Are hospitals with both medical/surgical and psychiatric services associated with decreased difficulty in ambulance transfer for patients with self-harm behaviour? A nationwide retrospective observational study using ambulance transfer data in Japan.

OBJECTIVES: Ambulance diversion and prolonged prehospital transfer time have a significant impact on patient care outcomes. Self-harm behaviour in particular is associated with difficulty in hospital acceptance and longer prehospital transfer time. This study aimed to determine if hospitals with both medical/surgical and psychiatric inpatient beds and high-level emergency care centres are associated with a decreased rate of difficulty in hospital acceptance and shorter prehospital transfer time for patients seeking medical care after self-harm behaviour. DESIGN AND SETTING: A retrospective observational study using the database of Japanese ambulance dispatch data in 2015. PARTICIPANTS: Patients who were transferred by ambulances after self-harm behaviour. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Multivariable logistic regression analysis and multivariable linear regression analysis were performed to assess whether the presence of hospitals with both medical/surgical and psychiatric inpatient beds and high-level emergency care centres in the city were associated with a decreased rate of difficulty in hospital acceptance and shorter prehospital transfer time. RESULTS: The number of transfers due to self-harm behaviour in 2015 was 32 849. There was an association between decreased difficulty in hospital acceptance and the presence of high-level emergency care centres (OR 0.63, 95% CI 0.55 to 0.71, p<0.01) and hospitals with both medical/surgical and psychiatric inpatient beds (OR 0.50, 95% CI 0.38 to 0.66, p<0.01). There was a significant reduction in prehospital transfer time in the city with high-level emergency care centres (4.21 min, 95% CI 3.53 to 4.89, p<0.01) and hospitals with medical/surgical and psychiatric inpatient beds (3.46 min, 95% CI 2.15 to 4.77, p<0.01). CONCLUSION: Hospitals with both medical/surgical and psychiatric inpatient beds and high-level emergency care centres were associated with significant decrease in difficulty in hospital acceptance and shorter prehospital transfer time.

Role of Hfq in Genome Evolution: Instability of G-Quadruplex Sequences in E. coli.

Certain G-rich DNA repeats can form quadruplex in bacterial chromatin that can present blocks to DNA replication and, if not properly resolved, may lead to mutations. To understand the participation of quadruplex DNA in genomic instability in Escherichia coli (E. coli), mutation rates were measured for quadruplex-forming DNA repeats, including (G3T)4, (G3T)8, and a RET oncogene sequence, cloned as the template or nontemplate strand. We evidence that these alternative structures strongly influence mutagenesis rates. Precisely, our results suggest that G-quadruplexes form in E. coli cells, especially during transcription when the G-rich strand can be displaced by R-loop formation. Structure formation may then facilitate replication misalignment, presumably associated with replication fork blockage, promoting genomic instability. Furthermore, our results also evidence that the nucleoid-associated protein Hfq is involved in the genetic instability associated with these sequences. Hfq binds and stabilizes G-quadruplex structure in vitro and likely in cells. Collectively, our results thus implicate quadruplexes structures and Hfq nucleoid protein in the potential for genetic change that may drive evolution or alterations of bacterial gene expression.

On the Dependability and Feasibility of Layperson Ratings of Divergent Thinking.

A new system for subjective rating of responses to divergent thinking tasks was tested using raters recruited from Amazon Mechanical Turk. The rationale for the study was to determine if such raters could provide reliable (aka generalizable) ratings from the perspective of generalizability theory. To promote reliability across the Alternative Uses and Consequence task prompts often used by researchers as measures of Divergent Thinking, two parallel scales were developed to facilitate feasibility and validity of ratings performed by laypeople. Generalizability and dependability studies were conducted separately for two scoring systems: the average-rating system and the snapshot system. Results showed that it is difficult to achieve adequate reliability using the snapshot system, while good reliability can be achieved on both task families using the average-rating system and a specific number of items and raters. Additionally, the construct validity of the average-rating system is generally good, with less validity for certain Consequences items. Recommendations for researchers wishing to adopt the new scales are discussed, along with broader issues of generalizability of subjective creativity ratings.

Rapid detection of Staphylococcus aureus in lower respiratory tract secretions from patients with suspected ventilator-associated pneumonia: evaluation of the Cepheid Xpert MRSA/SA SSTI assay.

A preclinical evaluation was conducted to evaluate the performance of the Cepheid Xpert assay on 135 lower respiratory tract secretions for detection of methicillin-resistant Staphylococcus aureus and S. aureus. Compared with the quantitative culture, the sensitivity, specificity, and positive and negative predictive values were 99.0%, 72.2%, 90.7%, and 96.3%, respectively.

Are central venous catheter tip cultures reliable after 6-day refrigeration?

Present guidelines recommend culturing only central venous catheter (CVC) tips from patients with suspected catheter-related bloodstream infection (CR-BSI). However, a high proportion of these suspicions are not confirmed. Moreover, CVC tip culture increases laboratory workload, and reports of colonization may be meaningless or misleading for the clinician. Our working hypothesis was that CVC tips should be refrigerated and cultured only in patients with positive blood cultures. We evaluated the effect of 6-day refrigeration of 215 CVC tips. We selected all the catheters with a significant count according to the Maki's roll-plate technique and randomly assigned them to 2 groups. In group A, the catheters were recultured after 24 h of refrigeration, and in group B, the catheters were recultured after 6 days more of refrigeration, so that the refrigeration time evaluated would be of 6 days. The yield of refrigerated CVC tips that grow significant colony counts of primary culture in group B was compared with the yield of refrigerated catheter tips in group A. The difference showed that 6-day refrigeration reduced the number of significant CVCs by 15.2%. Only 61 CVCs were obtained from patients with CR-BSI, and in most of them, blood cultures were already positive before CVC culture, so only 0.91% of the CR-BSI episodes would have been misdiagnosed as culture negative after refrigeration. Refrigeration of CVC tips sent for culture and culturing only those from patients with positive blood cultures reduce the workload in the microbiology laboratory without misdiagnosing CR-BSI.

Contaminated feeding bottles: the source of an outbreak of Pseudomonas aeruginosa infections in a neonatal intensive care unit.

BACKGROUND: Outbreaks of Pseudomonas aeruginosa have been reported in relationship with contamination of staff fingernails, hands, water baths, hand lotions and others. To our knowledge, contamination of milk and feeding bottles as a source of an outbreak of P aeruginosa infections has not been reported. The incidence of P aeruginosa infection/colonization in our neonatal intensive care unit increased from 1.9 per 1000 patient-days in August 2004 to 8.8 per 1000 patient-days in September 2004. METHODS: Samples were collected including hand and body lotions, water from the incubator humidifying system, the health care worker hands, and the feeding bottle preparation room. Strains were epidemiologically characterized by pulsed-field gel electrophoresis of SpeI-digested genomic DNA. P aeruginosa was isolated from a total of 30 neonates during the period September 2004 to December 2004. RESULTS: All cultures (139) of hand and body lotions, water from the incubator humidifying system, and hands of health care personnel were negative. Nine out of 48 samples collected from the feeding bottle preparation room were positive for P aeruginosa (6 samples of in-house prepared milk and 3 samples of water from dishwashers). Pulsed-field gel electrophoresis with SpeI showed that the strains isolated from neonates and from environmental samples were identical. Discontinuation of in-house preparation of feeding bottles and incorporation of unidose milk bottles stopped the outbreak. CONCLUSION: The preparation and solution of milk from multidose powder preparation may be a source of P aeruginosa infections in a neonatal intensive care unit. The use of manufactured, nonmanipulated, unidose feeding bottles should be considered more adequate.

Value of a single galactomannan determination (Platelia) for the diagnosis of invasive aspergillosis in non-hematological patients with clinical isolation of Aspergillus spp.

We studied 75 patients with non-hematological conditions from whom Aspergillus spp. were recovered from clinical specimens during the period March 2003 to August 2006. The patients were classified according to EORTC criteria and the presence of galactomannan (Platelia Aspergillus) in their sera was evaluated. Ten of these patients (13.3%) had proven or probable invasive aspergillosis, i.e., chronic obstructive pulmonary disease in five (50%), HIV infection in one (10%), lymphoma in one (10%), liver transplant in one (10%), solid malignancies in one (10%), and corticosteroid treatment in one (10%). The sensitivity, specificity, and positive and negative predictive values for the detection of galactomannan, using cut-offs of > or =0.5 ng/ml and > or =1 ng/ml were 60%/50%, 89.23%/100%, 46.15%/100%, and 93.55%/92.86% (p=0.001 and p<0.001), respectively. The determination of galactomannan in the sera of non-neutropenic patients could prove to be a useful microbiological finding when diagnosing invasive aspergillosis.

Evaluation of procalcitonin as a marker of infection in a nonselected sample of febrile hospitalized patients.

The level of procalcitonin is undetectable in healthy individuals and slightly increased in viral infections and noninfectious inflammatory responses. It has been described to be notably increased in bacterial, parasitic, or fungal infections. Procalcitonin has been reported to be a reliable marker for severe bacterial infections, although it has mainly been studied in specific entities or in selected groups of patients. We prospectively determined the procalcitonin level in 103 unselected febrile hospitalized patients. Most of them had a proven (39) or probable bacterial infection (44). Procalcitonin was more frequently positive in bacteremic patients (p = 0.01), in patients with a proven bacterial infection (p < 0.01), and in those with a high sepsis score (p < 0.005), however; when cases with proven bacterial infection were considered as a reference, the sensitivity of the test was only 54% and the specificity 70%. Procalcitonin determination should not be included systematically in the screening of febrile hospitalized patients.

Asma ocupacional por iroko / Occupational asthma due to iroko

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Lack of significant cross-reactivity between Leishmania serology and mycobacteriosis in patients infected with HIV-1.

OBJECTIVE: To determine the existence of cross-reactions between Leishmania serology and mycobacteriosis in patients infected with HIV-1. PATIENTS AND METHODS: HIV-positive individuals, with culture-proven episodes of tuberculosis or disseminated Mycobacterium avium complex (MAC) infection, were identified from the data files of our microbiology laboratory. Patients were included if leishmania serology had been performed within a period of 2 months before and 1 month after the diagnosis of mycobacterial disease. RESULTS: We identified 106 cases of tuberculosis and 38 of disseminated MAC infection with concomitant leishmania serology in HIV-infected individuals. Among them, only two cases (1.8%), both with tuberculosis and without visceral leishmaniasis, showed positive leishmania serology. The two cases are discussed. CONCLUSIONS: We conclude that, in spite of its low sensitivity, serology is a useful diagnostic tool in co-infected patients, mainly because of its high specificity and the low rate of cross-reactivity with two of the most frequent causes of fever of unknown origin in HIV-positive patients from our area.