Chest CT screening for COVID-19 in elective and emergency surgical patients: experience from a UK tertiary centre.

AIM: To determine the incidence of possible COVID-19-related lung changes on preoperative screening computed tomography (CT) for COVID-19 and how their findings influenced decision-making. To also to determine whether the patients were managed as COVID-19 patients after their imaging findings, and the proportion who had SARS-CoV2 reverse transcriptionpolymerase chain reaction (RT-PCR) testing. MATERIALS AND METHODS: A retrospective study was undertaken of consecutive patients having imaging prior to urgent elective surgery (n=156) or acute abdominal imaging (n=283). Lung findings were categorised according to the British Society of Thoracic Imaging (BSTI) guidelines. RT-PCR testing, management, and outcomes were determined from the electronic patient records. RESULTS: 3% (13/439) of CT examinations demonstrated findings of classic/probable COVID-19 pneumonia, whilst 4% (19/439) had findings indeterminate for COVID-19. Of the total cohort, 1.6% (7/439) subsequently had confirmed RT-PCR-positive COVID-19. Importantly, all the patients with a normal chest or alternative diagnoses on CT who had PCR testing within the next 7 days, had a negative RT-PCR (92/407). There was a change in surgical outcome in 6% (10/156) of the elective surgical cohort with no change to surgical management was demonstrated in the acute abdominal emergency cohort requiring surgery (2/283). CONCLUSION: There was a 7% (32/439) incidence of potential COVID-19-related lung changes in patients having preoperative CT. Although this altered surgical management in the elective surgical cohort, no change to surgical management was demonstrated in the acute abdominal emergency cohort requiring surgery.

A retrospective analysis of in vivo eye irritation, skin irritation and skin sensitisation studies with agrochemical formulations: Setting the scene for development of alternative strategies.

Analysis of the prevalence of health effects in large scale databases is key in defining testing strategies within the context of Integrated Approaches on Testing and Assessment (IATA), and is relevant to drive policy changes in existing regulatory toxicology frameworks towards non-animal approaches. A retrospective analysis of existing results from in vivo skin irritation, eye irritation, and skin sensitisation studies on a database of 223 agrochemical formulations is herein published. For skin or eye effects, high prevalence of mild to non-irritant formulations (i.e. per GHS, CLP or EPA classification) would generally suggest a bottom-up approach. Severity of erythema or corneal opacity, for skinor eye effects respectively, were the key drivers for classification, consistent with existing literature. The reciprocal predictivity of skin versus eye irritation and the good negative predictivity of the GHS additivity calculation approach (>85%) provided valuable non-testing evidence for irritation endpoints. For dermal sensitisation, concordance on data from three different methods confirmed the high false negative rate for the Buehler method in this product class. These results have been reviewed together with existing literature on the use of in vitro alternatives for agrochemical formulations, to propose improvements to current regulatory strategies and to identify further research needs.

Impact of deprivation on cardiovascular risk factors in people with diabetes: an observational study.

AIM: To examine the influence of deprivation on prevalence of diabetes and of cardiovascular disease risk factors in people with diabetes. METHODS: Cross-sectional study of 52 280 people in diabetes registers of Greater Glasgow and Lothian NHS Board areas linked to hospital admission data. Results Age- and sex-adjusted prevalence of diabetes increased from 2.3% in the least deprived quintile (Q1) to 3.3% in the most deprived quintile (Q5; P < 0.001), as did prevalence of vascular disease (Q1 20%, Q5 27%; P < 0.001). Prevalence of current smoking (Q1 13%, Q5 32%; P < 0.001), obesity (Q1 38%, Q5 51%; P < 0.001) and above-target glycated haemoglobin (HbA(1c); > or = 7.5%: Q1 46% vs. Q5 47%; P = 0.01) were higher in the most deprived quintile. In contrast, the proportion of people with above-target cholesterol were similar (proportion > or = 5.0 mmol/l: Q1 26%, Q5 24%; P = 0.07) and the proportion of people with above-target systolic blood pressure (SBP) was lower (SBP > or = 140 mmHg: Q1 44%, Q5 37%; P = 0.02) in the most deprived quintile. In people with diabetes and prevalent vascular disease, deprivation was associated with failure to reach cholesterol target [odds ratio cholesterol > or = 5.0 mmol/l: Q5 vs. Q1 1.23 (1.04-1.45) P = 0.013]. SBP and cholesterol were markedly lower compared with previous population surveys. CONCLUSIONS: The burden of diabetes and vascular disease is greater in more deprived populations. Our data confirm a major advance in management of cholesterol and blood pressure management. Deprivation is still associated with failure to reach cholesterol targets in secondary prevention as well as higher prevalence of obesity and smoking.

Measuring movement-exacerbated pain in cognitively impaired frail elders.

OBJECTIVE: Prior research examining the utility of nonverbal measures of pain in persons with cognitive impairments has focused on acute procedurally-induced phasic pain (i.e., venipuncture and needle injections). The goal of the current project was to examine the utility of both self-report and nonverbal measures of pain in frail elders experiencing exacerbations of chronic musculoskeletal pain. These were assumed to be more representative of the day-to-day pain experience of elderly patients. DESIGN: Participants were 58 frail elders, 29 of whom had been found to have significant cognitive impairments. All were filmed as they undertook a series of structured activities (e.g., walking and reclining), and pain was assessed using self-report. Trained coders identified the incidence of pain-related behaviors using the videotapes. The various pain measures (i.e., self-report and nonverbal indices) were compared across both patient groups and the several activities. RESULTS: Consistent with our hypotheses, more pain was identified (using both self-report and nonverbal measures) when patients engaged in more physically demanding activities. Facial reactions varied as a function of patient cognitive status, with those participants who were cognitively impaired more responsive. Of the various nonverbal indices that we examined, guarded behavior appeared to be especially sensitive. The various pain indices were only modestly correlated with one another. CONCLUSIONS: This study supports the validity of self-report and behavioral measures of pain in frail elders with and without cognitive impairments. Each of the measures used contributed different information to pain assessment, suggesting that investigations of pain in elders with cognitive impairments should employ varying types of pain assessment tools.

Stable isotope dilution-mass spectrometry for determining total selenium levels in plants, soils and sewage sludges.

Quantitation of selenium in plants, soils and sludges was achieved by isotope dilution-mass spectrometry using a benchtop instrument. Samples for analysis were spiked with (76)Se isotope solution. Plant material was digested on a heating block at 150 degrees C using a mixture of nitric acid and hydrogen peroxide. Selenium in soils and sludges was released by treatment with nitric acid followed by digestion with nitric and hydrofluoric acids. Selenium in the digests was reduced to Se(IV) with hydrochloric acid and derivatised with nitro-1, 2-phenylenediamine to 5'-nitropiazselenol. Analysis by gas chromatography-mass spectrometry using selected ion monitoring was validated using certified reference materials (CRMs) and gave results within the certified range with a low standard deviation. The CRMs plant (Chinese cabbage leaves) and soil (Chinese soil) were found to contain (+/-95% confidence limits) 0.091(+/-0.007) mug g(-1) and 1.67(+/- 0.04) mug g(-1)Se respectively. The certified values were 0.083(+/-0.008) mug g(-1) and 1.56(+/-0.12) mug g(-1) respectively. The selenium content of four different freely drained acid Scottish soils under grasslands was in the range 0.5-0.8 mug g(-1) air-dried soil. Sewage sludges were found to contain measurably more selenium than the soils, and samples of three sludges taken from sites in the UK contained between 1.1 and 3.5 mug g(-1) dry matter.

Electron microscopic examination of the extracellular polymeric substances in anaerobic granular biofilms.

Scanning electron microscopy revealed that collapsed extracellular polymeric substances (EPS) surrounded bacteria present in granular sludge. Treatment of granular sludge with whole-cell antiserum and staining with polycationic ferritin demonstrated that bacteria were enveloped by extensive EPS. Antibody stabilization permitted a visualization of the EPS which more closely resembled its natural hydrated state. The EPS was seen to completely fill the intercellular spaces in the microcolonies. Both pure and mixed microcolonies were observed to be enclosed by EPS. The presence of these large amounts of EPS indicates that this extracellular layer is important in maintaining the structural integrity of granular sludge.

Transitional care: filling the gap for older patients.

Frequently, when the acute phase of a frail older person's illness resolves, the patient is too weak to function independently and cannot be discharged from hospital. Acute care staff often lack the ability and resources to deal adequately with these situations. A program of transitional (or subacute) care at Ontario's Mississauga Hospital has been shown to fill this gap in the continuum of care by improving the functional level of frail elders and ensuring better bed utilization.

Tap in on ear thermometry.

In February 1992, nursing departments at The Mississauga Hospital, a 530-bed community hospital in Southern Ontario, purchased First Temp Genius ear thermometers to replace the electronic predictive thermometers then in use. Ear thermometers collect infrared heat radiation from the ear canal with a probe, then convert the radiation to a temperature reading. Although quick and easy to use with patients of all ages, there are nonetheless some issues concerning their use that still must be addressed.

Life enrichment for long-stay patients in acute care: an interdisciplinary program.

Mr. T's stay on a medical unit became much more meaningful and enjoyable for him as a result of the LEP. Patient Focus sessions, which included input from his family, elicited several changes. Reassessments revealed that he could walk short distances with assistance, hence, he was placed on a toileting regime and he remained continent. His volunteer devoted at least two visits a week to him, and as the communication patterns improved, he was able to be taken to the coffee shop regularly. Furthermore, his hidden talents were discovered in recreation sessions and he soon started bringing samples of artwork to his room to be posted on his bulletin board. Smiles and laughter, instead of anger, became the norm when people greeted him in his chair by the nursing station. The team felt that Mr. T had reached nursing home level of care but, unfortunately, his history of aggressive behaviour tended to make nursing home administrators wary and non-receptive. To date, the consensus of the health care teams which are involved with the LEP is that 45 minutes every two weeks for discussion and planning for a selected long-stay patient has been time well spent. The teams are proud of their collaborative efforts and achievements. Most of all, the patients and their families are pleased with the improved quality of life that has emerged.

Maternal listeriosis in pregnancy without fetal or neonatal infection.

Maternal infection with Listeria monocytogenes without fetal or neonatal involvement is relatively rare. Eleven cases arising in England and Wales between 1967 and 1988 are presented.

Layered structure of bacterial aggregates produced in an upflow anaerobic sludge bed and filter reactor.

The ultrastructure of bacterial granules that were maintained in an upflow anaerobic sludge bed and filter reactor was examined. The reactor was fed a sucrose medium, and it was operated at 35 degrees C. Scanning and transmission electron microscopy revealed that the granular aggregates were three-layered structures. The exterior layer of the granule contained a very heterogeneous population that included rods, cocci, and filaments of various sizes. The middle layer consisted of a slightly less heterogeneous population than the exterior layer. A more ordered arrangement, made up predominantly of bacterial rods, was evident in this second layer. The third layer formed the internal core of the granules. It consisted of large numbers of Methanothrix-like cells. Large cavities, indicative of vigorous gas production, were evident in the third layer. On the basis of these ultrastructural results, a model that presents a possible explanation of granule development is offered.

Plugging of a model rock system by using starved bacteria.

The effects of starvation on bacterial penetration through artificial rock cores were examined. Klebsiella pneumoniae was starved in a simple salts solution for a duration of up to 4 weeks. These cell suspensions were injected into sintered glass bead cores, and the resulting reductions in core permeabilities were recorded. Vegetative cell cultures of K. pneumoniae grown in a sodium citrate medium were injected into other, similar cores, and the reductions in core permeabilities were recorded. The starved cell suspensions did not completely block the core pores, whereas the vegetative cultures reduced core permeability to less than 1%. Scanning electron microscopy of core sections infiltrated with either vegetative or starved cells showed that the former produced shallow "skin" plugs and copious amounts of glycocalyx at the inlet face, whereas the latter produced very little glycocalyx and the cells were distributed evenly throughout the length of the core. The use of a DNA assay to produce a cell distribution profile showed that, compared with the vegetative cells, starved bacteria were able to penetrate deeper into the cores. This was due to the smaller size of the cells and the reduction in biofilm production. This ability of starved bacteria to penetrate further into cores than the normal-size vegetative cells can be usefully applied to selective plugging for enhanced oil recovery. To further test the suitability of starved cells for use in selective plugging, the activities of starved cells present within cores were monitored before and after nutrient stimulation. Our data indicate that with nutrient stimulation, the starved cells lose their metabolic dormancy and produce reductions in core permeability due to cell growth and polymer production.