Does the Application of a Semiocclusive Dressing Alter the Microflora of Healthy Intact Skin on the Foot?

BACKGROUND: The skin on human feet presents unique environments for the proliferation of potentially pathogenic commensals. This study examined microflora changes on healthy intact skin under a semiocclusive dressing on the medial longitudinal arch of the foot to determine changes in growth, distribution, and frequency of microflora under the dressing. METHODS: Nine human participants wore a low-adherent, absorbent, semiocclusive dressing on the medial longitudinal arch of the left foot for 2 weeks. An identical location on the right foot was swabbed and used as a control. Each foot was swabbed at baseline, week 1, and week 2. The swabs were cultured for 48 hours. Visual identification, Gram staining, DNase test agar, and a latex slide agglutination test were used to identify genera and species. RESULTS: Microflora growth was categorized as scant (0-10 colony-forming units [CFU]), light (11-50 CFU), moderate (51-100 CFU), or heavy (>100 CFU). Scant and light growth decreased and moderate and heavy growth increased under the dressing compared with the control. Seven different genera of bacteria were identified. Coagulase-negative Staphylococcus spp appeared most frequently, followed by Corynebacterium spp. CONCLUSIONS: Changes in microflora distribution, frequency, and growth were found under the dressing, supporting historical studies. Microflora changes were identified as an increase in bioburden and reduction in diversity. The application of similar methods, using more sophisticated identification and analysis techniques and a variety of dressings, could lead to a better understanding of bacterial and fungal growth under dressings, informing better dressing selection to assist the healing process of wounds and prevent infection.

High throughput production of single-wall carbon nanotube fibres independent of sulfur-source.

Floating catalyst chemical vapor deposition (FC-CVD) methods offer a highly scalable strategy for single-step synthesis and assembly of carbon nanotubes (CNTs) into macroscopic textiles. However, the non-uniform axial temperature profile of a typical reactor, and differing precursor breakdown temperatures, result in a broad distribution of catalyst particle sizes. Spun CNT fibres therefore contain nanotubes with varying diameters and wall numbers. Herein, we describe a general FC-CVD approach to obtain relatively large yields of predominantly single-wall CNT fibres, irrespective of the growth promoter (usually a sulfur compound). By increasing carrier gas (hydrogen) flow rate beyond a threshold whilst maintaining a constant C : H2 mole ratio, CNTs with narrower diameters, a high degree of graphitization (G : D ratio ∼100) and a large throughput are produced, provided S : Fe ratio is sufficiently low. Analysis of the intense Raman radial breathing modes and asymmetric G bands, and a shift in the main nanotube population from thermogravimetric data, show that with increasing flow rate, the fibres are enriched with small diameter, metallic CNTs. Transmission electron microscopy corraborates our primary observation from Raman spectroscopy that with high total flow rates, the fibres produced consist of predominantly small diameter SWCNTs.

Motivations, Satisfaction, and Fears of Death and Dying in Residential Hospice Volunteers: A Prospective Longitudinal Study.

RATIONALE: Studies conducted on hospice volunteers' characteristics and experiences have been cross-sectional. We conducted a prospective study to examine changes in the volunteer experience over time in a cohort of volunteers during the first year of a new residential hospice. METHOD: Eighty-two active volunteers completed an online baseline survey, and of these, 39 completed a follow-up survey at 6 months. The survey included measures of motivations to volunteer, satisfaction with role and with the organization, and fear of death and dying. RESULTS: Repeated measures analyses indicated that motivations to volunteer remained stable over time while volunteer satisfaction increased with time. Baseline level of fears of death and dying varied by age, volunteer role, and motivations to volunteer and decreased at 6 months. CONCLUSION: Volunteering in a residential hospice tends to be a satisfying experience that helps to allay fears about death and dying.

Altered placental development in pregnancies resulting in sudden infant death syndrome (SIDS).

BACKGROUND: Sudden infant death syndrome (SIDS) is postulated to be a developmental disorder originating during fetal life in utero. Knowledge regarding the intrauterine environment in which SIDS infants develop is, however, inadequate and how the placenta develops prior to a SIDS event has not been studied. AIM: To investigate the morphological development of the placenta obtained from full-term infants who subsequently succumbed to SIDS. STUDY DESIGN: To estimate the percentage and total volumes of the chorionic villi and villous trophoblast membrane using stereological techniques. SUBJECTS: Placentas were obtained retrospectively from normal birthweight (SIDS-NBW n=18) and small-for-gestational age (SIDS-SGA, n=14) infants who had succumbed to SIDS, and compared to either control (n=8) or SGA placentas (n=7), respectively. RESULTS: SIDS-NBW placentas displayed evidence of augmented villous growth shown by significantly greater volumes of placental chorionic villi (gas-exchanging (GE) villi) in comparison to controls; this was not observed for SIDS-SGA placentas. However, both SIDS-NBW and SIDS-SGA placentas displayed significantly greater volumes of the cytotrophoblast (CT) (SIDS-NBW only), syncytiotrophoblast (SIDS-SGA only) and syncytial knots (SCT-K) and those displaying apoptotic syncytial nuclei (AP SCT-K). In contrast, SGA placentas displayed significantly reduced volumes of chorionic villi, GE villi and the villous trophoblast indicating a SIDS-specific effect associated with augmented placental growth. CONCLUSIONS: Our findings provide initial evidence that placental abnormality, although not necessarily causative, may precede a subset of SIDS cases supporting the hypothesis that the origins of SIDS begin during fetal life in utero.

Urgent suspected cancer referrals from general practice: audit of compliance with guidelines and referral outcomes.

BACKGROUND: Late diagnosis contributes to the UK having poorer cancer survival than many countries in Europe. Cancer referral guidelines help GPs decide which patients to refer urgently for further investigation. AIM: To examine primary care referral patterns, compliance with referral guidance, and eventual outcome for patients. DESIGN AND SETTING: Prospective audit within general practice in Scotland. METHOD: GPs in Scotland reviewed all urgent suspected cancer referrals over a 6-month period. They noted the final diagnosis and assessed whether the referral was in accordance with agreed referral guidelines. RESULTS: A total of 18 775 urgent suspected cancer referrals were analysed from 516 GP practices. The referral rate ranged from 3.7 to 24.0 per 1000 per annum; 30.8% of referrals were for patients aged under 50 years, yet this age group accounts for only 11.1% of all diagnosed cancers; 10.3% of all urgent cancer referrals were for suspected melanoma, despite this cancer accounting for only 4.1% of new cancers. The proportion of patients subsequently diagnosed with cancer was greatest for leukaemia (61.7%), prostate (52.6%), and lung cancer referrals (39.7%), and lowest for melanoma (11.8%), oesophago-gastric (11.2%), brain (10.6%), and laryngeal cancer referrals (7.8%). Compliance with referral guidelines was 90.9%. A large proportion of referrals considered to be outside the guidelines still had a cancer diagnosed (urological 15.9%, lung 8.8%, colorectal 8.4%, and breast 6.4%). CONCLUSION: There is wide variation in GP referral rates for suspected cancer with a greater than expected proportion of referrals for younger people. Many referrals considered to be outside the national guidelines were diagnosed with cancer, suggesting factors other than those in referral guidelines alert GPs to the possibility of cancer.

Strategic implementation and accountability: the case of the long-term care alliance.

A group of chief executives of long-term care homes formed an alliance in order to tap the resources residing within their management teams. Adopting a strategic implementation project based on a framework of accountability, the executives were able to better understand the uncertainties of the environment and potentially structure their strategic implementation to best use scarce resources. The framework of accountability allowed the homes to recognize the need for a strong business approach to long-term care. Communication improved throughout the organizations while systems and resources showed improved utilization. Quality became the driving force for all actions taken to move the organizations toward achieving their visions.