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An infection surveillance system based on a hospital's digital twin [4D-Disease Outbreak Surveillance System (4D-DOSS)] is being developed in Singapore. It offers near-real-time infection surveillance and mapping capabilities. This early economic modelling study was conducted, using meticillin-resistant Staphylococcus aureus (MRSA) as the pathogen of interest, to assess the potential cost-effectiveness of 4D-DOSS. A Markov model that simulates the likelihood of MRSA colonization and infection was developed to evaluate the cost-effectiveness of adopting 4D-DOSS for MRSA surveillance from the hospital perspective, compared with current practice. The cycle duration was 1 day, and the model horizon was 30 days. Probabilistic sensitivity analysis was conducted, and the probability of cost-effectiveness was reported. Scenario analyses and a value of information analysis were performed. In the base-case scenario, with 10-year implementation/maintenance costs of 4D-DOSS of $0, there was 68.6% chance that 4D-DOSS would be cost-effective. In a more pessimistic but plausible scenario where the effectiveness of 4D-DOSS in reducing MRSA transmission was one-quarter of the base-case scenario with 10-year implementation/maintenance costs of $1 million, there was 47.7% chance that adoption of 4D-DOSS would be cost-effective. The value of information analysis showed that uncertainty in MRSA costs made the greatest contribution to model uncertainty. This early-stage modelling study revealed the circumstances for which 4D-DOSS is likely to be cost-effective at the current willingness-to-pay threshold, and identified the parameters for which further research will be worthwhile to reduce model uncertainty. Inclusion of other drug-resistant organisms will provide a more thorough assessment of the cost-effectiveness of 4D-DOSS. [ABSTRACT FROM AUTHOR]

HIV disproportionately affects young Black men who have sex with men (YBMSM) in the Southern United States. Pre-exposure prophylaxis (PrEP) is an efficacious, biomedical approach to prevent HIV. While Mississippi (MS) has among the highest rates of new HIV infections, it also ranks among the top three states for unmet PrEP need. Thus, increasing engagement in PrEP care for YBMSM in MS is imperative. A potential method to improve psychological flexibility and promote PrEP uptake, explored by this study, is the incorporation of Acceptance and Commitment Therapy (ACT) into PrEP interventions. ACT is an evidence-based intervention used to treat a wide range of mental and physical illnesses. Twenty PrEP-eligible YBMSM and ten clinic staff working with YBMSM in MS were surveyed and interviewed between October 2021 and April 2022. The brief survey covered PrEP structural barriers, PrEP stigma, and psychological flexibility. Interview topics included internal experiences related to PrEP, existing health behaviors, PrEP related personal values, and relevant constructs from the Adaptome Model of Intervention Adaptation (service setting, target audience, mode of delivery, and cultural adaptations). Qualitative data were coded based on ACT and the Adaptome model, organized using NVivo, then thematically analyzed. Patients identified side effects, costs, and taking a daily prescription as top barriers to taking PrEP. Staff reported the top barrier to PrEP for clients was concern others would believe they were living with HIV. Levels of psychological flexibility and inflexibility varied widely among participants. The resulting thematic categories derived from the interviews included 1) thoughts, emotions, associations, memories, and sensations (TEAMS) related to PrEP and HIV, 2) general health behaviors (existing coping techniques, views on medication, HIV/PrEP approach and avoidance), 3) values related to PrEP use (relationship values, health values, intimacy values, longevity values), and 4) Adaptome Model adaptations. These results informed the development of a new intervention, ACTPrEP. Interview data organized by the Adaptome Model of Intervention Adaptation determined appropriate ACT-informed intervention components, content, intervention adaptations, and implementation strategies. Interventions informed by ACT that help YBMSM endure short-term discomfort related to PrEP by relating it to their values and long-term health goals are promising for increasing individuals' willingness to initiate and maintain PrEP care. • HIV disproportionately affects young Black men who have sex with men (YBMSM). Pre-exposure prophylaxis (PrEP) prevents HIV. • 20 PrEP-eligible YBMSM and 10 clinic staff in Mississippi were surveyed and interviewed between October 2021 and April 2022. • Thematic categories: thoughts, emotions, associations, memories, and sensations, health behaviors, values, and adaptations. • Interventions informed by ACT can help YBMSM endure short-term discomfort and increase willingness to initiate PrEP. [ABSTRACT FROM AUTHOR]

Pharmacokinetic analysis is an experimentally determined theory of how a drug behaves when in vivo. Volume of distribution, clearance and terminal half-life are defined. Compartmental modelling is introduced and some relevant graphs are described in this article. Applications of this theory in anaesthesia are considered. [ABSTRACT FROM AUTHOR]

Articular cartilage tissue exhibits a spatial dependence in material properties that govern mechanical behaviour. A mathematical model of cartilage tissue under one dimensional confined compression testing is developed for normal tissue that takes account of these variations in material properties. Modifications to the model representative of a selection of mechanisms driving osteoarthritic cartilage are proposed, allowing application of the model to both physiological and pathophysiological, osteoarthritic tissue. Incorporating spatial variations into the model requires the specification of more parameters than are required in the absence of these variations. A global sensitivity analysis of these parameters is implemented to identify the dominant mechanisms of mechanical response, in normal and osteoarthritic cartilage tissue, to both static and dynamic loading. The most sensitive parameters differ between dynamic and static mechanics of the cartilage, and also differ between physiological and osteoarthritic pathophysiological cartilage. As a consequence changes in cartilage mechanics in response to alterations in cartilage structure are predicted to be contingent on the nature of loading and the health, or otherwise, of the cartilage. In particular the mechanical response of cartilage, especially deformation, is predicted to be much more sensitive to cartilage stiffness in the superficial zone given the onset of osteoarthritic changes to material properties, such as superficial zone increases in permeability and reductions in fixed charge. In turn this indicates that any degenerative changes in the stiffness associated with the superficial cartilage collagen mesh are amplified if other elements of osteoarthritic disease are present, which provides a suggested mechanism-based explanation for observations that the range of mechanical parameters representative of normal and osteoarthritic tissue can overlap substantially. [ABSTRACT FROM AUTHOR]

Stroke and carotid atherosclerosis are associated with dementia. Carotid endarterectomy (CEA) reduces stroke risk, although its effect on later dementia is uncertain. Participants in the Asymptomatic Carotid Surgery Trial (ACST-1), randomly allocated to immediate vs. deferral of CEA (i.e., no intervention unless or until triggered by ipsilateral transient ischaemic attack or stroke), were followed, to study effects on dementia. From 1993 to 2003, ACST-1 included 3 120 participants with asymptomatic tight carotid stenosis. All UK and Swedish patients (n = 1 601; 796 immediate vs. 805 deferral) were followed with trial records, national electronic health record linkage, and (UK only) by post and telephone. Cumulative incidence and competing risk analyses were used to measure the effects of risk factors and CEA on dementia risk. Intention to treat analyses yielded hazard ratios (HRs; immediate vs. deferral) of dementia. The median follow up was 19.4 years (interquartile range 16.9 – 21.7). Dementia was recorded in 107 immediate CEA patients and 115 allocated delayed surgery; 1 290 patients died (1 091 [538 vs. 536] before any dementia diagnosis). Dementia incidence rose with age and with female sex (men: 8.3% aged < 70 years at trial entry vs. 15.1% aged ≥ 70; women: 15.1% aged < 70 years at trial entry vs. 22.4% aged ≥ 70 years) and was higher in those with pre-existing cerebral infarction (silent or with prior symptoms; 20.2% vs. 13.6%). Dementia risk was similar in both randomised groups: 6.7% vs. 6.6% at 10 years and 14.3% vs. 15.5% at 20 years, respectively. The dementia HR was 0.98 (95% confidence interval [CI] 0.75 – 1.28; p =.89), with no heterogeneity in the neutral effect of immediate CEA on dementia related to age, carotid stenosis, blood pressure, diabetes, country of residence, or medical treatments at trial entry (heterogeneity values p >.05). CEA was not associated with significant reductions in the long term hazards of dementia, but the CI did not exclude a proportional benefit or hazard of about 25%. [ABSTRACT FROM AUTHOR]

Despite the public health significance of overweight and obesity, weight management has remained a low priority for health-related programming on university campuses. Investigate the need for and feasibility of implementing university-based weight loss programs. The Practical, Robust Implementation and Sustainability Model (PRISM) was used as a framework. Semi-structured individual interviews were conducted with fifteen university staff and students from two large U.S. universities in the Northeast and Mid-Atlantic. Interviews aimed to assess readiness, preferences, characteristics, barriers and facilitators in each of the four adapted PRISM domains: (1) Organizational and Recipient (Student) Perspectives on the Intervention, (2) Recipient (Student) Characteristics, (3) Internal Environment (organizational characteristics and infrastructure), and (4) External Environment. Verbatim transcriptions were analyzed using inductive and deductive thematic analyses. Themes were extracted as outlined by Consensual Qualitative Research. Participants supported university-based weight loss programs, but recognized barriers of resources, coordination across entities, and competing health issues taking priority for school programming. Campus built environment and students' busy schedules were identified as barriers to maintaining healthy weight and participation in weight loss programs. Recommendations included designing weight loss programming with a positive and holistic approach, minimizing weight-stigma, ensuring support from university leaders and students, and securing external funding. The identified themes provide recommendations for universities looking to develop and implement weight loss programming. [ABSTRACT FROM AUTHOR]

To evaluate the perspectives and clinical practice of physiotherapists regarding rehabilitation after anterior cruciate ligament reconstruction (ACLR). Online survey. Survey platform. Greek physiotherapists. The survey consisted of 7 sections: participant demographics, importance of ACLR rehabilitation, clinical measurements, practice, criteria to progress rehabilitation, return to running and return to sport. Significant variability in measures and criteria used for clinical decision-making were found including: limb symmetry in strength and function, knee range of motion and effusion, progression, and return to sport criteria. The majority of the practitioners (28.3%) extrapolate knee strength from hop capacity. Return to running ranged from 3 to 5 months post-operatively reflecting that this was tied to physical capacities, not time from surgery. 70.0% of the Greek physiotherapists would allow return to sport ≤9 months after ACLR. Agreement was found in using: physical measures, function, and dynamic stability in ACLR rehabilitation, but the mode and interpretation varied substantially. Less than 29.0% of the physiotherapists reported using patient-reported outcome measures in their decision-making. Current ACLR rehabilitation practices in Greece are largely not aligned with the contemporary scientific evidence and guidelines. • Criteria for clinical decision-making were variable between physiotherapists. • Clinical measures used by physiotherapists presented significant variability. • Current ACLR practices are largely not aligned with evidence and guidelines. [ABSTRACT FROM AUTHOR]

Donor-derived cell-free DNA (dd-cfDNA) has been studied as a non-invasive biomarker for post-heart transplant rejection surveillance. However, elevated levels may be seen in patients without evidence of graft dysfunction or rejection. We present a middle-aged heart transplant recipient with CMV Viremia and elevated cfDNA levels. A 43-year-old woman with orthotropic heart transplant nine months prior presented with shortness of breath and was found to have CMV viremia. Her CMV viral load was 113,000 IU/mL and her dd-cfDNA was 0.22%, increased from previous visit of <0.12%. Echo showed no evidence of endocarditis and normal left ventricular systolic function with EF of 65-70%. The patient was negative for any donor specific antibodies. A biopsy was performed and was negative for T-cell mediated rejection and showed no pathologic evidence of antibody-mediated rejection (Grade 0R, pAMR0). A CT scan revealed evidence of CMV pneumonitis. Her symptoms improved with treatment of ganciclovir and cytogam. At two-week follow-up, her CMV viral load dropped to <137 IU/mL and dd-cfDNA returned to <0.12%. (Figure 1) Dd-cfDNA may be elevated in the presence of CMV infection. Further studies are needed to validate these preliminary findings. [ABSTRACT FROM AUTHOR]

To evaluate the reporting of eligibility criteria and baseline participant characteristics in randomised controlled trials investigating the effects of exercise interventions in tendinopathy. Randomised controlled trials investigating the effects of exercise therapy compared to a non-exercising intervention in upper and lower limb tendinopathy were included. Data extraction was categorised into the following domains: participant demographics, tendinopathy descriptors, general health, participant recruitment and eligibility criteria. The review included the following tendinopathies: Achilles (n = 9), gluteal (n = 2), lateral elbow tendinopathy (n = 15), patellar (n = 3) plantar (n = 3), and rotator cuff (n = 13). Age, sex, duration of symptoms and symptom severity were commonly reported across the review, while prior history of tendinopathy was poorly reported (6/45). Variables such as physical activity level (17/45), sleep (0/45), psychological factors (2/45), medication at baseline (8/45), co morbid health complaints (10/45) and sociodemographic factors (11/45) were poorly reported across the included studies. Substantial variation existed between studies in the specific eligibility criteria used. The findings of this systematic review demonstrate that participant characteristics are poorly reported in exercise trials in tendinopathy. To improve effectiveness of exercise interventions in tendinopathy, improved reporting of participant characteristics may allow better comparisons and targeted interventions for specific subgroups. • Participant characteristics are poorly reported in exercise trials in tendinopathy. • Poor reporting Poor reporting limits the external validity of findings. • Improving reporting of participant characteristics as recommended in the international scientific tendinopathy symposium may help address this issue. [ABSTRACT FROM AUTHOR]

Objectives: Document the mechanism and incidence of pectoralis major ruptures in a professional rugby league cohort, and compare to any existing data.Design: Retrospective case series.Methods: Case series which documents 3 such injuries incurred while effecting a tackle in 3 rugby league players from the same squad (of 36) in the same season.Results: At the initial point of contact, all three players were in a similar shoulder position of outer-range abduction and horizontal abduction and subsequently it appeared their pectoralis major was torn while attempting to effect the tackle.Conclusions: Complete tears of the pectoralis major muscle are rare but significant injuries often requiring surgical intervention to restore full function in collision sport athletes. In this same season, the organisation changed their defensive approach which may have contributed to these injuries. Each player was managed with acute surgical repair and returned to play at the same level. Suggestions are made to consider the possible training injury implications of changing tackle technique. [ABSTRACT FROM AUTHOR]

• Interactions between Ag NPs, HIV-1 PR, and specific peptides are studied. • The Ag NPs can bind with either HIV-1 PR or the peptides. • Mix Ag NPs with peptide for 24 h can efficiently inhibit activity of HIV-1 PR. • Late presence of Ag NPs cannot inhibit the HIV-1 PR activity. Use of silver nanoparticles (Ag NP's) as inhibitor for HIV-1 protease (PR) has practical interest. However, the interactions between the Ag NP's, HIV-1 PR, and the target peptides are not well demonstrated. This study experimentally revealed the interactions of the synthesized Ag NP's, HIV-1 PR, and five specific peptides with similar amino acid sequences to HIV's polyproteins. The Ag NP's can bind with either HIV-1 PR or the peptides. Incubating Ag NP's with peptide for 24 h can efficiently inhibit activity of HIV-1 PR. But HIV-1 PR would cleave peptides faster than the binding rate of Ag NP's and the peptides; therefore, late presence of Ag NP's would have no inhibition on the HIV-1 PR activity. [ABSTRACT FROM AUTHOR]

Document reliability and normative data for a novel device measuring weight-bearing ankle range of motion after ankle injury. Cross-sectional Cohort, two occasions one day apart. Sports medicine hospital. 87 ankle-injured male athletes at a late stage of their rehabilitation and 25 uninjured subjects. The injured athletes had met all criteria to return to functional, on-field rehabilitation. Reliability (Intra-Class correlation Coefficient (ICC), and Minimum Detectable Change as a percent of the grand mean), weight-bearing range of motion (degrees) of dorsiflexion, plantarflexion, inversion, and eversion. Good (dorsiflexion = 0.82[0.76–0.87] and inversion = 0.81[0.75–0.86]) and excellent (plantarflexion = 0.93[0.90–0.95]) reliability was documented, however reliability for the eversion measure showed only fair reliability (0.61[0.49–0.70]). Reduced range of motion in the injured leg was seen in all 4 directions, however with different magnitudes: Large differences were plantarflexion (−8.5°, ES = 0.80), medium for dorsiflexion (−5.2°, 0.57), small for inversion (−4.8°, 0.36), and trivial for eversion (−1.7°, 0.15). The device demonstrated clinically useful reliability for measuring these ranges of motion in a functional, weight-bearing position. PF ROM showed the greatest reduction in range in these athletes at a late stage of their rehabilitation. • The device measures weight-bearing ankle ROM with excellent reliability for DF, PF and inversion, & good reliability for eversion. • Normative data are provided for a relatively large cohort of male athletes's ankle range of motion for these 4 movements. • Despite meeting functional sports-specific goals, weight-bearing PF ROM remains diminished in comparison to the healthy leg. [ABSTRACT FROM AUTHOR]

This study examines neuromuscular firing patterns in overhead athletes and non-athletes of the periscapular, prime-moving, and rotator cuff muscles during "clinical" cardinal plane physiological movements. Cohort prospective study. EMG recordings were taken of the periscapular, prime-moving, and rotator cuff muscles during flexion, scaption, and abduction performed at fast, medium, and slow speeds with a loaded (3 kg) and unloaded arm. 14 Handball players and 20 non-athletes. Differences in firing patterns between groups were analyzed by fitting mixed linear models with random intercepts per subject, and fixed factors for group, muscle, movement type, speed, and load. No difference in timing of activation was seen between the professional athletes and non-athletes. Speed and load appear to independently vary muscle activation timing in a non-intuitive manner in both athletes and non-athletes. Onset timing of periscapular, prime movers and rotator cuff muscles are prior to movement in all scenarios studied, with rotator cuff muscles firing last. Onset activation patterns in overhead athletes are not different to non-athletes during cardinal plane movements. • Onset activation of shoulder muscles are no different between overhead and no athletes. • All shoulder muscles assessed activate prior movement in all movements, speed and load condition. • Medium speed and loaded condition have demonstrate earlier activation. [ABSTRACT FROM AUTHOR]

Abstract Objectives To evaluate if application of blood flow restriction (BFR) combined with low-load resistance training (LLRT) would induce significant anterior knee pain (AKP) reduction compared to LLRT alone. Design Randomised Controlled Trial. Setting Institutional physiotherapy clinic. Participants Forty males suffering from AKP were randomly allocated in the LLRT-BFR or LLRT group. BFR was applied at 80% of complete vascular occlusion. Four sets of open kinetic chain knee extensions were implemented in both groups using a pain monitoring model. Main outcome measures Pain (0–10) was assessed immediately after LLRT-BFR or LLRT application and after a physiotherapy session (45 min) during shallow and deep single-leg squat (SLS S , SLS D), and step-down test (SDT). Results Significant immediate pain reduction was found in LLRT-BFR group in SLS S , SLS D and SDT (d = 1.32, d = 1.12, d = 0.88 respectively), but no difference was found in LLRT group. Following the physiotherapy session pain reduction was sustained in LLRT-BFR group in both SLSs and SDT (d = 1.32, d = 0.78, d = 0.89 respectively). For the control group significant pain reduction was only found in SLS S (d = 0.56). No significant between-group differences were observed. Conclusions The pain reduction induced by LLRT-BFR could indicate this intervention as a preconditioning process prior to the rehabilitation of AKP. Highlights What are the findings? • LLRT-BFR significantly reduced pain in functional activities immediately post-intervention, and this was sustained for at least 45 min, with large effect sizes, an effect not seen in the LLRT group. • There were no non-responders in the LLRT-BFR group in contrast to the LLRT group where 20% of the participants reported symptoms worsening post-intervention. How might this impact on clinical practice in the future? • LLRT-BFR may be used to reduce knee pain before rehabilitation, providing clinicians a window of opportunity for knee loading exercises, which are typically otherwise associated with symptoms. [ABSTRACT FROM AUTHOR]

Background: Dry surface biofilms (DSBs) persist for extended periods in hospital, and may play a significant role in transmission of healthcare-associated infections.Aim: To determine whether DSBs may be transferred from hospital surfaces to healthcare workers' hands.Method: Twelve-day Staphylococcus aureus DSB was grown on polycarbonate and glass coupons in a CDC Biofilm Reactor®. A total of 1.8 × 106 and 8.8 × 105 bacteria grew on the polycarbonate and glass coupons respectively. Transmission was tested by lifting the coupon with forefinger and thumb of ungloved hands to a height of 30 cm, then touching horse blood agar (HBA) plates 19 sequential times. Transferred bacterial number was determined by colony-forming units. The effect of DSB wetting on biofilm transfer was tested with 5% neutral detergent treatment for 5 s.Findings: Between 5.5 and 6.6% of the DSB bacteria were transferred to hands with one touch and ∼20% were then transferred to HBA with one touch, giving an overall transfer rate of 1.26% and 1.04% for polycarbonate and glass coupons, respectively. Detergent treatment had little effect on bacterial removal from coupons, but, for biofilm grown on polycarbonate, significantly increased transferral to HBA (P < 0.001) to 5.2%. Large numbers of bacteria were transferred by bare hands to multiple fomites. One-third of polycarbonate coupons transferred >1000 colonies during the first five sequential touches. Sufficient bacteria to cause infection were transmitted up to 19 times following one touch of the DSB.Conclusion: DSB bacteria are transferred by hands from one fomite to multiple fomites, suggesting that DSB may serve as a persistent environmental source of pathogens. [ABSTRACT FROM AUTHOR]

Pharmacokinetic analysis is an experimentally determined theory of how a drug behaves when in vivo. Volume of distribution, clearance and terminal half-life are defined. Compartmental modelling is introduced and some relevant graphs are described in this article. Applications of this theory in anaesthesia are considered. [ABSTRACT FROM AUTHOR]

Cleaning is fundamental to infection control. This report demonstrates that a Staphylococcus aureus biofilm is significantly more difficult to remove than dried planktonic bacteria. A single wiping action removed >99.9% (>3 log10) of dried planktonic bacteria, whereas only 1.4 log10 of biofilm (96.66%) was removed by 50 wiping actions with a standardized wiping process. [ABSTRACT FROM AUTHOR]

Objectives Compare maximum plantar force (Fmax) during running in soccer players following anterior cruciate ligament reconstruction (ACLR) as they pass return to sport (RTS) criteria. Design Case control study. Methods Soccer players after ACLR (n = 16) and matched healthy controls (n = 16) ran on a treadmill at 12, 14 and 16 km/h while plantar loading data was measured using an in-shoe pressure system (Pedar-X, Novel). Fmax and contact time of the injured and uninjured limbs in athletes <9 months post-ACLR and those ≥9 months ACLR were compared to healthy players (no ACLR). Results Significant differences with large effect sizes in Fmax asymmetry were seen at all running speeds for the athletes <9 months ACLR compared to those ≥9 months, and the healthy subjects. Fmax difference peaked at 16 km/h; 32 ± 11%BW in <9 months ACLR group compared to 6 ± 5%BW in ≥9 months group; ES = 1.67, p < 0.01. There was a non-significant trend for increasing asymmetry with increasing speed for subjects who were <9 months after ACLR while the reverse was true for those ≥9 months and the healthy subjects. Conclusions Relatively large unloading of the ACLR limb (but not differences in contact times) are seen during running for athletes <9 months post-ACLR despite having completed functional criteria required to permit RTS training. These asymmetries appear to slightly increase with increasing speed, and the reverse is true for healthy controls and those ≥9 months after ACLR surgery. [ABSTRACT FROM AUTHOR]

Background Australia has established guidelines on cleaning for reusable ultrasound probes and accompanying equipment. This is a preliminary study investigating cleanliness standards of patient-ready ultrasound equipment in 5 separate health care facilities within a major city. Methods The cleanliness was assessed using rapid adenosine triphosphate (ATP) testing used with a sampling algorithm which mitigates variability normally associated with ATP testing. Each surface was initially sampled in duplicate for relative light units (RLUs) and checked for compliance with literature recommended levels of cleanliness (<100 RLUs). Triplicate sampling was undertaken where necessary. A cleaning intervention step (CIS) followed using a disposable detergent wipe, and the surface was retested for ATP. Results There were 253 surfaces tested from the 5 health care facilities with 26% (66/253) demonstrating either equivocal or apparent lack of cleanliness. The CIS was conducted on 148 surfaces and demonstrated that for >91% (135/148) of surfaces, the cleaning standards could be improved significantly ( P  > .001). For 6% (9/148) of devices and surfaces, the CIS needed to be repeated at least once to achieve the intended level of cleanliness (<25 RLUs). Conclusions This study indicates that ATP testing is an effective, real-time, quality assurance tool for cleanliness monitoring of ultrasound probes and associated equipment. [ABSTRACT FROM AUTHOR]

Objective To evaluate if a single blood flow restriction (BFR)-exercise bout would induce hypoalgaesia in patients with anterior knee pain (AKP) and allow painless application of therapeutic exercise. Design Cross-sectional repeated measures design. Setting Institutional out-patients physiotherapy clinic. Patients Convenience sample of 30 AKP patients. Intervention BFR was applied at 80% of complete vascular occlusion. Four sets of low-load open kinetic chain knee extensions were implemented using a pain monitoring model. Main outcome measurements Pain (0–10) was assessed immediately after BFR application and after a physiotherapy session (45 min) during shallow and deep single-leg squat (SSLS, DSLS), and step-down test (SDT). To estimate the patient rating of clinical effectiveness, previously described thresholds for pain change (≥40%) were used, with appropriate adjustments for baseline pain levels. Results Significant effects were found with greater pain relief immediate after BFR in SSLS (d = 0.61, p < 0.001), DSLS (d = 0.61, p < 0.001), and SDT (d = 0.60, p < 0.001). Time analysis revealed that pain reduction was sustained after the physiotherapy session for all tests (d (SSLS)  = 0.60, d (DSLS)  = 0.60, d (SDT)  = 0.58, all p < 0.001). The reduction in pain effect size was found to be clinically significant in both post-BFR assessments. Conclusion A single BFR-exercise bout immediately reduced AKP with the effect sustained for at least 45 min. [ABSTRACT FROM AUTHOR]

Background Organisms causing healthcare associated infections can be sourced from the inanimate environment around patients. Residing in a biofilm increases the chances of these organisms persisting in the environment. We aimed to characterise bacterial environmental contamination, genetically and physiologically, and relate this to general intensive care unit (ICU) cleanliness. Methods Cleanliness was determined by adenosine triphosphate (ATP) measurements of 95 high-touch objects. Bacteriological samples were obtained from the same sites (n = 95) and from aseptically removed sections (destructive samples, n = 20). Bacterial enrichment culture was conducted using tryptone soya broth prior to plating on horse blood agar, MacConkey agar, and screening chromogenic agar for identification of multidrug resistance organism (MDRO). Bacterial load and microbial diversity were determined using quantitative PCR (qPCR) and next generation DNA sequencing respectively. Confocal laser scanning microscopy and scanning electron microscopy were used to visually confirm the biofilm presence. Results Many intensive care surfaces (61%) were highly contaminated by biological soil as determined by ATP bioluminescence testing. The degree of biological soiling was not associated with bacterial contamination as detected by qPCR. Bacterial load ranged from 78.21 to 3.71 × 10 8 (median = 900) bacteria/100 cm 2 . Surface swabs from 71/95 sites (75%) were culture-positive; of these 16 (22.5%) contained MDRO. The most abundant genera were Staphylococcus, Propionibacterium, Pseudomonas, Bacillus, Enterococcus, Streptococcus and Acinetobacter . Biofilm was visually confirmed by microscopy on 70% (14/20) of items. Conclusion Bacterial biofilms and MDROs were found on ICU surfaces despite regular cleaning in Saudi Arabia, suggesting that biofilm development is not controlled by current cleaning practices. [ABSTRACT FROM AUTHOR]

Previous studies of the impact of post-trauma research participation indicate that while the research experience may be emotional, it can still be valued by participants. This paper describes participant experiences of the Australian post-bushfire research study–Beyond Bushfires. It examines the relationships between distress during research participation, probable mental health conditions, and satisfaction with the research experience over time. A range of strategies was incorporated into the study, including a distress and risk assessment and referral protocol, to minimise any risk of harm for people who had experienced the 2009 bushfires and their aftermath. Participants included 1056 respondents (Wave 1) interviewed via telephone and web-based survey between December 2011 through January 2013, and 736 (76.1%) of the participants were re-surveyed between July and November 2014 (Wave 2). Research impact was monitored through two questions about survey experience on each occasion. Reported distress at completing the survey was generally low, while overall satisfaction was relatively high. Participants’ reported satisfaction was not associated with their reported level of distress as a result of the survey; and reported participation distress at Wave 1 did not predict whether a respondent would return to complete the survey at Wave 2. Fire-related Posttraumatic stress symptoms were associated with increased satisfaction and likelihood to return at Wave 2. These findings suggest that for Beyond Bushfires survey respondents the perceived benefits outweighed the costs of participation over time. [ABSTRACT FROM AUTHOR]

Background: The importance of biofilms to clinical practice is being increasingly realized. Biofilm tolerance to antibiotics is well described but limited work has been conducted on the efficacy of heat disinfection and sterilization against biofilms.Aim: To test the susceptibility of planktonic, hydrated biofilm and dry-surface biofilm forms of Staphylococcus aureus, to dry-heat and wet-heat treatments.Methods: S. aureus was grown as both hydrated biofilm and dry-surface biofilm in the CDC biofilm generator. Biofilm was subjected to a range of temperatures in a hot-air oven (dry heat), water bath or autoclave (wet heat).Findings: Dry-surface biofilms remained culture positive even when treated with the harshest dry-heat condition of 100°C for 60min. Following autoclaving samples were culture negative but 62-74% of bacteria in dry-surface biofilms remained alive as demonstrated by live/dead staining and confocal microscopy. Dry-surface biofilms subjected to autoclaving at 121°C for up to 30min recovered and released planktonic cells. Recovery did not occur following autoclaving for longer or at 134°C, at least during the time-period tested. Hydrated biofilm recovered following dry-heat treatment up to 100°C for 10min but failed to recover following autoclaving despite the presence of 43-60% live cells as demonstrated by live/dead staining.Conclusion: S. aureus dry-surface biofilms are less susceptible to killing by dry heat and steam autoclaving than hydrated biofilms, which are less susceptible to heat treatment than planktonic suspensions. [ABSTRACT FROM AUTHOR]

West Nile Virus (WNV) has been known to have devastating outcomes in solid organ transplant (SOT) recipients; we report successful resolution of WNV at our institution. A 58 year old man status post heart transplant July 2017 presented to an outside hospital for a 3 day onset of fever, nasal congestion & a severe headache. Of note, patient was bitten by a mosquito 2 weeks prior. Upon arrival at our institution, workup was initiated to identify causative organisms. Nares influenza swab, viral panels, & blood cultures were negative. Chest radiograph, CT chest, Head & sinuses were all unremarkable. Cerebrospinal fluid (CSF) had high white blood cell count, but was negative for Meningitis, AFB, fungal or yeast elements. WNV IgM in Blood & CSF was positive for WNV Meningitis. Empiric antibiotics & antivirals started on admission were stopped. He was treated with two doses of intravenous immunoglobulin (IVIG). Immunosuppressants were significantly reduced. Mycophenolate (MMF) was discontinued & tacrolimus (FK) dose was reduced. Supportive therapy with intravenous fluids & antipyretics as needed. Patient remained febrile with maximum temperature of 102 & finally defervesced after one week. He gradually improved symptomatically, & was discharged 8 days after admission. MMF was restarted 10 days after discharge at a reduced dose. FK dose was also gradually increased to baseline regimen. Headaches, nausea, & fatigue persisted for about one month, during which time nonessential medications were held. Patient improved subsequently has remained stable to date. WNV infection is associated high mortality & morbidity in SOT patients. The WNV endemic in the US effects warmer states from July to October. WNV may be transmitted to SOT recipients at the time of SOT, by transfusion, or infected mosquito bite. This case highlights the possibility of survival & successful resolution of WNV infection with early recognition, minimization of immunosuppression, & supportive therapy with IVIG. [ABSTRACT FROM AUTHOR]

Objectives Endovenous thermal ablation (EVTA) of varicose veins was introduced in the late 1990s with radiofrequency ablation (RFA) using the VNUS Closure device. The results of the original VNUS Closure device for the abolition of truncal venous reflux at 15 years are reported. Methods A prospective audit of a group of patients treated with VNUS Closure 15 years previously was carried out, using clinical assessment and duplex ultrasound. A total of 189 patients were treated with VNUS Closure between March 1999 and December 2001 and were invited for clinical assessment (subjective and objective) and duplex ultrasonography (DUS) to assess treatment outcome and de novo disease progression. DUS outcome of the treated vein was graded: 1, complete success (complete atrophy); 2, partial success (> 1 patent section; none giving rise to recurrent varicose veins); 3, partial failure (≥ 1 patent sections giving rise to recurrent varicose veins); 4, complete failure. Results Fifty-eight patients (91 legs, 101 truncal veins) returned for follow-up DUS, giving a 31.5% response rate (many patients had moved or had died in the 15 years). Two truncal veins had been excluded following treatment elsewhere presumably for partial or complete failure. At a mean of 15.4 years post-procedure, 51 (56%) reported no varicose veins, 58 (100%) that they were pleased that they had the procedure and 57 (98%) that they would recommend the procedure. DUS showed 88% of patients achieved success with no clinical recurrence in the originally treated veins. De novo reflux was identified in 47 of 91 legs (51.6%), showing disease progression in veins that were originally competent. Conclusions RFA with VNUS Closure achieved excellent long-term technical success in treating venous reflux in truncal veins 15 years post-procedure, demonstrated by DUS. This bodes well for the increased use of EVTA in treating truncal vein reflux. [ABSTRACT FROM AUTHOR]

Pinus morrisonicola has been reported bio-benefit and contains high amount of antioxidant bioactive compounds. This study followed a previous work to pretreat the Pinus morrisonicola by compression-puffing process and then extracted the antioxidant phenolic compounds from the pretreated samples for the measurements. The effects of ethanol concentration, extraction temperature and liquid–solid ratio on the extraction yield (total flavonoids content and total phenolic content) and antioxidant activity (DPPH scavenging activity, FRAP and ABTS scavenging activity) are reported for demonstration the pretreatment efficiencies. Semi-qualitative characterization of the extract compounds was conducted. [ABSTRACT FROM AUTHOR]

Objectives: To determine the normal profiles for hip strength and range of motion (ROM) in a professional football league in Qatar, and examine the effect of leg dominance, age, past history of injury, and ethnicity on these profiles.Design: Cross-sectional cohort study.Methods: Participants included 394 asymptomatic, male professional football players, aged 18-40 years. Strength was measured using a hand held dynamometer with an eccentric test in side-lying for hip adduction and abduction, and the squeeze test in supine with 45° hip flexion. Range of motion measures included: hip internal and external rotation in 90° flexion, hip IR in prone, bent knee fall out and hip abduction in side-lying. Demographic information was collected and the effect on the profiles was analysed using linear mixed models with repeated measures.Results: Strength values (mean±SD) were: adduction=3.0±0.6Nm/kg, abduction=2.6±0.4Nm/kg, adduction/abduction ratio=1.2±0.2, Squeeze test=3.6±0.8N/kg. Range of motion values: internal rotation in flexion=32±8°, external rotation=38±8°, internal rotation in prone=38±8°, bent knee fall out=13±4.4cm, abduction in side-lying=50±7.3°. Leg dominance had no clinically relevant effect on these profiles. Multivariate analysis demonstrated that age had a minor influence on squeeze strength (-0.03N/kg/year), external rotation (-0.30°/year) and abduction range (-0.19°/year) but past history of injury, and ethnicity did not.Conclusions: Normal values are documented for hip strength and range of motion that can be used as reference profiles in the clinical assessment, screening, and management of professional football players. Leg dominance, recent past injury history and ethnicity do not need to be accounted for when using these profiles for comparison purposes. [ABSTRACT FROM AUTHOR]

The burning velocity is a fundamental parameter in combustion that has been accurately measured with different methods for a variety of gaseous and liquid hydrocarbon fuels. However, it is still unclear whether this concept also applies to the combustion of particulate-fuel suspensions. Attempts to measure the burning velocity in particulate suspensions have been made using a range of experimental techniques, but no study has yet attempted to reconcile the results from different studies. The present work reports the first realization of a stabilized aluminum flame using a counterflow burner. The flow is tracked using Particle Image Velocimetry and the flame speed is obtained as a function of aluminum concentration. The results are then compared to previous data obtained for stabilized flames, spherically-expanding flames, and flames propagating in tubes. The results are in reasonable agreement, given the experimental uncertainties in all of the techniques employed to date, suggesting that the notion of a laminar burning velocity may be applied to suspensions of particulate fuels. [ABSTRACT FROM AUTHOR]

This study is aimed to increase the extraction yield and efficiency of the antioxidant phenolic compounds from Pinus morrisonicola . The optimum extraction conditions for the phenolic compounds from pine needles are determined by using response surface methodology with a central-composite design. Effects of ethanol concentration, extraction temperature and liquid–solid ratio on the extraction yield (total flavonoids content and total phenolic content) and antioxidant activity (2,2′-diphenyl-1-picryhydrazyl (DPPH) scavenging activity, ferric reducing antioxidant power (FRAP) and 2,2′-Azino-bis(3-ethylbenzothiazoline-6-sulfonic acid) diammonium salt (ABTS) scavenging activity) are investigated. The optimum conditions to maximize the extraction yields and antioxidant activity of the pine needles extracts are: 36.1% v/v of ethanol, 70 ºC and 50 ml/g of liquid–solid ratio. The pine needles extracts are shown to be free of 311 tested pesticide residues or certain heavy metals and exhibit comparable quantities of total flavonoids contents, total phenolic contents and the antioxidant activities with commercial products. [ABSTRACT FROM AUTHOR]

Objectives: Clinicians commonly interpret the findings of shoulder rotational ranges of motion using various approaches: an apparent reduction in dominant arm internal rotation ("GIRD"), a difference in total rotational range of motion-i.e. differences in the sum of internal and external rotational range (TRROM), and a combination of rotational ROM and torsional difference ("GIRD-torsion"). We have noticed that these approaches are being considered to provide equivalent estimates of shoulder rotational range. This investigation sought to document the extent of agreement of these three different approaches when classifying athletes' "at-risk" status.Design: Observational cohort study.Methods: 162 professional male athletes participating in overhead sports (baseball, handball, and volleyball) had their GIRD, TRROM, and GIRD-torsion calculated, and classified as "at risk" using standard cut-points of 20°, 5°, and 10°, respectively.Results: 25 (15.4%) athletes were classified as "at-risk" using GIRD, 55 (34%) with TRROM, and 30 (18.5%) using GIRD-torsion. Only 3/162 (1.9%) athletes were classified as "at-risk" by all 3 approaches, 4 athletes were concurrently classified as "at-risk" by GIRD and TRROM (Kappa=-0.142, poor agreement), 11 by GIRD and GIRD-torsion (Kappa=0.279, fair agreement), and 11 by TRROM and GIRD-torsion (Kappa=0.025, slight agreement).Results: 25 (15.4%) athletes were classified as at risk using GIRD, 55 (34%) with TRROM, and 30 (18.5%) using GIRD-torsion. Only 3/162 (1.9%) athletes were classified as at risk by all 3 approaches, 4 athletes were concurrently classified as at risk by GIRD and TRROM (Kappa=-0.142, poor agreement), 11 by GIRD and GIRD-torsion (Kappa=0.279, fair agreement), and 11 by TRROM and GIRD-torsion (Kappa=0.025, slight agreement).Conclusions: The three described approaches yield demonstrably different findings, and these approaches cannot be used interchangeably. Examples of clinical reasoning are provided to assist with the interpretation of these different measures. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the pharmacokinetics (PK) and early effects of conventional transarterial chemoembolization (TACE) using sorafenib and doxorubicin on tumor necrosis, hypoxia markers, and angiogenesis in a rabbit VX2 liver tumor model.Materials and Methods: VX2 tumor-laden New Zealand White rabbits (N = 16) were divided into 2 groups: 1 group was treated with hepatic arterial administration of ethiodized oil and doxorubicin emulsion (DOX-TACE), and the other group was treated with ethiodized oil, sorafenib, and doxorubicin emulsion (SORA-DOX-TACE). Animals were killed within 3 days of the procedure. Levels of sorafenib and doxorubicin were measured in blood, tumor, and adjacent liver using mass spectrometry. Tumor necrosis was determined by histopathological examination. Intratumoral hypoxia-inducible factor (HIF) 1α, vascular endothelial growth factor (VEGF), and microvessel density (MVD) were determined by immunohistochemistry.Results: The median intratumoral concentration of sorafenib in the SORA-DOX-TACE group was 17.7 μg/mL (interquartile range [IQR], 7.42-33.5 μg/mL), and its maximal plasma concentration (Cmax) was 0.164 μg/mL (IQR, 0.0798-0.528 μg/mL). The intratumoral concentration and Cmax of doxorubicin were similar between the groups: 4.08 μg/mL (IQR, 3.18-4.79 μg/mL) and 0.677 μg/mL (IQR, 0.315-1.23 μg/mL), respectively, in the DOX-TACE group and 1.68 μg/mL (IQR, 0.795-4.08 μg/mL) and 0.298 μg/mL (IQR, 0.241-0.64 μg/mL), respectively, in the SORA-DOX-TACE group. HIF-1α expression was increased in the SORA-DOX-TACE group than in the DOX-TACE group. Tumor volume, tumor necrosis, VEGF expression, and MVD were similar between the 2 groups.Conclusions: The addition of sorafenib to DOX-TACE delivered to VX2 liver tumors resulted in high intratumoral and low systemic concentrations of sorafenib without altering the PK of doxorubicin. [ABSTRACT FROM AUTHOR]

Background Dry needling (DN) is reported to decrease pain and improve functional movements yet the mechanisms remain unclear. Changes in muscle tone and other mechanical properties after DN could contribute to these findings but have not been investigated. Objectives Examine EMG and passive mechanical properties of the quadriceps muscle before and after DN. Design EMG, MyotonPro and clinical measurements were taken pre and post DN. Setting Rehabilitation department at Aspetar Sports Medicine Hospital, Qatar. Participants 20 subjects reporting pain and quadriceps muscle tension. Main outcome measures Pain (VAS, measured during a single leg step down), knee flexion range, and passive mechanical properties of the superficial quadriceps were measured using the MyotonPro device. Results Pain decreased (p < 0.01) and ROM increased in flexion (p < 0.001). EMG activity (RMS) was decreased at rest in the Vastus Lateralis (VL (p < 0.05, ES = 0.22). All other sEMG parameters were not significantly different (all p > 0.11, ES = 0.13). Passive mechanical properties were not significantly different in rectus femoris (RF) and VL. Decrement and Resistance of the Vastus Medialis (VM) were significantly decreased (p < 0.05, ES > 0.19). Conclusions DN resulted in small reductions in: pain, resting activation (EMG of VL), decrement and resistance (of VM). [ABSTRACT FROM AUTHOR]

Background: Dry hospital environments are contaminated with pathogenic bacteria in biofilms, which suggests that current cleaning practices and disinfectants are failing.Aim: To test the efficacy of sodium hypochlorite solution against Staphylococcus aureus dry-surface biofilms.Methods: The Centers for Disease Control and Prevention Biofilm Reactor was adapted to create a dry-surface biofilm, containing 1.36 × 10(7)S. aureus/coupon, by alternating cycles of growth and dehydration over 12 days. Biofilm was detected qualitatively using live/dead stain confocal laser scanning microscopy (CLSM), and quantitatively with sonicated viable plate counts and crystal violet assay. Sodium hypochlorite (1000-20,000parts per million) was applied to the dry-surface biofilm for 10min, coupons were rinsed three times, and residual biofilm viability was determined by CLSM, plate counts and prolonged culture up to 16 days. Isolates before and after exposure underwent minimum inhibitory concentration (MIC) and minimum eradication concentration (MEC) testing, and one pair underwent whole-genome sequencing.Findings: Hypochlorite exposure reduced plate counts by a factor of 7 log10, and reduced biofilm biomass by a factor of 100; however, staining of residual biofilm showed that live S. aureus cells remained. On prolonged incubation, S. aureus regrew and formed biofilms. Post-exposure S. aureus isolates had MICs and MECs that were not significantly different from the parent strains. Whole-genome sequencing of one pre- and post-exposure pair found that they were virtually identical.Conclusions: Hypochlorite exposure led to a 7-log kill but the organisms regrew. No resistance mutations occurred, implying that hypochlorite resistance is an intrinsic property of S. aureus biofilms. The clinical significance of this warrants further study. [ABSTRACT FROM AUTHOR]

Objective/Background Traditionally, sclerotherapy has been thought to work by the cytotoxic effect of the sclerosant upon the endothelium alone. However, studies have shown that sclerotherapy is more successful in smaller veins than in larger veins. This could be explained by the penetration of the sclerosant, or its effect, into the media. This study aimed to investigate intimal and medial damage profiles after sclerosant treatment. Methods Fresh human varicose veins were treated ex vivo with either 1% or 3% sodium tetradecyl sulphate (STS) for 1 or 10 minutes. The effect of the sclerosant on the vein wall was investigated by immunofluorescent labelling of transverse vein sections using markers for endothelium (CD31), smooth muscle (α-actin), apoptosis (p53) and inflammation (intercellular adhesion molecule-1 [ICAM-1]). Polidocanol (POL; 3%) treatment at 10 minutes was similarly investigated. Results Endothelial cell death was concentration- and time-dependent for STS but incomplete for both sclerosants. Time, but not concentration, significantly affected cell death ( p > .001). A 40% and 30% maximum reduction was observed for STS and POL, respectively. Destruction of 20–30% of smooth muscle cells was found up to 250 μm from the lumen after 3% STS treatment for 10 minutes. POL treatment for 10 minutes showed inferior destruction of medial cells. Following STS treatment and 24-hour tissue culture, p53 and ICAM-1 were upregulated to a depth of around 300 μm. This effect was not observed with POL. Conclusion Inflammatory and apoptotic markers show the same distribution as medial cell death, implying that sclerotherapy with STS works by inducing apoptosis in the vein wall rather than having an effect restricted to the endothelium. Incomplete loss of endothelial cells and penetration of the sclerosant effect up to 250 μm into the media suggest that medial damage is crucial to the success of sclerotherapy and may explain why it is less effective in larger veins. [ABSTRACT FROM AUTHOR]

This interaction of silver nanoparticles (AgNP) with human immune-deficiency virus aspartic protease (HIVPR) is examined by molecular dynamics simulation using the Colores (Situs) package and biophysical techniques using UV–vis spectroscopy, dynamic light scattering, transmission electron microscopy and circular dichroism. The ‘docking’ of AgNP with HIVPR creates a complex [AgNP–HIVPR] to initiate a hypochromic time-dependent red-shift for the surface plasmon resonance maximum. MD simulations reflect large perturbations to enzyme conformations by fluctuations of both rmsd and B-factors. Increase in changes to electrostatic potentials within the enzyme, especially, with chain B, suggest hydrophobic interactions for the binding of the AgNP. This is supported by changes to mainchain and sidechain dihedrals for many hydrophobic amino acid including Cys 95 , Trp 6 and Trp 42 . Circular dichroism spectra reveal disappearance of α-helices and β-sheets and increase in random coil first from chain B then chain A. During initial stages of the interactive simulation the enzyme is conformational flexible to accommodate the AgNP, that docks with the enzyme under a cooperative mechanism, until a more stable structure is formed at convergence. There is a decrease in size of the HIVPR–AgNP complex measured by changes to the gyration radius supporting evidence that the AgNP associates, initially, with chain B. [ABSTRACT FROM AUTHOR]

Background The persistence of multidrug-resistant organisms (MDROs) within an intensive care unit (ICU) possibly contained within dry surface biofilms, remains a perplexing confounder and is a threat to patient safety. Identification of residential locations of MDRO within the ICU is an intervention for which new scientific approaches may assist in finding potential MDRO reservoirs. Method This study investigated a new approach to sampling using a more aggressive environmental swabbing technique of high-touch objects (HTOs) and surfaces, aided by 2 commercially available adenosine triphosphate (ATP) bioluminometers. Results A total of 13 individual MDRO locations identified in this pilot study. The use of ATP bioluminometers was significantly associated with the identification of 12 of the 13 individual MDRO locations. The MDRO recovery and readings from the 2 ATP bioluminometers were not significantly correlated with distinct cutoffs for each ATP device, and there was no correlation between the 2 ATP devices. Conclusion The specific MDRO locations were not limited to the immediate patient surroundings or to any specific HTO or type of surface. The use of ATP testing helped rapidly identify the soiled locations for MDRO sampling. The greatest density of positive MDRO locations was around and within the clinical staff work station. [ABSTRACT FROM AUTHOR]

Summary Background Hospital-associated infections cause considerable morbidity and mortality, and are expensive to treat. Organisms causing these infections can be sourced from the inanimate environment around a patient. Could the difficulty in eradicating these organisms from the environment be because they reside in dry surface biofilms? Aim The intensive care unit (ICU) of a tertiary referral hospital was decommissioned and the opportunity to destructively sample clinical surfaces was taken in order to investigate whether multidrug-resistant organisms (MDROs) had survived the decommissioning process and whether they were present in biofilms. Methods The ICU had two ‘terminal cleans’ with 500 ppm free chlorine solution; items from bedding, surrounds, and furnishings were then sampled with cutting implements. Sections were sonicated in tryptone soya broth and inoculated on to chromogenic plates to demonstrate MDROs, which were confirmed with the Vitek2 system. Genomic DNA was extracted directly from ICU samples, and subjected to polymerase chain reaction (PCR) for femA to detect Staphylococcus aureus and the microbiome by bacterial tag-encoded FLX amplicon pyrosequencing. Confocal laser scanning microscopy (CLSM) and scanning electron microscopy (SEM) were performed on environmental samples. Findings Multidrug-resistant bacteria were cultured from 52% (23/44) of samples cultured. S. aureus PCR was positive in 50%. Biofilm was demonstrated in 93% (41/44) of samples by CLSM and/or SEM. Pyrosequencing demonstrated that the biofilms were polymicrobial and contained species that had multidrug-resistant strains. Conclusion Dry surface biofilms containing MDROs are found on ICU surfaces despite terminal cleaning with chlorine solution. How these arise and how they might be removed requires further study. [ABSTRACT FROM AUTHOR]

Background The 4 monitoring methods used to manage the quality assurance of cleaning outcomes within health care settings are visual inspection, microbial recovery, fluorescent marker assessment, and rapid ATP bioluminometry. These methods each generate different types of information, presenting a challenge to the successful integration of monitoring results. A systematic approach to safety and quality control can be used to interrogate the known qualities of cleaning monitoring methods and provide a prospective management tool for infection control professionals. We investigated the use of failure mode and effects analysis (FMEA) for measuring failure risk arising through each cleaning monitoring method. Methods FMEA uses existing data in a structured risk assessment tool that identifies weaknesses in products or processes. Our FMEA approach used the literature and a small experienced team to construct a series of analyses to investigate the cleaning monitoring methods in a way that minimized identified failure risks. Results FMEA applied to each of the cleaning monitoring methods revealed failure modes for each. The combined use of cleaning monitoring methods in sequence is preferable to their use in isolation. Conclusions When these 4 cleaning monitoring methods are used in combination in a logical sequence, the failure modes noted for any 1 can be complemented by the strengths of the alternatives, thereby circumventing the risk of failure of any individual cleaning monitoring method. [ABSTRACT FROM AUTHOR]

Ethanol from biomass feedstocks has the potential to reduce greenhouse gas emissions for fuel production. This work calculates the potential environmental impact from the production of ethanol from sweet sorghum using several processing options. The following three processing options were evaluated: 1) a farm scale decentralized option where all steps except the dehydration are performed on the farm, 2) a semi-centralized process where distillation and dehydration are performed at a biofuel refinery, and 3) a centralized process where sorghum stem is transported to a facility where all processing is performed. Results show that a centralized process where sweet sorghum stem is transported to a processing facility to produce ethanol has significant negative environmental impacts when compared to corn ethanol and other processing options. The centralized option resulted in a 62% increase in GHG emissions and a 50% increase in non-renewable energy use compared to corn ethanol. When the decentralized and semi-centralized options were compared to corn ethanol production, GHG emissions were reduced by 39% and 25% respectively. Non-renewable energy use reductions were 27% in the decentralized process and a 15% reduction in the semi-centralized process. [ABSTRACT FROM AUTHOR]

Objectives Previous research into pelvic venous reflux has suggested that the size of the ovarian veins indicates the presence or absence of reflux. It is already known that vessel diameter is not an indicator of reflux in the great saphenous vein. However, to this day, physicians still use vein size to plan treatment of refluxing ovarian veins. The authors aimed to investigate whether or not vessel diameter can be used as an indicator of reflux in the ovarian veins. Methods Nineteen female patients (mean 40.2 years, range 29–60) presenting to a specialist vein unit with leg varicose veins underwent duplex ultrasonography (DUS). All were found to have a significant pelvic contribution to their leg reflux on transvaginal duplex ultrasonography (TVS) and were referred to an interventional radiologist for treatment by transjugular coil embolization. During the procedure, the diameter of the ovarian veins was measured using digital subtraction venography. Results Thirty-four ovarian veins were measured (17 right, 17 left) and of these 18 were found to be non-refluxing while 16 displayed reflux. The mean diameter of the non-refluxing veins was 7.2 mm (range 3–13 mm) and that of the refluxing veins was 8.5 mm (range 4–13 mm). This difference was found to be insignificant at a 95% confidence level (Student t test, p = .204). Conclusions There is no significant difference between the diameters of competent and refluxing ovarian veins and, as such, techniques that measure vein diameter may not be suitable for the diagnosis of venous reflux in the ovarian veins. [ABSTRACT FROM AUTHOR]

Background: The effect of interventions on functional impairment is an important outcome in stroke prevention trials and should be considered as an adjunct to counting discrete events. In the NAVIGATE-ESUS trial, 7213 patients with recent embolic strokes of undetermined source were randomized to rivaroxaban (15 mg once daily) or aspirin (100 mg daily). After 11 months there was no effect on the prevention of recurrent stroke.Aims: To determine the effect of rivaroxaban compared to aspirin on functional and cognitive outcomes.Methods: Function and cognition were measured at baseline, 1 year, and study end using the Standard Assessment of Global Everyday Activities (SAGEA), a 15-item scale assessing cognitive, instrumental, and basic activities of daily living as well as mobility, and the Montreal Cognitive Assessment (MoCA). Changes in scores were calculated by subtracting either study end or 1-year scores from baseline, and differences in distributions were compared using the Mann-Whitney U test. SAGEA and MoCA scores were also correlated with recurrent stroke.Results: Follow-up SAGEA scores were available in 6378 (88%) participants. There was no difference in change in function for those allocated to rivaroxaban compared to aspirin (Mann-Whitney U test, p = 0.8), with both distributions having a median (25p,75p) change of 0 (-2,1). Overall, more of those who experienced a recurrent stroke (n=247; mostly minor ischemic), reported functional difficulty at study end versus entry, compared with those who did not (51% versus 30%, chi-square test, p< 0.001), and this was consistent across global regions. There was no difference in the change in cognition by treatment group, nor were recurrent strokes associated with a change in cognition.Conclusions: Rivaroxaban, compared to aspirin, was not associated with changes in functional or cognitive status in patients with recent ESUS. The SAGEA scale detected changes in functional status associated with recurrent strokes in an international stroke population. [ABSTRACT FROM AUTHOR]

Dual heart and kidney transplantation (HKTx) is becoming an increasingly common surgical approach to selected patients with end-stage heart failure and end-stage renal disease. To date, there are no published reports of HKTx performed with near-concurrent total abdominal hysterectomy. Herein we present a case of a female patient who underwent successful HKTx with total abdominal hysterectomy. A 39 year old African American woman with a body mass index of 22 kg/m2 with significant uterine fibroids (figure 1), dilated cardiomyopathy from prior viral myocarditis, and chronic kidney disease was transferred to our institution for consideration of dual organ transplant.Upon transfer, the patient presented in SCAI shock Class D on dual inotropes. Despite the high doses of milrinone and dobutamine, her hemodynamics remained suboptimal with a blood pressure of 86/54 and heart rate of 130. Her exam was notable for elevated jugular venous pressure, cool extremities, and a loud systolic murmur with radiation to the apex. Labs revealed a sodium of 127meq/L and a worsening creatinine of 3.7mg/dL from a baseline of 2.5mg/dL. A right heart catheterization revealed elevated biventricular filling pressures and persistently low cardiac index (1.5 L/min/m2). She required the addition of epinephrine and a balloon pump for stabilization.She was then presented for an urgent heart and kidney transplantation, but given significant uterine fibroids, and relatively small BMI and waist circumference, gynecological surgery was consulted for need of total abdominal hysterectomy for the placement of the kidney. A planned surgical approach, to include orthotopic heart transplantation with concurrent total abdominal hysterectomy, followed by next-day kidney transplant, was devised. The patient was counseled regarding future inability of pregnancy. She was successfully transplanted with no intraoperative complications. On post-op day 10, the patient developed hemoperitoneum that required exploratory laparotomy with the evacuation of hemoperitoneum and re-suturing of the vaginal cuff. She was discharged 18 days after transplant. Her follow-up to date has been uneventful. Our case demonstrates that heart and kidney transplantation with total abdominal hysterectomy is a safe and effective method in patients with a small BMI and enlarged leiomyoma that may prohibit implantation of the donor kidney. [ABSTRACT FROM AUTHOR]

Background and Objectives: Function is an important outcome after stroke; traditional assessments may not capture functional deficits important to patients. We examined the validity of the Standard Assessment of Global Everyday Activities (SAGEA), a patient-reported outcome that assesses activities important to patients and for use in international clinical trials.Methods: The NAVIGATE-ESUS trial evaluated rivaroxaban compared to aspirin in preventing recurrent stroke in 7213 participants. The Modified Rankin Scale (mRS), the National Institutes of Health Stroke Scale (NIHSS), and the SAGEA were collected at entry. Chi square tests were used to compare proportions and Spearman rank correlations were used to compare between measures. SAGEA was compared to the Modified Frailty Index (MFI) and the occurrence of infarct to examine criterion validity RESULTS: Participants were 67 years, 2/3 were male, and at baseline 30% had no disability and 58% had slight disability according to mRS scores. SAGEA was weakly correlated with the mRS (r=0.37), the NIHSS (r=0.29) and the MFI (r=0.30). Of the 2154 with an mRS score of 0, 61% reported difficulty on the SAGEA. The largest discrepancies between SAGEA and other measures were because of cognitive functional deficits detected by the SAGEA that were not identified on other assessments. A larger number of MRI identified infarcts (acute and covert) were associated with a higher SAGEA score (p=0.007).Conclusions: The SAGEA is a simple, globally applicable measure of cognitive and functional abilities that identifies issues that other commonly used assessments of disability and function do not capture. [ABSTRACT FROM AUTHOR]

Pharmacokinetic analysis is an experimentally determined theory of how a drug behaves when in vivo. Volume of distribution, clearance and terminal half-life are defined. Compartmental modelling is introduced and some relevant graphs are described in this article. Applications of this theory in anaesthesia are considered. [ABSTRACT FROM AUTHOR]

Superficial venous surgery and perforator vein surgery, specifically, have a long and varied history in the evolution of vascular surgery, especially because venous disease continues to be extremely common. As with other areas of our specialty, perforator vein procedures have progressed from being purely open operations to becoming less invasive procedures. Despite this, there remains much discussion (as well as overt disagreement) about whether perforator vein surgery is actually appropriate and beneficial in the first place. Surgeons have no level I evidence from randomized controlled studies to determine whether perforator vein surgery does or does not reduce the chances of recurrence of superficial venous varicosities, so we must rely on the evidence as it currently is. Perhaps not surprisingly, our two experts have assembled divergent opinions on the role of perforator venous surgery in contemporary practice. [ABSTRACT FROM AUTHOR]

Highlights: [•] Interaction of silver nanoparticles with HIV protease. [•] FRET showed the nanoparticles were bound 1.03nm [Ag] from a single tryptophan. [•] Nanoparticles bind to a cysteine residue that is 1.05nm from the active site. [•] Nanoparticles may have implication against human immunodeficiency in clinical trial. [ABSTRACT FROM AUTHOR]