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Z uwagi na złożoną etiologię zaburzeń depresyjnych, uwzględniającą w ich powstawaniu i przebiegu interakcję czynników biologicznych i psychospołecznych, istotne jest kompleksowe oraz zintegrowane podejście do tego problemu zdrowotnego, uwzględniające poza tradycyjnymi metodami leczenia również dodatkowe formy oddziaływań, które mogą być pomocne w terapii. Jedną z nich jest zwiększenie aktywności fizycznej. Celem pracy jest przedstawienie znaczenia aktywności fizycznej w zapobieganiu i leczeniu zaburzeń depresyjnych w oparciu o wyniki badań przeprowadzonych w latach 2014 - 2019. Przeprowadzony przegląd badań wskazuje, iż dostosowana do potrzeb i stanu zdrowia aktywność fizyczna może pełnić rolę w zapobieganiu i uzupełniającą w terapii zaburzeń depresyjnych, w tym również tych, które występują w przebiegu schorzeń somatycznych. Rekomendując trening fizyczny w tej grupie osób, należy jednak mieć na uwadze, iż pochopne motywowanie pacjentów z ciężką postacią zaburzenia do tego typu aktywności, może uaktywniać ich poczucie winy z powodu trudności w sprostaniu wyzwaniu, prowokujące myśli i zachowania samobójcze.

Introduction. Alcoholism is a phenomenon with multi-factorial conditions and numerous health and socialconsequences, which makes its treatment a real challenge not only for the addict himself and his relatives, but alsofor the entire medical team involved in the therapy process. For this reason, in order to strengthen the therapeuticeffects of alcoholic disease, it is important to conduct research aimed at determining the factors that shape theeffectiveness of the implemented methods. With this in mind, it has been assumed that the aim of the research isto determine the relationship between the therapeutic methods used in the Clinical Alcohol Dependency TherapyUnit (COTUA), taking into account the tasks of a nurse, and the assessment of their effectiveness in the perceptionof patients after craniocerebral trauma with a diagnosis of alcohol disease.Material and Methods. 100 COTUA patients were tested, in which the diagnostic survey method was used and aquestionnaire was chosen as a technique.Results. The conducted analyses showed that, in the opinion of the respondents, the leading tasks of the nurses atCOTUA include informing patients about the principles and methods of therapy, familiarizing them with thetopography of the ward, the Charter of Patient’s Rights, the regulations of the ward, the schedule of the day and itsspecifics, administering medicines, providing a sense of safety, providing psychological support, transferring knowledgeand learning how to live with the disease and cooperating with the therapeutic team. In addition, three quarters ofthe respondents indicated that the nurses working in the ward are willing to talk to patients about alcohol dependence,and a comparable percentage of the respondents assessed the effectiveness of the therapeutic methods used by thetherapeutic team in relation to their own alcohol dependence problem very well and well.Conclusions. Patients’ assessment of the effectiveness of the therapeutic methods used depends on the nurses’ tasksof conducting therapeutic conversations with patients, providing them with knowledge, learning how to live withthe disease, cooperating with the therapeutic team and the nurses’ readiness to talk to patients about alcoholdependence. (JNNN 2021;10(1):26–34)

Description, A rapid test measures neutralizing antibodies against SARS-CoV-2 variants of concern in 1 hour., Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants are concerning in the ongoing coronavirus disease 2019 (COVID-19) pandemic. Here, we developed a rapid test, termed CoVariant-SCAN, that detects neutralizing antibodies (nAbs) capable of blocking interactions between the angiotensin-converting enzyme 2 receptor and the spike protein of wild-type (WT) SARS-CoV-2 and three other variants: B.1.1.7, B.1.351, and P.1. Using CoVariant-SCAN, we assessed neutralization/blocking of monoclonal antibodies and plasma from COVID-19–positive and vaccinated individuals. For several monoclonal antibodies and most plasma samples, neutralization against B.1.351 and P.1 variants is diminished relative to WT, while B.1.1.7 is largely cross-neutralized. We also showed that we can rapidly adapt the platform to detect nAbs against an additional variant—B.1.617.2 (Delta)—without reengineering or reoptimizing the assay. Results using CoVariant-SCAN are consistent with live virus neutralization assays and demonstrate that this easy-to-deploy test could be used to rapidly assess nAb response against multiple SARS-CoV-2 variants.

The rise in rates of opioid abuse in recent years has led to an increase in the incidence of neonatal abstinence syndrome (NAS). Despite having a greater understanding of NAS and its symptoms, there still remains a lack of information surrounding the long-term effects of prenatal exposure to drugs of abuse on neurological development. One potential outcome of prenatal drug exposure that has been increasingly explored is disruption in normal synaptogenesis within the central nervous system. Both opioids and gabapentin, an antiepileptic drug commonly co-abused by opioid abuse disorder patients, have been shown to interfere with the normal functioning of astrocytes, non-neuronal glial cells known to serve many functions, including regulation of synaptic development. The goal of this study was to investigate the effects of prenatal drug exposure on synaptogenesis within brain regions associated with the mesolimbic dopamine pathway, the primary reward pathway within the brain associated with drug abuse and addiction, in a pregnant mouse model. Immunohistochemistry (IHC) and confocal fluorescence microscopy imaging studies on the brains of postnatal day 21 (P21) mouse pups revealed a significant increase in the mean number of excitatory synapses within the anterior cingulate cortex (ACC), nucleus accumbens (NAc), and prefrontal cortex (PFC) in mice that were prenatally exposed to either the opioid drug buprenorphine or gabapentin. These studies also revealed a significant decrease in the mean number of inhibitory synapses within the NAc and PFC of mice treated with buprenorphine. This observed net increase in excitatory signaling capability within the developing mesolimbic dopamine pathway suggests that exposure to drugs of abuse in utero can trigger maladaptive neuronal connectivity that persists beyond the earliest stages of life.

Introduction Depressive disorders are one of the most common psychiatric disorders. Recognition of signs of mental health disorders is not always easy, hence the availability of simple and accurate tools for assessing them is very important in the practice of primary care. Objective The aim of the study is to assess the theoretical accuracy and reliability of the Patient Health Questionnaire-9 (PHQ-9) in Polish conditions, when applied to general population studies for adults aged between 35–64. Material and methods The study comprised a population of 4,040 people. Women constituted 59% of the research population and people living in the countryside 65%. The average age of participants was 53.45 ± 7.05 years. According to PHQ-9, 727 people (18.0%) had moderate, moderate to severe or severe depression. PHQ-9 showed a significant positive internal cohesion (Cronbach’s alpha = 0.77), and factor charges oscillated between 0.43–0.63, and the R 2 coefficients of determination were in the range of 0.21–0.40. Conclusions The Polish version of PHQ-9 is a valid tool for diagnosing depression in the general population aged 35–64. Good psychometric properties and compactness make the PHQ-9 a useful clinical and research tool.

Introduction . Satisfaction of patients with nursing care is an important, subjective indicator of the quality of relational care, conditioned by the level of care provided and individual patient perception of care. The project adopted a compensation model for the satisfaction of patients with care. Aim . The aim of the work is to present what dimension of satisfaction from nursing is dominant among patients with lumbar spine pain syndrome and to determine whether their assessment depends on the severity of functional consequences of pain. Material and Methods . The research was performed using the diagnostic survey method and the survey technique. The research tools allowing for the collection of information were: Newcastle Satisfaction with Nursing Scale — NSNS and Visual Analog Scale by Barbara Headley. In addition, an original questionnaire was developed by the authors, taking into account medical and socio-demographic variables. The research was carried out from January to October 2017 among 205 patients of two neurosurgical clinics. The selection of patients for the research was purposeful. The project received a positive opinion of the Bioethics Committee at the Medical University in Lublin. Statistical analysis was performed using, among others, multivariate analysis of MANOVA variance in a mixed scheme. Results . In the assessment of patients with lumbar spine pain syndrome, the dominant dimension of satisfaction with nursing is the positive experience from the nursing care received at the ward (M = 5.66, SD = 0.56), and satisfaction with the care received is at a statistically significantly lower level (M = 3.05, SD = 0.48). The overall satisfaction with nursing is highest in patients displaying low (M = 4.40, SD = 0.49) and high (M = 4.43, SD = 0.53) functional consequences of pain. Conclusions . The results of the research compiled in the context of the compensatory satisfaction model indicate that patients formulating an opinion in terms of satisfaction with nursing are based on an objective assessment, i.e.: experienced care events. (JNNN 2019;8(1):4–10)

Anesthetic drugs have been tested for years on rats, rabbits, dogs, cats and monkeys, which may raise ethical concerns. Researchers do not always pay attention to the possibility of using techniques of anesthesia, analgesia or euthanasia in relation to invertebrate animals. It has previously been shown that earthworms meet the requirements of laboratory animals, and being a good alternative to studies on vertebrates, may also be used as the first stage of testing anesthetics. Lethal concentrations of procaine and lidocaine for E. fetida and D. veneta were established using modified filter paper contact test. Using a modified method developed for testing anesthetics, mature earthworms (clitellate) both species were used to check the effectiveness of lidocaine and procaine in safe immobilizing of earthworms. The reactions of earthworms in contact with anesthetics were different. The possibility of using a higher concentration range of procaine and lidocaine for E. fetida than for D. veneta, as E. fetida demonstrated greater resistance to the stress caused by the action of chemical substances. The response to this stress varied and depended on the concentration used, however higher concentrations of anesthetics caused rapid body movements and discharge of the celomatic fluid as well as morphological changes observed after 48 hours. Procaine was not effective in immobilizing earthworms, but lidocaine proved effective in reversibly immobilizing both species. For E. fetida, lidocaine in concentrations of 1.4 and 1.6 at 95 and 90 min respectively resulted in full immobilization of animals, which then survived following 24h and 48h of recovery. For D. veneta, lidocaine in concentrations 1.3 and 1.4 during 40 min proved effective and safe to use, as all individuals survived following 24h and 48h of recovery.

Introduction. As a result of involution processes and diseases, changes occur in the human body, as a result of which, psychophysical fitness declines with age. Comprehensive rehabilitation is the way of improving and maintaining health condition, including, among others, the appropriate level of physical activity and the quality of affective functioning. This type of program was carried out as part of the Outpatient Healthcare Home (DDOM) at the Witold Chodźko Institute of Rural Health in Lublin. Aim. The objective of the present study was to assess the impact of comprehensive ambulatory rehabilitation, including tailored endurance training preceded by an ergospirometry test, on indicators demonstrating the level of involvement in daily physical activities and the severity of depressive symptoms of patients over 60 years of age receiving health services at DDOM. Material and methods. The study involved 60 seniors participating in the rehabilitation cycle implemented as part of the services provided to patients at DDOM of the Witold Chodźko Institute of Rural Health in Lublin. The tests were carried out in the test-retest model on the first and last day of the kinesiotherapy cycle. The tests were performed with use of International Physical Activity Questionnaire IPAQ and Geriatric Depression Scale GDS. The patient rehabilitation program included adapted systemic kinesiotherapy (endurance training with a load determined according to individual exercise capacity, as determined on the basis of the ergospirometry test) and local kinesiotherapy and physical therapy adapted to the needs resulting from the condition of the musculoskeletal system. Results. After the completion of the rehabilitation cycle we compared the tests carried out before it, and the patients received higher scores in the scales of IPAQ questionnaire for measuring weekly, intensive and mode-rate physical activity and time required for walking and were less likely to spend their time sitting or lying down. There were also lower scores of the respondents in GDS scale used to assess the severity of depressive symptoms. Conclusions. As a result of the rehabilitation program applied, DDOM patients simultaneously obtained the desired changes in the level of involvement in physical activity and minimization of the intensity of depressive symptoms.

Introduction The answer to current social and health needs of people aged over 60 are the multidirectional and carefully planned, comprehensive activation and rehabilitation activities carried out as part of Daycare Centres (DCC). The aim of creating and the functioning of DCCs deployed all over Poland is to improve the health and psychophysical fitness of this group of people. Health factors and psychophysical fitness determine the ability to live independently, both today, and later in life. Objective The objective of the study was to assess the impact of comprehensive ambulatory rehabilitation, including tailored endurance training preceded by an ergospirometry test, on indicators demonstrating the ability to live independently and the risk ratio of future health problems in the elderly. Material and methods 60 people participating in a rehabilitation cycle implemented as part of the services provided to patients aged over 60 in the DCC of the Witold Chodźko Institute of Rural Medicine (IMW) in Lublin comprised the sample. The tests were carried out in the test-retest model on the first and last day of the kinesiotherapy cycle. Patients were tested using standardized Barthel, I-ADL and VES-13 questionnaires. The rehabilitation programme applied included systemic kinesiotherapy (endurance training) with a load determined according to individual exercise capacity, determined on the basis of a ergospirometry test, and varied rehabilitation activities resulting from the condition of the locomotor system, as provided for under the project. Results After completing the rehabilitation cycle, patients obtained higher results in comparison to the tests carried out before the beginning of the cycle in the Barthel index used to measure functional efficiency (Z = 5.41; p = 0.001), as well as lower in the I-ADL scale used to test the degree of dependence on the help of others when performing complex activities of everyday life (Z = 2.63; p = 0.009) and in VES-13 scale used to assess the risk of geriatric health problems (Z = 5.47; p = 0.001). Conclusions As the result of the use of comprehensive rehabilitation, including obligatory endurance training, desired changes were achieved in terms of fitness and independence in performing advanced daily activities and reducing the risk of geriatric health problems.

Introduction. The provision of adequate health care for a successively growing group of geriatric patients requires taking into account many factors in order to preserve and/or improve their overall health and the related functional capacity. Its crucial aspects include the ability to safely change position and locomotion, as well as the severity of discomfort from the osteoarticular system. Aim. The objective of the present study was to assess the impact of comprehensive ambulatory rehabilitation including tailored endurance training, preceded by an ergospirometry test, on indicators showing the risk of falls and the severity of pain symptoms of patients aged 60 and over, receiving health services at the Outpatient Healthcare Home (DDOM). Material and methods. The study involved 60 seniors during their rehabilitation cycle implemented as part of the services provided to patients at DDOM of the W. Chodźko Institute of Rural Health in Lublin. The tests were carried out in the test-retest model on the first and last day of the kinesiotherapy cycle. The Tinetti scale of the risk of falls, balance and walk and Visual Analogue Scale of the severity of pain sensations (VAS) were utilized in the research. The patient rehabilitation program at the DDOM included adapted systemic kinesiotherapy (endurance training with a load determined according to individual exercise capacity, as determined on the basis of the ergospirometry test) and local kinesiotherapy as well as physical therapy adapted to the needs resulting from the condition of the musculoskeletal system. Results. After completing the rehabilitation cycle, the patients obtained higher scores, compared to the tests carried out before the beginning of the rehabilitation cycle, in the scales of Tinetti Questionnaire. There were also lower results of the respondents in VAS scale used to assess the severity of pain sensations. Conclusions. As a result of the rehabilitation program applied, DDOM patients simultaneously obtained the desired changes in minimizing the risk of falls, improving the ability to maintain balance and fitness while walking, as well as reducing the severity of pain sensation.

Aim of study. The Fluoxetine Or Control Under Supervision (FOCUS)-Poland trial tested in a Polish cohort the hypothesis that fluoxetine improves recovery after stroke. Clinical rationale for study. Some studies have suggested that fluoxetine may improve functional outcomes after stroke, but these results needed confirmation. Between 2012 and 2014, large clinical trials were initiated by the FOCUS Trial Collaboration. Recently, results from the UK, Sweden, Australia, New Zealand and Vietnam have been published. We here present the results of the FOCUS trial conducted in Poland. Material and methods. This was a randomised, double-blind, placebo-controlled study based on the FOCUS trial protocol. Patients who had a persisting neurological deficit were randomly assigned 2-15 days after stroke onset to receive for six months either fluoxetine 20 mg/day or a placebo. The primary outcome was functional status measured using the modified Rankin Scale (mRS) at six months after randomisation. Functional status at 12 months was also assessed, as was neurological deficit at six and 12 months. Data was also collected on adverse events. Results. Between 19 December 2014 and 13 March 2018, 30 patients were given fluoxetine and 31 were given a placebo. For the primary outcome, the distribution across mRS categories was similar for the fluoxetine and placebo groups at six months (common odds ratio 0.88; 95% confidence interval 0.31–2.50; p = 0.81), and there was no difference at 12 months (p = 0.864). There were no differences between groups in stroke recovery or in motor function recovery of the affected hand. There were no significant differences in any other secondary outcomes at six or 12 months. Patients given fluoxetine were less likely than those given the placebo to receive new antidepressant medication within six months (2 [6.67%] vs. 4 [12.90%]). Conclusions and clinical implications. Consistent with other trials based on the FOCUS protocol, fluoxetine did not improve motor recovery or general stroke outcome at six and 12 months in the Polish cohort studied. However, patients receiving fluoxetine required therapy with additional antidepressant medication less frequently.

Background Several disease states commonly associated with methamphetamine (METH) use produce liver dysfunction, and in the bile duct ligation (BDL) model of hepatic dysfunction, rats with liver injury are more sensitive to METH effects. Additionally, both female rats and humans are known to be more sensitive to METH than males. In consideration of known sex-dependent differences in METH pharmacokinetics, this study sought to determine the potential interaction between sex and liver dysfunction variables on METH pharmacokinetics. Methods Sham or BDL surgery was performed on male and female rats on day 0. Serum biomarker and pharmacokinetics studies with 3 mg/kg subcutaneous (SC) METH were performed on day 7. METH-induced weight loss was measured on day 8. Liver histology evaluation and brain METH concentration measurements were performed on day 9. Results While BDL surgery produced significantly elevated alanine aminotransferase and bile duct proliferation in male compared to female rats, there were no significant interactions between sex and liver function in the pharmacokinetic parameters. Both liver dysfunction and female sex, however, were associated with significantly slower METH serum clearance and significantly higher brain METH concentrations (p Conclusions BDL-induced hepatic dysfunction produces substantial reductions in METH clearance and increased brain METH concentrations in both male and female rats, despite less liver injury in females. This preclinical model may be useful to identify and correct potential liver dysfunction comorbidity-related problems with future pharmacotherapy for stimulant use disorder with METH prior to expensive clinical trials.

Summary Background Early and accurate identification of individuals with viral infections is crucial for clinical management and public health interventions. We aimed to assess the ability of transcriptomic biomarkers to identify naturally acquired respiratory viral infection before typical symptoms are present. Methods In this index-cluster study, we prospectively recruited a cohort of undergraduate students (aged 18–25 years) at Duke University (Durham, NC, USA) over a period of 5 academic years. To identify index cases, we monitored students for the entire academic year, for the presence and severity of eight symptoms of respiratory tract infection using a daily web-based survey, with symptoms rated on a scale of 0–4. Index cases were defined as individuals who reported a 6-point increase in cumulative daily symptom score. Suspected index cases were visited by study staff to confirm the presence of reported symptoms of illness and to collect biospecimen samples. We then identified clusters of close contacts of index cases (ie, individuals who lived in close proximity to index cases, close friends, and partners) who were presumed to be at increased risk of developing symptomatic respiratory tract infection while under observation. We monitored each close contact for 5 days for symptoms and viral shedding and measured transcriptomic responses at each timepoint each day using a blood-based 36-gene RT-PCR assay. Findings Between Sept 1, 2009, and April 10, 2015, we enrolled 1465 participants. Of 264 index cases with respiratory tract infection symptoms, 150 (57%) had a viral cause confirmed by RT-PCR. Of their 555 close contacts, 106 (19%) developed symptomatic respiratory tract infection with a proven viral cause during the observation window, of whom 60 (57%) had the same virus as their associated index case. Nine viruses were detected in total. The transcriptomic assay accurately predicted viral infection at the time of maximum symptom severity (mean area under the receiver operating characteristic curve [AUROC] 0·94 [95% CI 0·92–0·96]), as well as at 1 day (0·87 [95% CI 0·84–0·90]), 2 days (0·85 [0·82–0·88]), and 3 days (0·74 [0·71–0·77]) before peak illness, when symptoms were minimal or absent and 22 (62%) of 35 individuals, 25 (69%) of 36 individuals, and 24 (82%) of 29 individuals, respectively, had no detectable viral shedding. Interpretation Transcriptional biomarkers accurately predict and diagnose infection across diverse viral causes and stages of disease and thus might prove useful for guiding the administration of early effective therapy, quarantine decisions, and other clinical and public health interventions in the setting of endemic and pandemic infectious diseases. Funding US Defense Advanced Research Projects Agency.

Introduction and objective An important role in the pathogenesis of asthma in children is played by individual parameters and environmental factors, in particular, those related to the place of residence. The aim of this study was to assess the impact of the living environment on the basic demographic and clinical parameters of preschool children with IgE-dependent asthma. Material and methods 176 children (126 from urban and 52 from rural areas) aged 5.22±0.34 years, with newly-diagnosed IgE-dependent asthma, hospitalised at the Clinic for Lung Diseases and Paediatric Rheumatology of the Prof. Antoni Gębala Children’s Hospital of Lublin, were qualified for the study. Medical documentation of the children was analysed, including the implementation of vaccinations. Due to the clinical form of the disease, patients were separated into groups with mild, moderate and severe asthma. Results No statistically significant differentiation was observed between age and current body weight and height of the children. Similarly, gender and the clinical form of asthma were not significantly correlated with the place of residence. Children with asthma, at the time of exacerbation symptoms of the disease, living in a city, significantly more often (p

Introduction and objective Patient satisfaction with nursing care is one of important indicators of health care quality. As for pain, it is an indicator of patient health. The goal of the study is to identify socio-demographic and medical factors that differentiate the assessment of satisfaction with nursing care of hospitalized patients. Material and methods The study involved performing a diagnostic survey using standardized instruments, i.e. the Newcastle Satisfaction with Nursing Scale (NSNS) and the Visual Analog Scale by Barbara J. Headley for pain scoring. The study included 205 patients hospitalized for lumbar pain syndrome on two neurosurgery wards in Poland. The mean patient age was 51 years. Most respondents declared having high school or vocational education. The mean time of hospitalization before the study was 2 days. Results The results demonstrated that patient satisfaction with nursing care is independent of patient age, education, duration of hospitalization, or number of hospitalizations. In contrast, the experience of nursing care is dependent on education, and less educated patients (primary or vocational education) had higher scores in this category. With regards to pain, it was perceived as more intense by women and by patients hospitalized for a shorter period of time. Conclusions Satisfaction with nursing care among patients with lumbar pain syndrome does not depend on socio-demographic or medical variables. Experience of nursing care depends on patient's education.

RationaleAsthma exacerbations often occur due to infectious triggers, but determining whether infection is present and whether it is bacterial or viral remains clinically challenging. A diagnostic strategy that clarifies these uncertainties could enable personalized asthma treatment and mitigate antibiotic overuse.ObjectivesTo explore the performance of validated peripheral blood gene expression signatures in discriminating bacterial, viral, and noninfectious triggers in subjects with asthma exacerbations.MethodsSubjects with suspected asthma exacerbations of various etiologies were retrospectively selected for peripheral blood gene expression analysis from a pool of subjects previously enrolled in emergency departments with acute respiratory illness. RT-PCR quantified 87 gene targets, selected from microarray-based studies, followed by logistic regression modeling to define bacterial, viral, or noninfectious class. The model-predicted class was compared to clinical adjudication and procalcitonin.ResultsOf 46 subjects enrolled, 7 were clinically adjudicated as bacterial, 18 as viral, and 21 as noninfectious. Model prediction was congruent with clinical adjudication in 15/18 viral and 13/21 noninfectious cases, but only 1/7 bacterial cases. None of the adjudicated bacterial cases had confirmatory microbiology; the precise etiology in this group was uncertain. Procalcitonin classified only one subject in the cohort as bacterial. 47.8% of subjects received antibiotics.ConclusionsOur model classified asthma exacerbations by the underlying bacterial, viral, and noninfectious host response. Compared to clinical adjudication, the majority of discordances occurred in the bacterial group, due to either imperfect adjudication or model misclassification. Bacterial infection was identified infrequently by all classification schemes, but nearly half of subjects were prescribed antibiotics. A gene expression-based approach may offer useful diagnostic information in this population and guide appropriate antibiotic use.

Introduction One possible way of iron loss is sweating. It is unclear how physical activity performed by untrained individuals affects the iron status in sweat. Objective The purpose of this study was to analyse iron concentration in sweat during 4-week exercise training to determine the changes in iron excretion during follow-up exercises. Material and methods 43 untrained volunteers participated in the study, 29 of whom completed the full exercise programme. The training programme consisted of exercises on a cycle ergometer and cross-trainer. In the first week, participants exercised for 8 minutes on each device, in the second for 10 minutes, and in the third and fourth weeks they exercised for 15 min on each device. Intensity was submaximal and defined as 85% of maximal heart rate. A sterile sweat patch was placed on the skin between shoulder blades. Results Concentration of iron on the first and the fifteenth day of exercises was comparable and statistically insignificant. Iron concentration was highly increased on the last day of training in comparison with first (p

BACKGROUND: Pneumonia is a common complication of hospitalisation in severely ill patients who need mechanical ventilation. The aim of this study was to assess the usefulness of the International Nosocomial Infection Control Consortium programme for the surveillance of ventilator-associated pneumonia (VAP). METHODS: A prospective study (1 Jan 2012−30 June 2014) was conducted in the 20-bed ICU. The device utilisation ratios for lung ventilation and the frequency (density and incidence) and aetiology of VAP were estimated in ICU patients. RESULTS: From a total of 1097 patients, VAP infections were diagnosed in 93. Thirty percent of patients with VAP died. The incidence index was 8.47 per 100 admissions to the ICU. VAP infections accounted for 46% of the overall count of device-associated healthcare-associated infections. Mechanical ventilation was used in 71 ± 8 patients during the 11 862 patient days and 8425 ventilation days. The rate of VAP per 1000 ventilator days was 11.15/9.34 /10.23 in years 2012/2013/2014 (half a year), respectively. The main VAP pathogens were Acinetobacter baumannii (45%) and Pseudomonas aeruginosa (17%). CONCLUSION: During the reported time span, the incidence of VAP was lower than in the INICC report (2007–2012), but it was tenfold higher than in the NHSN/CDC report (dated 2012). Because of the unchanged VAP level during the 2.5-year observation period, the root cause needs to be determined and action should be taken to resolve this issue.

This research empirically explores the relation between carbon dioxide emission and economic growth during the period 1992-2010, using panel data on the European Union countries. Both fixed and random effect models are employed to test the Environmental Kuznets Curve (EKC) relationship between CO2 emissions and GDP per capita. While no U-shaped EKC was confirmed empirically for all 28 current EU member states, the graphical analysis demonstrates a justified turning point for CO2 emissions as GDP per capita reaches the level of 23,000 USD. Furthermore, there is a firm empirical ground for the EKC hypothesis based on data from 16 older, relatively high-income EU states. Thus, though not empirically confirmed, there is ample data verifying the existence of the EKC in EU economies.

Sustainability is the contemporary meta-paradigm that influences both theory and practice of management. It reflect attitude of companies towards their environment, including natural resources, and enables obtaining competitive advantage if applied and implemented holistically and in a mature way. The goal of the paper is to present results of the assessment of organizational maturity in the aspect of sustainable resources management. The research was carried in Greatpoland (Wielkopolska) and Lower Silesia (Dolny Slask) regions in Poland between 2015 and 2016 to identify the level of maturity in the aspect of sustainable resources management.

Background Bacterial and viral infections are difficult to clinically distinguish, leading to antibiotic overuse and resistance. Host response signatures are an alternative to traditional pathogen-detection methods to differentiate these etiologies. Several gene expression signatures have been described although performance in ambiguous clinical phenotypes is unknown. Here, we validate a host response signature and explore its performance in microbiology-negative and co-infection cases. Methods RT-PCR taqman low-density array (TLDA) was used to measure 87 gene targets in a training cohort of 151 samples from patients with microbiologically confirmed and clinically adjudicated phenotypes (48 bacterial; 54 viral; 49 non-infectious illness [NI]). This data were used to construct three distinct classifiers: bacterial vs. nonbacterial; viral vs. nonviral; and non-infectious vs. infectious. This model was then applied to 75 subjects with co-infection and 40 suspected bacterial cases without microbiological confirmation. Results Leave-one-out cross validation on the training cohort demonstrated AUC values of 0.85, 0.89, and 0.88 for bacterial, viral, and NI, respectively. In 40 subjects with microbiology-negative bacterial infections, a bacterial or co-infection signature was present in 72%. Of 75 subjects with co-infection, 53 included a bacterial infection following recent viral infection and 22 were bacterial infections in patients with chronic viral infection (e.g., HCV, HIV). Bacterial infection and co-infection were successfully identified in these varied scenarios. Conclusion This gene expression signature distinguished bacterial, viral, and noninfectious causes of illness. The host response was able to confirm the majority of suspected bacterial infection without confirmatory microbiology but also highlighted a viral response in many. Furthermore, the use of distinct viral and bacterial signatures was capable of identifying co-infection. Such a host gene expression strategy, when translated to a clinically useful platform, can offer new insights into the etiology of both simple and complex cases that are not currently available. Disclosures G. S. Ginsburg, Host Response Inc.: Board Member, Founder, Scientific Advisor and Shareholder, Stock (currently worth

Background Despite advances in molecular techniques the etiology of acute respiratory infections (ARIs) is often difficult to differentiate either at the point of care or with advanced microbiological techniques. There is growing interest in host biomarker assays, including those based on gene expression patterns in circulating cells, to aid in differentiation of viral and bacterial diseases. However, there are concerns about how such tests perform in vulnerable aging populations where host responses are often muted. Methods In order to assess performance of gene expression-based biomarkers, we enrolled patients presenting to the emergency department with clinical ARI and selected 184 individuals aged ≤25 and ≥60 years old with proven viral or bacterial ARI. Gene expression in peripheral blood was measured with Affymetrix microarrays. Published viral and bacterial signatures were applied to the data and Bayesian approaches were used to develop novel discriminative models. Results We noted a marked decline in signature performance between younger and older individuals in both viral (AUC 0.90 vs. 0.64) and bacterial (AUC 0.91 vs. 0.50) infections. Incorporation of age-related genomic changes was able to restore much of the signature performance in older individuals. When examining the genomic differences driving the drop in signature performance, we found marked perturbations in expression of immunoglobulin genes and pathways driving known immunoregulatory mechanisms that provide novel insights into an age-related decline in ARI-focused immunity. Conclusion Pathogen class-specific host-based gene expression signatures offer great promise as diagnostic tools. However, altered immune responses in vulnerable populations such as the elderly are also manifested at the genomic level and can affect diagnostic signature performance. Age-specific alterations in the components of a diagnostic signature can minimize much of this effect, however this work highlights the need for consideration of age during biomarker development for infectious diseases. Furthermore, studies of age-related differences in biomarker performance can lead to important breakthroughs in our understanding of age-associated alterations in immunity. Disclosures All authors: No reported disclosures.

Background Asthma exacerbations often occur due to infectious triggers. However, determining whether an infection is present and whether it is bacterial or viral remains clinically challenging leading to antibiotic overuse. A diagnostic strategy that clarifies these uncertainties can enable personalized asthma treatment and mitigate antibiotic resistance. Host gene expression is a promising alternative to pathogen-detection methods. Methods Forty-six patients presenting to the emergency department with asthma exacerbations were enrolled. Cases were clinically adjudicated as having bacterial, viral, or non-infectious etiologies. RT-PCR taqman low density array (TLDA) was used to quantify 87 gene targets, followed by logistic regression modeling to define class. Etiologies were correlated with clinical information including symptoms and antibiotic prescriptions. Results Most clinical parameters were similar between groups including duration of symptoms, presence of sick contacts, and severity of nasal symptoms, cough, headache, throat discomfort, and malaise. Only fever/chills (P = 0.006) and a composite of all symptoms (P = 0.02) were significantly different. In contrast to clinically adjudicated phenotypes, host response signatures identified very few bacterial triggers. Notably, none of the adjudicated bacterial cases had positive confirmatory microbiology. Instead, 29 and 57% were identified as having a viral infection or no infection, respectively. Despite the absence of bacterial infections identified using host gene expression, antibiotics were prescribed in 47.8% of all cases. Conclusion Host response signatures indicated that asthma exacerbation is infrequently caused by bacterial infections, even when clinical adjudications suggest this to be the case. Instead, most are either of viral or non-infectious etiologies. Despite most cases being classified as nonbacterial, empiric antibiotics were prescribed nearly half the time. A host gene expression approach can offer clinically useful diagnostic information to guide more appropriate antibiotic use among patients with asthma exacerbation. Disclosures G. S. Ginsburg, Host Response Inc.: Board Member, Founder, Scientific Advisor and Shareholder, Stock (currently worth < $100). C. W. Woods, Host Response: Founder, Licensing agreement or royalty; Qvella: Collaborator, Research support; BioFire: Collaborator, none. E. L. Tsalik, Host Response, Inc.: Founder, Equity.

Acute respiratory infections caused by bacterial or viral pathogens are among the most common reasons for seeking medical care. Despite improvements in pathogen-based diagnostics, most patients receive inappropriate antibiotics. Host response biomarkers offer an alternative diagnostic approach to direct antimicrobial use. This observational, cohort study determined whether host gene expression patterns discriminate non-infectious from infectious illness, and bacterial from viral causes of acute respiratory infection in the acute care setting. Peripheral whole blood gene expression from 273 subjects with community-onset acute respiratory infection (ARI) or non-infectious illness as well as 44 healthy controls was measured using microarrays. Sparse logistic regression was used to develop classifiers for bacterial ARI (71 probes), viral ARI (33 probes), or a non-infectious cause of illness (26 probes). Overall accuracy was 87% (238/273 concordant with clinical adjudication), which was more accurate than procalcitonin (78%, p

In the paper the model of the Occupational Health and Safety management system (OHS management system model.) implementable in organizations striving for continuous improvement and excellence is presented. The concepts of excellent organizations and organizational maturity are explained. The model presented by the author is the result of the case study based research conducted in five manufacturing companies in the Wielkopolska region. All the analyzed companies in a very clear way focus their attention on the issue of improving OHS management system and are interested in are assessment of organizational maturity in this area and meet the requirements of any health and safety excellence model. The basic assumption of the model is application of the continuous improvement principle at three management levels: strategic, tactical and operational. As an extension of the model presented, the option of the implementation of Deming’s fourteen principles to the area of health and safety management is introduced. Approach to the management of health and safety presented points to the ever increasing interest of enterprises in these issues, in addition it proves the fact that achieving and improving organizational maturity is only possible with regard to issues of health and safety.

Quality assessment can be performed with natural language (in descriptive form) or with numbers (in quantitative form). Such approach enables consideration of all the aspects and characteristics beyond quantification, difficult or impossible to assess with numbers, hence requiring linguistic representation. Application of fuzzy index to work conditions quality assessment provides objective identification of hazards and their influence on work conditions quality.

The elaboration is a case study and the research was carried out in the company Alco-Mot Ltd., which employs 120 people. The company specializes in the production of lead poles for industrial and traction batteries using gravity casting. The elements embedded in the cast are manufactured on a machining centre, which provides the stability of the process and of the dimensions of the product as well as a very short production time. As a result of observation and analysis the authors have developed a concept for the implementation of a dynamic suggestion system in ALCO-MOT, including, among others, a standard for actions in the implementation of the suggestion system, as well as clear guidelines for the processing and presentation of the activities undertaken in the time between the establishment of the concept (suggestions) and the benefits analysis after the proposed solutions have been implemented. The authors also present how suggestions proposed by ALCO-MOT staff contributed to the improvement of the processes of production and quality control. Employees offered more than 30 suggestions, of which more than a half are being implemented now and further actions are being prepared for implementation. The authors will present the results of improvements in, for example, tool replacement time, scrap reduction. The authors will present how kaizen can improve the production and quality control processes. They will present how the production and quality control processes looked before and after the implementation of employee suggestions.

To the Editor: We read with much interest an excellent and thorough review published in the January issue of Kidney International by Siew and Davenport on an alarming increase in incidence of acute kidney injury (AKI) in North America and Western Europe.1 The question asked by the Authors, namely whether these changes reflect the real rise or are rather driven by better diagnostics, reimbursement issues, and a more liberal use of dialysis, seems to be crucial and should prompt future well-designed studies. Therefore, we would like to share our experience. Recently, we retrospectively analyzed the data obtained from individual hospital records of 774 consecutive patients with AKI, as defined by KDIGO criteria,2 requiring dialysis (AKI-D) in our single university hospital between Jan 2005 and Dec 2009. A subgroup of 126 patients, residents of three identifiable districts of Warsaw covered by the hospital with an estimated adult population of 149,687, were isolated to count the incidence.