception Test for Children (RATC). RESULTS: Significant differences between the treatment and control groups were demonstrated on the BRIEF and on the RATC, suggesting that the intervention improved executive functioning and emotional problem-solving skills. CONCLUSION: These findings yield promising evidence of the effectiveness of the neurocognitive habilitation intervention in improving executive functioning and emotional problem solving in children with FAS or ARND.

Can homemade fit testing solutions be as effective as commercial products?

BACKGROUND: Fit testing is used to determine whether a N95 mask will provide respiratory protection for the wearer by preventing inhalation of airborne transmitted microorganisms. National guidelines recommend that healthcare workers (HCW) who use N95 masks require fit testing. Quantitative fit testing requires the purchasing and use of fit testing solutions and associated equipment. In high volume, these solutions are expensive and may not be readily available, as was seen in the 2009 H1N1 influenza pandemic. The aim of this study was to determine how a homemade solution compared against a commercially available product and a placebo. METHODS: Afit test was performed on the same person, on three separate occasions, using three different solutions - commercial (45% sodium saccharin), homemade (to be disclosed) and placebo (water). The solution was double blinded and solutions were chosen and administered in a random order. RESULTS: Atotal of 48 people participated in this study.At the threshold testing stage, 8.3% did not taste any solution, 16.7% of people could taste the placebo, 89.6% could taste the commercial solution and 91.7% could taste the homemade solution. All persons who could taste the commercial solution could taste homemade solution. CONCLUSION: The findings of our study suggest that fit testing solutions could be made locally with a similar effect to that of commercial products, that quantitative fit testing is unreliable and that serious consideration should be given to the role of quantitative fit testing in future guidelines and standards. We recommend that this study be conducted on a larger scale to support our findings.

Working with dental school admissions committees to enroll a more diverse student body.

The American Dental Education Association's Admissions Committee Workshop (ADEA ACW) was designed to challenge dental school administrators and admissions committee members to review their current admissions practices and to explore ways to attract a more diverse student body. Presented at the invitation of dental schools, this half-day interactive workshop provides opportunities for a dental school's administrators, staff, and admissions committee members to learn about the value of diversity in the educational environment and how to implement holistic admissions practices that take into consideration the experiences, attributes, and metrics of candidates for admission. This report explores the rationale for the development of the ADEA ACW, discusses lessons learned from presentation of the workshop at more than twenty-seven U.S. dental schools, and tracks enrollment trends of underrepresented minority students in dental schools where the workshop has been presented.

Evaluating the impact of the ADEA Admissions Committee Workshops.

Drawing on the interconnection of workforce diversity and oral health access, the American Dental Education Association (ADEA) is leading a novel approach to improve student body diversity in U.S. dental schools through an admissions committee development program. With funding provided by the Pipeline, Profession, and Practice: Community-Based Dental Education program and the Robert Wood Johnson Foundation, ten dental directors/deans of admissions from a cross-section of U.S. dental schools were selected through a competitive application process to participate in a Train-the-Trainers Admissions Committee Workshop. After completing intensive training that was built on legally sound admissions practices, these new trainers copresented ADEA Admissions Committee Workshops in two-member teams at six U.S. dental schools. This report summarizes the evaluation of both the train-the-trainers workshop and six workshops held in summer 2009. Also summarized are post-workshop outcomes relative to structural diversity at the participating schools.

Neurodevelopmental functioning in children with FAS, pFAS, and ARND.

OBJECTIVE: The purpose of this article is to compare the neurodevelopmental profiles of 78 foster and adopted children with fetal alcohol syndrome (FAS), partial FAS (pFAS), or alcohol-related neurodevelopmental disorder (ARND). METHOD: Seventy-eight foster and adopted children underwent a comprehensive diagnostic evaluation. By using criteria more stringent than those required by current guidelines, the children were placed in 1 of 3 diagnostic categories: FAS, pFAS, or ARND. Each child was evaluated across the domains of neuropsychological functioning most frequently affected by prenatal exposure to alcohol. Multivariate analyses of variance were conducted to examine differences in neuropsychological functioning between the 3 diagnostic groups. Descriptive discriminant analyses were performed in follow-up to the multivariate analyses of variance. RESULTS: The children in the 3 diagnostic categories were similar for descriptive and child welfare variables. Children with FAS had significantly decreased mean weight, height, and head circumference. Children with FAS exhibited the most impaired level of general intelligence, significantly worse language-based memory compared with children with ARND, and significantly poorer functional communication skills than children with pFAS. On executive functioning, the FAS group of children performed significantly worse on sequencing and shift than either the pFAS or ARND groups. Children with pFAS and ARND were similar in all neurodevelopmental domains that were tested. CONCLUSION: The children who met tightly defined physical criteria for a diagnosis of FAS demonstrated significantly poorer neurodevelopmental functioning than children with pFAS and ARND. Children in these latter 2 groups were similar in all neurodevelopmental domains that were tested.

Demographics and quality profile of applicants to pediatric dentistry residencies.

PURPOSE: The purpose of this study was to use Postdoctoral Application Support Service (PASS) data to study the quality and demographic trends for pediatric dentistry residency applicants. METHODS: PASS data on grade point average (GPA) and National Dental Board Exam, Part I (NBI) scores were used to determine applicant quality. PASS demographic data included: (1) gender; (2) citizenship; (3) ethnicity; (4) previous practice of dentistry; and (5) completion of a residency or internship. RESULTS: GPAs showed a significant increase for the 6 years investigated. NBI scores also indicated a significant increase. Significantly more females than males applied to pediatric dentistry residencies. A significant increase in US/Canadian applicants was found. Ethnicity was similar to that of dental school graduates, with minor exceptions. In several of the years studied, there were significant differences in applicants who previously practiced dentistry or completed a residency/internship vs applicants who had no such previous experience. CONCLUSIONS: Significant increases in grade point averages and National Dental Board Exam, Part I scores suggest a high quality of pediatric dentistry residency applicants and this trend seem to be continuing. There are significantly more female than male applicants. More research is warranted on actual acceptance data.

The role of perceptual bias in complex figure recall.

Several studies have demonstrated that constructional and organizational abilities affect how well visual stimuli are remembered. The purpose of the present study was to determine whether perceptual bias, independent of constructional ability, influenced visual memory performance. Participants were 118 normal adults who were administered the Rey-Osterrieth Complex Figure (ROCF) and a similarity judgement task requiring then to decide which of two hierarchically constructed comparison figures most resemble a standard figure. The initial steps of a multiple regression analysis indicated that delayed recall of the ROCF was directly related to copy accuracy, inversely related to age, and better in males than females. In the final step of the regression model, performance on the similarity judgement task also predicted ROCF recall, with a more global perceptual bias predicting better recall. Results indicate that even when copy accuracy and demographic variables are accounted for, components of visual perception influence how well visual stimuli are encoded and recalled. Findings are consistent with research correlating global processing and spatial ability, and suggest that in addition to copy ability and organization, visuoperceptual bias must be considered as a moderator variable when interpreting performance as a visual memory test.