Establishing semi-automated infection surveillance in obstetrics and gynaecology.

BACKGROUND: Surveillance is an acknowledged method to decrease nosocomial infections, such as surgical site infections (SSIs). Electronic healthcare records create the opportunity for automated surveillance. While approaches for different types of surgeries and indicators already exist, there are very few for obstetrics and gynaecology. AIM: To analyse the sensitivity and workload reduction of semi-automated surveillance in obstetrics and gynaecology. METHODS: In this retrospective, single-centre study at a 1438-bed tertiary care hospital in Germany, semi-automated SSI surveillance using the indicators 'antibiotic prescription', 'microbiological data' and 'administrative data' (diagnosis codes, readmission, post-hospitalization care) was compared with manual analysis and categorization of all patient files. Breast surgeries (BSs) conducted in 2018 and caesarean sections (CSs) that met the inclusion criteria between May 2013 and December 2019 were included. Indicators were analysed for sensitivity, number of analysed procedures needed to identify one case, and potential workload reduction in detecting SSIs in comparison with the control group. FINDINGS: The reference standard showed nine SSIs in 416 BSs (2.2%). Sensitivities for the indicators 'antibiotic prescription', 'diagnosis code', 'microbiological sample taken', and the combination 'diagnosis code or microbiological sample' were 100%, 88.9%, 66.7% and 100%, respectively. The reference standard showed 54 SSIs in 3438 CSs (1.6%). Sensitivities for the indicators 'collection of microbiological samples', 'diagnosis codes', 'readmission/post-hospitalization care', and the combination of all indicators were 38.9%, 27.8%, 85.2% and 94.4%, respectively. CONCLUSIONS: Semi-automated surveillance systems may reduce workload by maintaining high sensitivity depending on the type of surgery, local circumstances and thorough digitalization.

Characterization of four functional biocompatible pressure-sensitive adhesives for rapid prototyping of cell-based lab-on-a-chip and organ-on-a-chip systems.

In the advent of affordable photo- and soft-lithography using polydimethylsiloxane (PDMS), low cost multi-step microfabrication methods have become available to a broad scientific community today. Although these methods are frequently applied for microfluidic prototype production in academic and industrial settings, fast design iterations and rapid prototyping within a few minutes with a high degree of flexibility are nearly impossible. To reduce microfluidic concept-to-chip time and costs, a number of alternative rapid prototyping techniques have recently been introduced including CNC micromachining, 3D printing and plotting out of numeric CAD designs as well as micro-structuring of thin PDMS sheets and pressure sensitive adhesives. Although micro-structuring of pressure sensitive adhesives promises high design flexibility, rapid fabrication and simple biochip assembly, most adhesives are toxic for living biological systems. Since an appropriate bio-interface and proper biology-material interaction is key for any cell chip and organ-on-a-chip system, only a limited number of medical-grade materials are available for microfluidic prototyping. In this study, we have characterized four functional biomedical-grade pressure sensitive adhesives for rapid prototyping (e.g. less than 1 hour) applications including structuring precision, physical and optical properties as well as biocompatibilities. While similar biocompatibility was found for all four adhesives, significant differences in cutting behavior, bonding strength to glass and polymers as well as gas permeability was observed. Practical applications included stability testing of multilayered, membrane-integrated organ-on-a-chip devices under standard cell culture conditions (e.g. 2-3 weeks at 37 °C and 100% humidity) and a shear-impact up to 5 dynes/cm2. Additionally, time- and shear-dependent uptake of non-toxic fluorescently labelled nanoparticles on human endothelial cells are demonstrated using micro-structured adhesive-bonded devices. Our results show that (a) both simple and complex microdevices can be designed, fabricated and tested in less than 1 hour, (b) these microdevices are stable for weeks even under physiological shear force conditions and (c) can be used to maintain cell monolayers as well as 3D cell culture systems.

Response of bispectral index to neuromuscular block in awake volunteers.

BACKGROUND: The bispectral index (BIS) monitor is a quantitative electroencephalographic (EEG) device that is widely used to assess the hypnotic component of anaesthesia, especially when neuromuscular blocking drugs are used. It has been shown that the BIS is sensitive to changes in electromyogram (EMG) activity in anaesthetized patients. A single study using an earlier version of the BIS showed that decreased EMG activity caused the BIS to decrease even in awake subjects, to levels that suggested deep sedation and anaesthesia. METHODS: We administered suxamethonium and rocuronium to 10 volunteers who were fully awake, to determine whether the BIS decreased in response to neuromuscular block alone. An isolated forearm technique was used for communication during the experiment. Two versions of the BIS monitor were used, both of which are in current use. Sugammadex was used to antagonise the neuromuscular block attributable to rocuronium. RESULTS: The BIS decreased after the onset of neuromuscular block in both monitors, to values as low as 44 and 47, and did not return to pre-test levels until after the return of movement. The BIS showed a two-stage decrease, with an immediate reduction to values around 80, and then several minutes later, a sharp decrease to lower values. In some subjects, there were periods where the BIS was <60 for several minutes. The response was similar for both suxamethonium and rocuronium. Neither monitor was consistently superior in reporting the true state of awareness. CONCLUSIONS: These results suggest that the BIS monitor requires muscle activity, in addition to an awake EEG, in order to generate values indicating that the subject is awake. Consequently, BIS may be an unreliable indicator of awareness in patients who have received neuromuscular blocking drugs. CLINICAL TRIAL REGISTRY NUMBER: ACTRN12613000587707.

Using (137)Cs and (210)Pbex and other sediment source fingerprints to document suspended sediment sources in small forested catchments in south-central Chile.

A study of the impact of forest harvesting operations on sediment mobilization from forested catchments has been undertaken in south-central Chile. The study focused on two sets of small paired catchments (treatment and control), with similar soil type, but contrasting mean annual rainfall, located about 400 km apart at Nacimiento (1200 mm yr(-1)) and Los Ulmos (2500 mm yr(-1)). The objective was to study the changes in the relative contribution of the primary sources of fine sediment caused by forestry operations. Attention focused on the pre-harvest and post-harvest periods and the post-replanting period was included for the Nacimiento treatment catchment. The sediment source fingerprinting technique was used to document the contributions of the potential sources. Emphasis was placed on discriminating between the forest slopes, forest roads and channel erosion as potential sources of fine sediment and on assessing the relative contributions of these three sources to the sediment yield from the catchments. The fallout radionuclides (FRNs) (137)Cs and excess lead-210, the environmental radionuclides (226)Ra and (40)K and soil organic matter (SOM) were tested as possible fingerprints for discriminating between potential sediment sources. The Kruskal-Wallis test and discriminant function analysis were used to guide the selection of the optimum fingerprint set for each catchment and observation period. Either one or both of the FRNs were selected for inclusion in the optimum fingerprint for all datasets. The relative contribution of each sediment source to the target sediment load was estimated using the selected fingerprint properties, and a mixing model coupled with a Monte Carlo simulation technique that takes account of uncertainty in characterizing sediment source properties. The goodness of fit of the mixing model was tested by comparing the measured and simulated fingerprint properties for the target sediment samples. In the Nacimiento treatment catchment the relative contribution from the forest slopes and forest roads increased from 16 to 25% and from 37 to 45%, respectively, after clearcutting. Similar changes in source contributions associated with clearcutting were documented for the Los Ulmos treatment catchment, where the relative contribution of the forest slopes increased from 10.5 to 30% and that of the roads from 10 to 20%. The results indicate that the changes in sediment source are closely related to the disturbance of the catchment by clearcutting, but are also influenced by the amount of rainfall that occurred after clearcutting. They also emphasise the need to implement better management practices during forest harvesting, to reduce the increase in sediment mobilization from catchment slopes and roads, which can result in loss of valuable soil and associated nutrients from the forest floor and cause degradation of the water quality of adjacent streams.

Fallout radionuclide-based techniques for assessing the impact of soil conservation measures on erosion control and soil quality: an overview of the main lessons learnt under an FAO/IAEA Coordinated Research Project.

This paper summarizes key findings and identifies the main lessons learnt from a 5-year (2002-2008) coordinated research project (CRP) on "Assessing the effectiveness of soil conservation measures for sustainable watershed management and crop production using fallout radionuclides" (D1.50.08), organized and funded by the International Atomic Energy Agency through the Joint FAO/IAEA Division of Nuclear Techniques in Food and Agriculture. The project brought together nineteen participants, from Australia, Austria, Brazil, Canada, Chile, China, Japan, Morocco, Pakistan, Poland, Romania, Russian Federation, Turkey, United Kingdom, United States of America and Vietnam, involved in the use of nuclear techniques and, more particularly, fallout radionuclides (FRN) to assess the relative impacts of different soil conservation measures on soil erosion and land productivity. The overall objective of the CRP was to develop improved land use and management strategies for sustainable watershed management through effective soil erosion control practices, by the use of ¹³7Cs (half-life of 30.2 years), ²¹°Pb(ex) (half-life of 22.3 years) and 7Be (half-life of 53.4 days) for measuring soil erosion over several spatial and temporal scales. The environmental conditions under which the different research teams applied the tools based on the use of fallout radionuclides varied considerably--a variety of climates, soils, topographies and land uses. Nevertheless, the achievements of the CRP, as reflected in this overview paper, demonstrate that fallout radionuclide-based techniques are powerful tools to assess soil erosion/deposition at several spatial and temporal scales in a wide range of environments, and offer potential to monitor soil quality. The success of the CRP has stimulated an interest in many IAEA Member States in the use of these methodologies to identify factors and practices that can enhance sustainable agriculture and minimize land degradation.

[Treatment of atrial fibrillation: behavioral, pharmacologic and catheter-based perspectives]. / Therapie des Vorhofflimmerns: Verhaltensorientierte, pharmakologische und katheter-interventionelle Perspektiven.

Atrial fibrillation (AF) is the most common heart rhythm disorder, with increasing prevalence in the aging population. The clinical presentation and evolution of AF can be highly variable. Therefore, treatment of AF can be challenging in some patients. This review summarizes recent developments in both prevention of thromboembolic events and rate/rhythm control highlighting the possibilities of behavioral, pharmacological, and catheter-based perspectives.

Effects of exercise training on mobilization and functional activity of blood-derived progenitor cells in patients with acute myocardial infarction.

BACKGROUND: The aim of the present study was to determine whether regular exercise training (ET) is effective at promoting the mobilization of CPCs and improving their functional activity in patients with recently acquired myocardial infarction (STEMI). Regular physical training has been shown to improve myocardial perfusion and cardiovascular function. This may be related in part to a mobilization of bone marrow-derived circulating progenitor cells (CPCs) as well as an enhanced vascularisation. METHODS: 37 patients with STEMI were randomly assigned to an ET group or a non-ET group (controls). Two weeks after STEMI, three weeks after regular ET and three months after ET, BNP levels, exercise echocardiography and exercise spiroergometry were evaluated. The number of CD34+/CD45+ and CD133+/CD45+ CPCs was measured by flow cytometry analysis. The migration capacity of the CPCs was determined with a boyden chamber and the clonogenic capacity by CFU-assay. RESULTS: In the ET-group the number and migration capacity of CPCs increased significantly after regular exercise training. The BNP level decreased significantly from 121 +/- 94 to 75 +/- 47 pg/ml (p<0.001) after the ET period, the left ventricular ejection fraction raised in parallel at peak exercise, and the cardiorespiratory condition improved as demonstrated by an increase of VO2max (from 1641 +/- 522 to 1842 +/- 724 ml/min, p<0.02). These three effects persist till three months after the ET period. CONCLUSIONS: Regular physical activity appears to predispose the mobilization and enhanced functional activity of CPCs, a phenomenon which might lead to an improved cardiac function in patients with recently acquired acute myocardial infarction.

Use of (7)Be to document soil erosion associated with a short period of extreme rainfall.

Intensification and expansion of agricultural production since the 1970s have increased soil erosion problems in south-central Chile. Quantitative information on soil loss is needed for erosion risk assessment and to establish the effectiveness of improved land management practices. Since information from traditional sources, such as erosion plots, is limited, attention has been directed to the use of environmental radionuclides for documenting erosion rates. Cs-137 has been successfully utilised for this purpose, but only provides information on medium-term erosion rates. There is also a need to document event-related soil erosion. This paper outlines the basis for using (7)Be measurements to document short-term erosion and reports its successful use for quantifying the erosion that occurred within an arable field, as a result of a period of heavy rainfall (400mm in 27 days) occurring in May 2005. The study field had been under a no-till, no-burning system for 18 years, but immediately prior to the period of heavy rainfall the harvest residues were burnt. The erosion recorded therefore reflected both the extreme nature of the rainfall and the effects of the burning in increasing surface runoff and erosion. The sampled area corresponded to that used previously by the authors to document the medium-term erosion rates associated with both conventional tillage and the subsequent switch to a no-till system. Comparisons between the erosion documented for the period of heavy rainfall in 2005 with these medium-term erosion rates permits some tentative conclusions regarding the importance of extreme events and the impact of burning in increasing the erosion associated with the no-till system.

Seasonal variation of the radiocaesium transfer soil-to-Swiss chard (Beta vulgaris var. cicla L.) in allophanic soils from the Lake Region, Chile.

The transfer factor (TF) of radiocaesium from soil-to-Swiss chard (Beta vulgaris var. cicla L.) was studied in two different characteristic allophanic soils (umbric andosol and dystric fluvisol) of the Lake Region, an important agricultural region situated in central-south Chile. To investigate especially the time dependence and the effect of K-fertilisation on the TF, field experiments were conducted. Plots of 7.6 m2 were labelled with 100 kBq 134Cs m(-2) at Santa Rosa Experiment Station close to the city of Valdivia characterised by a temperate climate and high precipitation rates. The variation in time of the radiocaesium TF soil-to-Swiss chard was observed during two consecutive years after soil contamination by sequential harvests and radiocaesium analyses of the plants. The TFs showed no significant ageing effect, but a pronounced seasonal decrease with effective half-lives of about 140 and 160 days for the umbric andosol without and with K-fertilisation, respectively, and of 50 and 60 days for the dystric fluvisol without and with K-fertilisation, respectively. The effect of K-fertilisation on the absolute values of the TF was determined by the ratio between the median TF values obtained for corresponding dates without and with use of K-fertiliser. A ratio of TF(without K)/TF(with K) = 1.8 for the umbric andosol and TF(without K)/TF(with K) = 2.9 for the dystric fluvisol was obtained, indicating a reduction of the TF by applying 90 kg K ha(-1). The maximal values of the TF to chard predicted by the equation characterising the seasonal decrease of the TF at the beginning of the harvest periods are 0.19 for the umbric andosol and 0.11 for the dystric fluvisol, both values for soil treated with common K-fertilisation.

Use of 137Cs measurements to estimate changes in soil erosion rates associated with changes in soil management practices on cultivated land.

Intensification of agricultural production in south-central Chile since the 1970s has caused problems of increased soil erosion and associated soil degradation. These problems have prompted a shift from conventional tillage to no-till management practices. Faced with the need to establish the impact of this shift in soil management on rates of soil loss, the use of caesium-137 (137Cs) measurements has been explored. A novel procedure for using measurements of the 137Cs depth distribution to estimate rates of soil loss at a sampling point under the original conventional tillage and after the shift to no-till management has been developed. This procedure has been successfully applied to a study site at Buenos Aires farm near Carahue in the 9th region of Chile. The results obtained indicate that the shift from conventional tillage to no-till management has caused net rates of soil loss to decrease to about 40% of those existing under conventional tillage. This assessment of the impact of introducing no-till management at the study site must, however, be seen as provisional, since only a limited number of sampling points were used. A simplified procedure aimed at documenting the reduction in erosion rates at additional sampling points, based solely on measurements of the 137Cs inventory of bulk cores and the 137Cs activity in the upper part of the soil has been developed and successfully tested at the study site. Previous application of 137Cs measurements to estimate erosion rates has been limited to estimation of medium-term erosion rates during the period extending from the beginning of fallout receipt to the time of sampling. The procedures described in this paper, which permits estimation of the change in erosion rates associated with a shift in land management practices, must be seen as representing a novel application of 137Cs measurements in soil erosion investigations.

Global fallout (137)Cs accumulation and vertical migration in selected soils from South Patagonia.

The spatial distribution and vertical migration of global fallout (137)Cs were studied in soils from South Patagonia at the austral region of South America in semi-natural and natural environments located between 50-54 degrees S and 68-74 degrees W. The (137)Cs areal activity density varied from 222 to 858 Bq m(-2), and was found to be significantly positively correlated (p<0.001) with the mean annual precipitation rate. The fraction of the total activity density observed in steppe grass varied from <0.03% to 0.12% (median <0.07%) and is considerably lower than the results obtained at the South Shetland Islands (median 8%) and in other temperate environments in south-central Chile (median 0.2%). The median of the convection velocity v(s) of (137)Cs in the soil in such polar isotundra climate has been determined to be 0.056 cm y(-1). This value is higher than v(s) determined under polar climate (-0.012 cm y(-1)) and is near to the upper limit of v(s)-values determined in temperate environments from Chile (0.019 cm y(-1)). The median value of the diffusion coefficient D(s) (0.048 cm(2) y(-1)) is similar to D(s) observed in an Antarctic region (0.043 cm(2) y(-1)) and lower than D(s) in temperate regions of Chile (1.24 cm(2) y(-1)). About 35 years after the highest depositions, (137)Cs had penetrated to a depth of 6-14 cm in the Patagonian soils and can be expected to remain in the rooting zone of grass for many decades. Nevertheless, because of its low transfer to steppe grass observed at this region, the radioecological sensitivity of this ecosystem with respect to fallout radiocesium seems to be lower than in other polar regions.

Global weapons' fallout 137Cs in soils and transfer to vegetation in south-central Chile.

The contamination and depth distribution of 137Cs in soil due to the fallout from atmospheric weapons' tests were measured at 29 sites in the 9th and 10th administrative regions in Chile located in the 40 degrees latitude in the southern hemisphere. The depth distribution in most of the sites follows no systematic pattern in the upper few centimetres, but below this depth an exponential decline could be deduced. The calculated relaxation depth appears to be a good indicator for estimating the long-term 137Cs distribution in these soil profiles. It ranges from 4.4 +/- 1.9 cm in Palehumults to 8.4 +/- 4.4 and 9.7 +/- 5.1 cm in Hapludands and Psamments, respectively. For these soil types the value for the relaxation depth tends to increase with decreasing clay content and increasing volume of coarse pores. 137Cs activity densities at the selected sites ranged from 450 to 5410 Bq m(-2) and correlate significantly (r = 0.791) with the mean annual rainfall rate of the sampling sites. 137Cs concentration ratios of prairie plants/soil were found to be in the range 0.008-2.3 and could be related to relaxation depths in undisturbed soils.

Fallout radiocesium in an Antarctic region: deposition history, activity densities and vertical transport in soils.

To improve the knowledge about the (137)Cs spatial distribution and vertical migration in soils of the Southern Hemisphere, the total areal activity density and the vertical transport parameters of this radionuclide were measured in an Antarctic region. For this purpose vegetation and incremental soil samples were collected at 21 representative sites located at 4 islands of the South Shetland Archipelago: King George, Robert, Greenwich and Snow (62-63 degrees S and 58-62 degrees W). The total (137)Cs activity density varied considerably from 118 to 662 Bq m(-2) (median 384 Bq m(-2), reference date 1995), with a high percentage of the total activity retained in the vegetation cover (5-98% in moss, 3-20% in lichen and 4-12% in grass). At most sites, the maximum activity density in soil was observed in the top layer from where it decreased continuously. To evaluate the transport parameters of (137)Cs from the activity-depth profiles, the classical convection-diffusion model was used based on the time-course of the annual deposition density of (137)Cs at the studied region. The values for the diffusion coefficient D(s) (median 0.043 cm(2) year(-1)) and the convection velocity v(s) (median -0.012 cm year(-1)) of radiocesium observed under a polar climate are small compared to the transport parameters determined in temperate zones. The data also indicate that at these sites the convectional transport of (137)Cs is almost negligible compared to the transport by diffusion. The high vulnerability of the Antarctic soils to (137)Cs deposition, as a consequence of its very slow transport due to the extreme climatic conditions at these latitudes, has been confirmed.

Fast neutron irradiation in advanced pre-irradiated head and neck tumors.

AIMS AND BACKGROUND: Radiotherapy with fast neutrons offers radiobiological advantages in the treatment of hypoxic and slowly proliferating tumors. Tumors recurring in pre-irradiated areas of the head and neck usually exhibit a low radiation sensitivity that seems to promise little success for a repeated irradiation with photons. In such a situation, radiotherapy with fast neutrons may offer an alternative treatment option. To evaluate the question, the Muenster patients were retrospectively analyzed. METHODS: During the period July 1986 to January 1994, 26 patients with local-regional recurrences of pre-irradiated head and neck tumors were treated with fast neutrons at our department. RESULTS: Median survival calculated by the Kaplan-Meier method was 7.4 months. The 1-year survival probability was 29.3% and the 2-year survival probability 5.9%. The objective tumor remission (complete + partial) was 50%. A subjective improvement of symptoms was reported by 42.3% of all patients. CONCLUSIONS: Despite relatively unfavorable survival rates produced by the therapy, good remission rates and thereby a good palliative effect can be attained with a short treatment time and tolerable side effects.

Simultaneous radiochemotherapy versus concomitant boost radiation for advanced inoperable head and neck cancer.

In this prospective, non-randomized study we compare the results of simultaneous radiochemotherapy (RCT) with those of concomitant boost treatment (CBT) in advanced head and neck cancer. From January 1993 to March 1999, 77 patients were treated with cisplatin, 5-FU, and 70.2 Gy (accelerated split-course); from January 1995 to March 1999, a further 33 patients received CBT to a total dose of 72 Gy. Toxicities were prospectively recorded according to RTOG/EORTC criteria. Acute and subacute reactions did not differ significantly. Severe late effects (III/IV) remained anecdotal (one fistula). Therapy-associated mortalities were 3%(RCT) vs. 0% (CBT), most tumors responding well to therapy (CR + PR: RCT: 72%, CBT: 63%). The 2-year probabilities for freedom from locoregional progression amounted to 42% (RCT) and 31% (CBT); p > 0.05. Tumor-specific 2-year survival amounted to 40% (RCT) and 34% (CBT); p > 0.05. Both of the treatment concepts yield high remission rates with moderate toxicities. Nevertheless, median time to recurrence is still fairly short. We could not find any differences for local control and survival. For patients who are not able to complete the full three courses of radiochemotherapy, the concomitant boost schedule presents a good alternative.

Results of prophylactic irradiation in patients with resected keloids--a retrospective analysis.

The data of 139 patients with 166 keloids treated postoperatively between 1962 and 1996 were evaluated for prognostic factors and outcomes. Treatment commenced within 48 h after surgery. Radiotherapy was carried out as brachytherapy, using an integrated radionuclide 90 Sr-90Y surface applicator. The median dose delivered to the subcutis amounted to 14 Gy (range 7.5-28.5 Gy). The overall recurrence-free response rate was calculated to be 80% for all keloids. Response rates differed significantly (p < 0.001) between the different anatomical regions. The recurrence rate was lowest (2%) with keloids of the face and neck and highest with keloids of the thorax (49%). Outcome also differed significantly, depending on the etiology. Keloids following burns had a poorer success rate than those developing after surgery or mechanical trauma (p < 0.001). We were unable to demonstrate any significance in outcome related to gender, age or size. No direct correlation was found between total doses and response rates. In our patients there were no signs of secondary malignancies in the irradiation area within a median follow-up period of 12 years. Two new prognostic factors have been identified: keloid etiology and localization of the disorder.

Results of fast neutron therapy of adenoid cystic carcinoma of the salivary glands.

BACKGROUND: Adenoid cystic carcinomas (ACC) seem to have a better response to fast neutron irradiation than to photon beam therapy because of the higher relative biological effectiveness of neutron radiation. METHODS: Between 1986 and 1995, 72 patients with ACC of the salivary glands were treated in Münster with fast neutrons. The median age was 54 years. All the patients had either recurrent or macroscopic rest tumor prior to neutron therapy. The median total dose was 15.03 Gy. Median follow-up was 50 months. RESULTS: 39.1% of the patients achieved a complete remission and 48.6% a partial remission. The survival probability was 86% after one year, 73% after two years and 53% after five years. The recurrence-free survival was 83% after one year, 71% after two years and 45% after five years. CONCLUSION: Neutron beam therapy seems to have been an effective treatment in these selected patients.