Excited states have been studied in 35Ar following the 16O(24Mg,1alpha1n)35Ar fusion-evaporation reaction at 60 MeV using the Ge-detector array GASP. A comparison with the mirror nucleus 35Cl shows ...two remarkable features: (i) A surprisingly large energy difference for the 13/2(-) states, in which the hitherto overlooked electromagnetic spin-orbit term is shown to play a major role, and (ii) a very different decay pattern for the 7/2(-) states, which provides direct evidence of isospin mixing.
Delirium has been associated with negative health consequences, which can potentially be improved by delirium risk modification. This study sought to determine if a quality improvement project to ...identify and modify delirium risk and discharge to rehabilitation is associated with improved outcomes for patients and health care systems.
In older veterans admitted to a tertiary VA hospital, delirium risk was assessed using cognitive impairment, vision impairment, and dehydration. Delirium risk was communicated to providers via electronic medical record. To modify delirium risk, interventions were provided in cognitive stimulation, sensory improvement, and sleep promotion. Primary outcomes included length of stay, restraint use, discharge to rehabilitation, and hospital variable direct costs. Outcomes were compared using a propensity-matched cohort of patients without intervention. Number of intervention categories was compared with primary outcomes.
Patients (n = 1527) were older (78.2 ± 8.3 years) and male (98%). Propensity-matched patients (n = 566) were well matched for age, gender, cognitive deficits, vision impairment, and dehydration. Patients with interventions were discharged to rehabilitation similarly (mean difference MD 2.2%, 95% CI -2.5-6.9) and had lower lengths of stay (MD -0.7 day, 95% CI -1.3 to -0.1), lower restraint use (MD -4.0%, 95% CI -6.7 to -1.2) and trended toward lower variable direct costs (MD -$1390, 95% CI -3586-807). Increasing number of interventions was associated with shorter length of stay, lower rate of restraint use, and lower variable direct costs.
This delirium risk modification project was associated with patient outcomes and reduced costs. Serious consideration should be given to delirium risk identification and modification programs.
To evaluate US Centers for Disease Control and Prevention recommended swab surface sample collection method for recovery efficiency and limit of detection for powdered Bacillus spores from nonporous ...surfaces. Stainless steel and painted wallboard surface coupons were seeded with dry aerosolized Bacillus atrophaeus spores and surface concentrations determined. The observed mean rayon swab recovery efficiency from stainless steel was 0·41 with a standard deviation (SD) of ±0·17 and for painted wallboard was 0·41 with an SD of ±0·23. Evaluation of a sonication extraction method for the rayon swabs produced a mean extraction efficiency of 0·76 with an SD of ±0·12. Swab recovery quantitative limits of detection were estimated at 25 colony forming units (CFU) per sample area for both stainless steel and painted wallboard. The swab sample collection method may be appropriate for small area sampling (10 -25 cm²) with a high agent concentration, but has limited value for large surface areas with a low agent concentration. The results of this study provide information necessary for the interpretation of swab environmental sample collection data, that is, positive swab samples are indicative of high surface concentrations and may imply a potential for exposure, whereas negative swab samples do not assure that organisms are absent from the surfaces sampled and may not assure the absence of the potential for exposure. It is critical from a public health perspective that the information obtained is accurate and reproducible. The consequence of an inappropriate public health response founded on information gathered using an ineffective or unreliable sample collection method has the potential for undesired social and economic impact.
Pyogenic flexor tenosynovitis (PFT) is frequently diagnosed by physical examination according to the Kanavel signs. This study proposes a modification of the Kanavel sign "tenderness over the course ...of the flexor sheath" by including palpation of the A1 pulley to increase specificity for diagnosis.
A retrospective review was performed over 8 months for patients in the emergency department who received a consult to hand surgery to rule out PFT. Two cohorts, nonPFT infections and PFT infections, were studied for the presence or absence of the four Kanavel signs, as well as tenderness specifically over the A1 pulley on the affected digit(s) or T1 pulley of the thumb.
There were a total of 33 patients in the two cohorts (21 nonPFT, 12 PFT) with statistically significant differences with regard to the presence of all the Kanavel signs. A1 pulley tenderness had the greatest odds ratio, positive predictive value, specificity, and accuracy when compared with all Kanavel signs. When used in conjunction with each Kanavel sign, there was an increase in specificity in all four signs. Receiver operating characteristic analysis revealed increased area under the curve with A1 pulley tenderness added, indicating improved ability to classify hand infections as PFT versus nonPFT.
Although the classic Kanavel signs have shown reliable clinical utility, this study finds that tenderness at the A1 pulley can be a useful specification of "tenderness over the course of the flexor sheath" to help with the diagnosis of PFT.
A rapid, cost-effective diagnostic or confirmatory test for the detection of early HIV-1 infection is highly desired, especially for use in resource-poor or point-of-care settings. The ...reverse-transcription loop-mediated isothermal amplification (RT-LAMP) technology has been evaluated for the detection of HIV-1 DNA and RNA, using six RT-LAMP primers designed against highly conserved sequences located within the protease and p24 gene regions. Amplification from lab-adapted HIV-1 DNA and RNA was detected as early as 30
min, with maximum sensitivity of 10 and 100 copies per reaction, respectively, reached at 60
min. Comparable sensitivity was observed with extracted nucleic acid from plasma and blood samples of HIV-1-infected individuals. Furthermore, the RT-LAMP procedure was modified for the direct detection of HIV-1 nucleic acid in plasma and blood samples, eliminating the need for an additional nucleic acid extraction step and reducing the overall procedure time to approximately 90
min.
Coalbead methane is part of the non-conventional gas reservoirs and makes a significant contribution to gas production in some parts of the world. Initially, it was assumed that coalbed methane was ...of thermogenic origin, but most recent studies based on isotope and chemical data and taking into account the hydrogeology of the basin have demonstrated that secondary biogenic gases are formed in many coal-bearing basins. This study, using a similar approach, evaluated the origin of the gas in the Elk Valley coalfield located in British Columbia, Canada. Isotope data in methane samples collected from testhole wells and piezometers show a range that varies from −51.8‰ to −65.4‰ and −303‰ to −415‰ for
δ
13C and
δ
2H, respectively. The
δ
2H data, which are among the most depleted data reported for coalbed methane, have to be related to the very depleted
δ
2H values of the groundwater (−148‰ to −163‰). Isotope and chemical data collected from DIC show a trend of increasing
δ
13C values (−11.9‰ to +34.9‰) associated with an increase in DIC concentration (216 to 1650 mg/l). The most
13C depleted DIC and low DIC waters are found in the shallow groundwater flow system representing conditions close to recharge areas, while the most
13C enriched DIC and high concentration DIC waters are found in the discharge areas associated with a deep groundwater flow system. The DIC pattern, which is typical for methanogenic aquifers, and the isotope data obtained in methane samples clearly indicate that the gas found in the Elk Valley coalfield is mainly biogenic in origin. This study reaffirms that an approach that combines an evaluation of the groundwater flow system, the isotopic characterization and concentration pattern of the main carbon pools (CH
4 and DIC), and the isotopic characterization of the groundwater is needed to fully evaluate the origin of gases in coal basins.
Indeterminate colitis: the real story Rudolph, William G; Uthoff, Sonja M S; McAuliffe, Tracy L ...
Diseases of the colon & rectum,
11/2002, Letnik:
45, Številka:
11
Journal Article
Recenzirano
Up to one in five patients undergoing surgery for ulcerative colitis will have ambiguous histology, with features of both ulcerative colitis and Crohn's disease, and are categorized as having ...indeterminate colitis. We hypothesized that functional outcomes in indeterminate colitis patients undergoing ileal pouch-anal anastomosis are comparable with those of ulcerative colitis patients undergoing ileal pouch-anal anastomosis.
Physician-conducted interviews of 120 consecutive ileal pouch-anal anastomosis patients with a preoperative diagnosis of ulcerative colitis were reviewed, with a mean follow-up of 54 months. All colectomy specimens were reviewed by a single pathologist. Any changes in histologic diagnosis from ulcerative colitis to indeterminate colitis or Crohn's disease, frequency of postoperative complications, pouch function, and long-term postoperative medication usage were recorded.
Although postoperative fistulas were more common in indeterminate colitis than ulcerative colitis (26 vs. 10 percent; P = 0.02, chi-squared), no indeterminate colitis patient required a permanent ileostomy as compared with six ulcerative colitis patients. Long-term functional results were similar. Overall, two-thirds of patients developed pouchitis. Ulcerative colitis and Crohn's disease patients were more likely to have had >3 episodes of pouchitis (58 and 72 percent) compared with indeterminate colitis patients (29 percent; P = 0.006, chi-squared). A greater number of Crohn's disease patients required maintenance oral antibiotic therapy (64 percent) to achieve satisfactory functional results compared with both indeterminate colitis and ulcerative colitis patients (20 and 28 percent; P = 0.014, chi-squared).
Although ileal pouch-anal anastomosis patients with indeterminate colitis have more postoperative fistulas, long-term function is equal to that of ulcerative colitis patients and better than Crohn's disease patients. Ileal pouch-anal anastomosis should be offered to patients with indeterminate colitis and those with severe colitis in whom clear differentiation between indeterminate colitis and ulcerative colitis cannot be made.
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