Comparing minimally invasive and proactive initial management of extremely preterm infants.

AIM: In 2005, we changed our minimally invasive departmental policy for infants born before 26 weeks of gestation to a proactive approach. This included structured guidelines as well as intubation and surfactant in the delivery room, if the parents agreed. The aim of this study was to evaluate the effect of this change of policy. METHOD: We compared the Ages and Stages Questionnaire (ASQ) scores, mortality rates and use of mechanical ventilation before (1999-2003) and after (2005-2011) the introduction of the new policy. RESULTS: Twenty-two per cent of 61 infants in the before group had an ASQ z-score of <-2 standard deviation at 18 months' corrected age, compared with 26% of 55 infants in the after group. Mortality decreased from 46% to 36% (p = 0.06) and the use of mechanical ventilation at any time during admission increased from 64% to 87% (p < 0.0001). CONCLUSION: We demonstrated that changing our policy to a proactive approach to the initial care of infants born before 26 weeks did not result in a major increase in psychomotor deficit. However, the use of mechanical ventilation increased significantly and survival tended to improve.

Increased nuchal translucency, normal karyotype and infant development.

OBJECTIVE: To investigate whether chromosomally normal fetuses with a nuchal translucency (NT) ≥ 99th percentile(3.5 mm) in the first trimester have an increased risk of delayed development at 2 years of age. METHODS: The study included children of women from 10 Danish hospitals who had fetal NT either ≥ 99th percentile (Group 1) or <95th percentile (Group 2) in the first trimester. The groups were matched by gender,gestational age at birth and maternal age. There were twice as many children in Group 2 as in Group 1. Follow-up was conducted at 2 years of age, infant development being assessed by the 'Ages and Stages Questionnaire'. The cutoff value for delayed development was defined as the 5th percentile from the first 100 questionnaires from Group 2. RESULTS: In a 1-year period 202 of 33 266 fetuses (0.6%)had NT ≥ 3.5 mm. Of these, 99 (49.0%) were liveborn with normal karyotype and normal ultrasound findings during pregnancy. The response rate to the ASQ was 83.3% in Group 1 and 71.4% in Group 2. A low ASQ score was found in 1.3% (1/80) and 4.4% (6/137)in Groups 1 and 2, respectively (P = 0.265), but no difference was found in the mean ASQ score between the two groups (P = 0.160). CONCLUSION: Fetuses with NT ≥ 99th percentile, normal karyotype and normal ultrasound findings during pregnancy had no increased risk of developmental delay at 2 years of age compared with fetuses with normal NT(<95th percentile).

Consumption of Raw Flour in the United States: Results from the 2019 U.S. Food and Drug Administration Food Safety and Nutrition Survey.

ABSTRACT: Several outbreaks of Shiga toxin-producing Escherichia coli infections in the past decade have been linked to flour and flour-associated products and have raised concerns that the consumption of raw flour represents a public health risk as a vehicle for foodborne pathogens. The extent to which consumers know and understand that they should not consume raw flour is unclear. In fall 2019, the U.S. Food and Drug Administration collected data on perceptions regarding uncooked flour and on self-reported consumption behaviors via the Food Safety and Nutrition Survey, a national probability survey of U.S. adults (≥18 years of age). Cross-tabulations and regressions were used to analyze the data (n = 2,171). Thirty-five percent of consumers reported having tasted or eaten something with uncooked flour in it in the previous 12 months. Responses differed significantly by sex, race, education, and age. On average, respondents indicated that uncooked flour is not likely to contain germs that can make people sick, with significant differences noted by demographic categories. Respondents rated raw homemade cookie dough as moderately likely to have germs that can make people sick, with significant demographic differences. These findings indicate that U.S. consumers are largely unaware that raw flour is risky to consume, and many people are consuming products that contain raw flour.

Hand Washing Observations in Fast-Food and Full-Service Restaurants: Results from the 2014 U.S. Food and Drug Administration Retail Food Risk Factors Study.

ABSTRACT: Properly executed hand washing by food service employees can greatly minimize the risk of transmitting foodborne pathogens to food and food contact surfaces in restaurants. However, food service employee hand washing is often not done correctly or does not occur as often as it should. The purpose of this study was to assess the relative impact of (i) the convenience and accessibility of hand washing facilities; (ii) the maintenance of hand washing supplies, (iii) multiunit status, (iv) having a certified food protection manager, and (v) having a food safety management system for compliance with proper hand washing. Results revealed marked differences in hand washing behaviors between fast-food and full-service restaurants; 45% of 425 fast-food restaurants and 57% of 396 full-service restaurants were out of compliance for washing hands correctly, and 57% of fast-food restaurants and 78% of full-service restaurants were out of compliance for employee hands being washed when required. Logistic regression results indicated the benefits of accessibility and maintenance of the hand washing sink and of a food safety management system for increasing the likelihood of employees washing hands when they are supposed to and washing them correctly when they do.

[Clinical case of the month. Spontaneous pneumopericardium after sternal dehiscence]. / Pneumopéricarde dans les suites d'une déhiscence de sternum.

We report a case of pneumopericardium occuring after cardiac surgery. Pneumopericardium is a rare condition; trauma is the most frequent etiology. Nontraumatic causes include fistulae in relationship with the bronchial tree or oesophagus and intrapericardial gazeous production due to bacterial pericarditis. Pericardiocentesis is indicated in case of air tamponade and local infection.

Transcriptome profile of yeast reveals the essential role of PMA2 and uncharacterized gene YBR056W-A (MNC1) in adaptation to toxic manganese concentration.

Adaptation of S. cerevisiae to toxic concentrations of manganese provides a physiological model of heavy metal homeostasis. Transcriptome analysis of adapted yeast cells reveals upregulation of cell wall and plasma membrane proteins including membrane transporters. The gene expression in adapted cells differs from that of cells under short-term toxic metal stress. Among the most significantly upregulated genes are PMA2, encoding an ortholog of Pma1 H+-ATPase of the plasma membrane, and YBR056W-A, encoding a putative membrane protein Mnc1 that belongs to the CYSTM family and presumably chelates manganese at the cell surface. We demonstrate that these genes are essential for the adaptation to toxic manganese concentration and propose an extended scheme of manganese detoxification in yeast.

On the relationship of image intensifier contrast ratios measured by two techniques.

In recent years the contrast ratio (CR) has played an important role in the quantitation of imaging performance of X-ray image intensifiers. In practice, one uses either a lead disc or strip for measurement of contrast ratios. A theoretical relationship relating contrast ratios measured by both disc and strip techniques is discussed and experimental results are presented. The theoretical analysis uses the point spread function model to describe veiling glare for an image intensifier. It has been shown that one can predict strip contrast ratios after a determination of the veiling glare point spread function from a measurement of disc contrast ratios.

The triad of empowerment: leadership, environment, and professional traits.

Empowerment is defined as "moving decision making down to the lowest level where competent decisions can be made." In the hospital setting, this would most commonly be at the point of direct patient care or staff nurse level; however, this kind of empowerment requires an environment of autonomy where mutual trust and respect are encouraged. The empowerment process requires that staff be prepared to accept and effectively use expanded decision-making responsibilities. The professional accountabilities of the empowered nurse include having a sense of value about their work and willingness to provide the full scope of practice as well as ability to work as equal members of a comprehensive interdisciplinary team. In order to move into a fully empowered position, professional nurses need mentoring, education, awareness of political activism opportunities, and networking skills.

[Comparison of two protocols of prophylactic antibiotic therapy in childhood appendectomy]. / Comparaison de deux protocoles d'antibioprophylaxie associée à l'appendicectomie de l'enfant.

OBJECTIVE: Antibiotic administration during acute appendicitis in children continues to be debated. The purpose of this study was to compare efficacy of two prophylactic antibiotic treatment guidelines in acute appendicitis and peritonitis in children. MATERIEL AND METHODS: The infectious complication rate after appendicectomy was compared during two distinct periods (before/after study). During the first period, the guidelines for antibiotic administration were based on ticarcillin-clavulanic acid. During the second period, the guidelines were based on amoxicillin-clavulanic acid for non-perforated appendicitis or appendicitis with localized peritonitis, and clavulanic acid was reserved for general peritonitis. All children younger than 16 years of age who underwent appendicectomy during the periods studied were included. Data were retrospectively collected from surgical and anesthetics charts. RESULTS: Ninety-five children during the first period and 238 during the second were included. In the children with non-perforated appendicitis, no postoperative infectious complication occurred in 74 children during the first period versus two out of 153 (1%) during the second period. In cases of perforated appendicitis, postoperative infectious complications occurred two cases (10%) during the first period versus nine (11%) during the second. There were no significant differences between the two periods. CONCLUSION: In this population, antibiotic administration guidelines based on amoxicillin-clavulanic acid for stages I-III of appendicitis maintained a low rate of postoperative infectious complications and were not associated with a higher postoperative infectious complication rate than guidelines based on ticarcillin-clavulanic acid.

Human African trypanosomiasis in Angola: clinical observations, treatment, and use of PCR for stage determination of early stage of the disease.

Biological and clinical observations are described for 224 patients infected by human African trypanosomiasis (HAT) in Angola in 2007 and 2008. Seven patients were initially classified in stage 1 (S1), 17 intermediate stage (IS) (WBC <20 lymphocytes/µl with absence of trypanosomes in cerebrospinal fluid (CSF) and no neurological signs), and 200 in stage 2 (S2). Out of 224 patients, 165 (73.6%) presented one or more neurological signs. During treatment with eflornithine, six deaths of S2 patients occurred, five of which were because of an encephalopathy syndrome. Nine patients were diagnosed with a relapse or suspected treatment failure during the follow-up: eight patients after treatment with eflornithine (relapse rate 4.1%) and one patient after pentamidine (6.6%). The contribution of PCR for stage determination evaluated for S1 and IS confirms the difficulty of stage determination, as one S1 patient and two IS patients were carriers of trypanosomes detected a posteriori by PCR in CSF but were treated with pentamidine while follow-up did not confirm treatment efficacy. Since 2001 in Angola, either by passive or active mode detection, approximately 80% of the new cases every year were in S2, whereas the annual number of cases has regressed, probably because the transmission of HAT is decreasing. However, stage determination and treatment remain two major issues for the chronic form of sleeping sickness.

Coarsening and pearling instabilities in silver nanofractal aggregates.

We investigate the morphological changes of 3D supported fractal aggregates generated through the deposition of silver clusters on graphite. The fractal relaxation, activated after their formation by perturbing them either by thermal annealing or by using a surfactant, as oxide molecules, carried by silver clusters in a subsequent deposition, shows evidence of two distinct fragmentation patterns. The post coarsening, driven by thermal heating, gives a broad asymmetrical distribution of fragments in agreement with a random process, whereas the entire silver fractal pearling fragmentation is driven by chemical adjunction of the surfactant.

Manager, manage thyself!

As the environment surrounding the delivery of health care remains unpredictable, nurse managers are challenged to create new and innovative ways to meet the demands before them. The ever-increasing challenges and decreasing resources can have great impact on the stress level of even the most seasoned nurse manager. This article offers nurse managers 10 useful strategies to enhance their stress management skills. The key for successful stress management is taking time to care for oneself and thus remain an effective leader in the organization.

Synthesis of silver molybdate clusters driven by laser-annealing.

The synthesis of silver rich molybdate clusters is achieved by laser induced chemical reaction of coadsorbed MoO(3) and O(2) molecules on free silver clusters. The reactants MoO(3) and/or O(2) molecules condensed at low temperature (77 K-175 K) on free silver clusters. Then, the silver clusters together with their adsorbed molecules are flashed either ionized with a discharge or ionized and heated by a laser. Then they are cooled down by evaporation. The synthesized chemical compounds are analyzed by a high-resolution time-of-flight mass spectrometer. If only one type of reactant is adsorbed on the cluster, only one oxide molecule is stabilized on the metallic core after the heating and cooling cycle. On the contrary, the coadsorption of the two types of molecules MoO(3) and O(2) on Ag(n) (+), at 77 K, leads to complex aggregates that transform, after laser heating, into a molybdate rich metal clusters. These synthesized species cool down by evaporating silver atoms showing evidence of a binary oxide that is more stable than the metallic core. Moreover we demonstrate that for small size molybdate clusters, a stoichiometric composition may differ from the bulk one.

Target concentration of propofol required to insert the laryngeal mask airway in children.

BACKGROUND: The aim of this prospective study was to determine the target concentration (CPRED) curves for laryngeal mask airway (LMA) insertion in children. METHODS: The CPRED of propofol required for insertion of the LMA was determined in 72 unpremedicated children, aged 3-10 years, ASA physical status I. CPRED was reached in 2 min according to a sequential allocation. LMA insertion was then performed by an experienced anaesthetist who was unaware of the concentration. Insertion conditions were noted as satisfactory (jaw relaxed, no coughing, gagging, swallowing or laryngeal spasm, minimal limb movement), excellent (no movement at all) or unacceptable if otherwise. RESULTS: The CPRED50 and CPRED90 were 7.86 microg.ml(-l)[95% confidence interval (CI) 6.46-9.26] and 10.71 microg.ml(-l) (95% CI 9.31-12.12), respectively, in the satisfactory group and 10.86 microg.ml(-l) (95% CI 10.14-11.57) and 13.71 microg.ml(-l) (95% CI 12.99-14.42) in the excellent group when calculations were based on Kataria's pharmacokinetics. These figures were increased 1.5-fold when calculations were based on Marsh's pharmacokinetics. With Schüttler's pharmacokinetics, CPRED50 were 4.62 microg.ml(-l) and 13.66 microg.ml(-l) for satisfactory and excellent groups, respectively. CONCLUSIONS: The target-controlled infusion technique for anaesthesia induction and insertion of the LMA was a safe and effective technique in our study.

Superficial mycoses and HIV infection in Yaounde.

The incidence of superficial infections in patients with human immunodeficiency virus (HIV) is increasing in Yaounde. To determine the prevalence of superficial mycoses in HIV-positive subjects, a study was carried out in different hospital settings in Yaounde over a period of 18 months. Clinical observations were followed by the culture of samples on Sabouraud's glucose agar. Of the 148 HIVab-positive patients examined, 79 (44 males and 35 females) had at least one superficial mycosis (53%). The clinical presentations and the causative organisms did not differ from those found in immunocompetent individuals. The main lesions were oral candidiasis (77%), tinea corporis (21%), tinea versicolor (15%), tinea pedis (13%) and tinea inguium (12%). Trichophyton rubrum and Candida albicans were the organisms most commonly isolated. These results indicate the benefit of studying superficial mycoses for optimal management of HIV patients.