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Objectives To determine the prevalence and impact of urinary incontinence (UI) in men with cystic fibrosis (CF). Design Prospective observational study. Setting Adult CF clinics at tertiary referral centres. Participants Men with CF ( n =80) and age-matched men without lung disease ( n =80). Interventions Validated questionnaires to identify the prevalence and impact of UI. Main outcome measures Prevalence of UI and relationship to disease specific factors, relationship of UI with anxiety and depression. Results The prevalence of UI was higher in men with CF (15%) compared to controls (10%) ( p =0.339). Men with CF and UI had higher scores for anxiety than those without UI (mean 9.1 (SD 4.8) vs 4.7 (4.1), p =0.003), with similar findings for depression (6.8 (4.6) vs 2.8 (3.4), p =0.002) using the Hospital Anxiety and Depression Scale. Conclusions Incontinence is more prevalent in adult men with CF than age matched controls, and may have an adverse effect on mental health. The mechanisms involved are still unclear and may differ from those reported in women.

Background NSABP B-36 compares 6 cycles of FEC-100 with 4 cycles of standard AC in pts with node-negative breast cancer. As reported separately, no significant differences between the two treatment arms were observed in the primary endpoint of disease-free survival or in the secondary endpoints of overall survival, recurrence-free, or distant recurrence-free intervals. Greater toxicity was reported in pts who received FEC compared to AC. We present here the results of the QOL and MH studies obtained prospectively in conjunction with the treatment study. We hypothesized that pts on FEC would experience greater treatment toxicity in the first 12 months of the study, and would have greater rates of amenorrhea at 18 months compared to pts on AC. Methods Among the 1,357 pts enrolled in the QOL study, 1,332 (675 AC, 657 FEC) submitted the baseline form and had QOL follow-up (fup) information. Pts completed: 1) the FACT-B instrument; 2) a symptom checklist; and 3) the SF-36 Vitality Scale, all at baseline, day 1 of cycle 4, and at 6, 12, 18, 24, 30, and 36 months after random assignment. FACT-B Trial Outcome Index (TOI), symptom severity, and vitality scores were compared between the two treatment arms using a mixed model for repeated measures analysis with adjustment for the baseline scores, type of surgery, and hormone receptor status, examining the first 12 months and the later time points separately. Menstrual status was collected at baseline for all enrolled pts, with subsequent assessments on day 1 of cycle 4, and at 6, 12, 18, 24, 30, and 36 months for pts with menstrual bleeding within 12 months prior to random assignment and not having had a hysterectomy and/or bilateral oophorectomy (1, 096 pts). Post-chemotherapy amenorrhea was defined as the lack of menstrual periods during the 12 months preceding the 18-month fup evaluation. Data from 921 pts (475 AC, 446 FEC) were available for analysis. Logistic regression, adjusted for type of surgery and hormone receptor status, was used to test for association of amenorrhea status and treatment. Results Both TOI and vitality scores were worse for pts on FEC compared to those on AC at 6 months (p Conclusions Women receiving FEC had diminished QOL at 6 months after random assignment, but no difference at 12 months or later. Premenopausal women receiving FEC experienced a higher rate of post-chemotherapy amenorrhea than women receiving AC. Support NCI grants U10-CA-12027, -37377, -69974, -69651 and -44066-26, and Pharmacia & Upjohn Company, a subsidiary of Pfizer, Inc. Citation Format: Patricia A Ganz, John W Wilson, Hanna Bandos, André Robidoux, Alexander HG Paterson, Johnathan Polikoff, Luis Baez-Diaz, Adam M Brufsky, Louis Fehrenbacher, Aroop Mangalik, Patrick J Ward, Louise Provencher, John T Hamm, Philip J Stella, Robert L Carolla, Richard G Margolese, Henry R Shibata, Edith A Perez, Norman Wolmark. Impact of treatment on quality of life (QOL) and menstrual history (MH) in the NSABP B-36: A randomized phase III trial comparing six cycles of 5-fluorouracil (5-FU), epirubicin, and cyclophosphamide (FEC) to four cycles of adriamycin and cyclophosphamide [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P3-12-01.

Established butterfly monitoring methods are designed for open habitats such as grasslands. Not all rare species occupy habitats that are easy to see across and navigate, in which cases a new approach to monitoring is necessary. We present a novel use of point transect distance sampling to monitor the Miami blue, a highly endangered butterfly that occupies dense shrub habitat. To monitor Miami blue density, we developed surveys consisting of butterfly counts in semi-circular plots. We examined the rate at which an observer detects new butterflies to determine the survey duration that meets the key assumption that butterflies are detected at their initial location. As a related secondary goal, we identified the determinants of adult flight phenology to target monitoring efforts during periods of high adult abundance. We observed peak Miami blue densities in April and July/August 2012, and July/August 2013. We estimated density using detections from a 10-sec survey, our most defensible and conservative estimate. Peak daily density estimates ranged from 592 to 680 butterflies per hectare. Adult density was related to precipitation patterns, with high densities occurring 4–6 weeks after particularly wet 4-week intervals. For butterfly species that exist in high enough densities, we recommend using point transect distance sampling in habitats where traditional methods are impossible to implement.

Cystic fibrosis (CF) is the most common life-limiting genetically acquired respiratory disorder. Patients with CF have thick mucus obstructing the airways leading to recurrent infections, bronchiectasis and neutrophilic airway inflammation culminating in deteriorating lung function. Current management targets airway infection and mucus clearance, but despite recent advances in care, life expectancy is still only 40 years. We investigated whether activin A is elevated in CF lung disease and whether inhibiting activin A with its natural antagonist follistatin retards lung disease progression. We measured serum activin A levels, lung function and nutritional status in CF patients. We studied the effect of activin A on CF lung pathogenesis by treating newborn CF transgenic mice (β-ENaC) intranasally with the natural activin A antagonist follistatin. Activin A levels were elevated in the serum of adult CF patients, and correlated inversely with lung function and body mass index. Follistatin treatment of newborn β-ENaC mice, noted for respiratory pathology mimicking human CF, decreased the airway activin A levels and key features of CF lung disease including mucus hypersecretion, airway neutrophilia and levels of mediators that regulate inflammation and chemotaxis. Follistatin treatment also increased body weight and survival of β-ENaC mice, with no evidence of local or systemic toxicity. Our findings demonstrate that activin A levels are elevated in CF and provide proof-of-concept for the use of the activin A antagonist, follistatin, as a therapeutic in the long-term management of lung disease in CF patients.

Human herpesvirus 8 (HHV-8) is the causal agent of Kaposi's sarcoma (KS). In Tobago, KS is not common; however, HHV-8 seropositivity has been reported to be 39.9% in men with prostate cancer compared to

Background : In the aftermath of the 2010 earthquake in Haiti, St. Luke Hospital was built to help manage the mass casualties and subsequent cholera epidemic. A major problem faced by the hospital system was the lack of an available and sustainable supply of medications. Long-term viability of the hospital system depended largely on developing an uninterrupted medication supply chain. Objective : We hypothesized that the implementation of a new Pharmacy Computerized Inventory Program (PCIP) would optimize medication availability and decrease medication shortages. Design : We conducted the research by examining how medications were being utilized and distributed before and after the implementation of PCIP. We measured the number of documented medication transactions in both Phase 1 and Phase 2 as well as user logins to determine if a computerized inventory system would be beneficial in providing a sustainable, long-term solution to their medication management needs. Results : The PCIP incorporated drug ordering, filling the drug requests, distribution, and dispensing of the medications in multiple settings; inventory of currently shelved medications; and graphic reporting of ‘real-time’ medication usage. During the PCIP initiation and establishment periods, the number of medication transactions increased from 219.6 to 359.5 ( p =0.055), respectively, and the mean logins per day increased from 24.3 to 31.5, p

A computationally efficient 3DHZETRN code capable of simulating High (H) Charge (Z) and Energy (HZE) and light ions (including neutrons) under space-like boundary conditions with enhanced neutron and light ion propagation was recently developed for a simple homogeneous shield object. Monte Carlo benchmarks were used to verify the methodology in slab and spherical geometry, and the 3D corrections were shown to provide significant improvement over the straight-ahead approximation in some cases. In the present report, the new algorithms with well-defined convergence criteria are extended to inhomogeneous media within a shielded tissue slab and a shielded tissue sphere and tested against Monte Carlo simulation to verify the solution methods. The 3D corrections are again found to more accurately describe the neutron and light ion fluence spectra as compared to the straight-ahead approximation. These computationally efficient methods provide a basis for software capable of space shield analysis and optimization.

Babesiosis is a zoonotic disease transmitted by Ixodes ticks seen in the United States and parts of Europe. Because of the typically mild course of most infections, the disease is uncommonly seen in clinical practice. However, asplenic patients can develop a life-threatening infection. The first line of therapy for Babesia infections is antiparasitic medications; however, red blood cell (RBC) exchange transfusion has been described as an adjunct therapy. We describe a severe case of babesiosis in an asplenic patient and review the evidence, indications, and protocols for RBC exchange transfusion in this setting.

Mycobacterium genavense is a non-tuberculous mycobacterium which can rarely cause disease in non-HIV immunocompromised hosts. We describe our experience with this unusual infection and perform a systematic review of the literature to describe the features of M. genavense infection in non-HIV immunocompromised hosts.All cases of Mycobacterium genavense infection in non-HIV patients at our institution were reviewed. In addition, we conducted a systematic review of the literature to identify previously published cases of M. genavense infections in non-HIV hosts.Two cases of M. genavense were identified at our center; a 51-year-old renal transplant recipient with a prosthetic knee joint infection and a 66-year-old woman with idiopathic CD4 lymphocytopenia with gastrointestinal tract disease. The systematic review identified 44 cases of M. genavense infection in non-HIV hosts. The most common underlying conditions were solid organ transplantation (40%), sarcoidosis (14%) and hematopoietic stem cell transplantation (7%). Disease most commonly involved the gastrointestinal tract, spleen, liver or bone marrow. Diagnosis was challenging with PCR required for identification in nearly all cases. Over one-third of patients died, which may reflect the combination of infection and underlying comorbidities. Overall cure was achieved in 61% with a mean duration of antimycobacterial therapy of 15.5 months (range 10-24).M. genavense infection is a rare mycobacterial infection in non-HIV immunocompromised hosts. It should be suspected in immunocompromised patients presenting with disseminated mycobacterial infection, acid fast bacilli on smear or histopathologic examination, with poor or no growth in mycobacterial cultures.

G551D, a mutation of the cystic fibrosis transmembrane conductance regulator (CFTR) gene, results in impaired chloride channel function in cystic fibrosis (CF) with multiple end-organ manifestations. The effect of ivacaftor, a CFTR-potentiator, on exercise capacity in CF is unknown. Twenty G551D-CF patients were recruited to a single-centre, double-blind, placebo-controlled, 28-day crossover study of ivacaftor. Variables measured included percentage change from baseline (%Δ) of VO2max (maximal oxygen consumption, primary outcome) during cardiopulmonary exercise testing (CPET), relevant other CPET physiological variables, lung function, body mass index (BMI), sweat chloride and disease-specific health related quality of life (QOL) measures (CFQ-R and Alfred Wellness (AWEscore)). %ΔVO2max was unchanged compared with placebo as was %Δminute ventilation. However, %Δexercise time (mean 7.3, CI 0.5–14,1, P=0.0222) significantly increased as did %ΔFEV1 (11.7%, range 5.3–18.1, P

Mycobacterium iranicum is a newly reported nontuberculous mycobacterial (NTM) species that has been previously isolated in twelve patients. Our report presents the thirteenth known case of M. iranicum, which caused septic arthritis of the right third proximal interphalangeal joint and associated tenosynovitis in a 39-year-old female following a rose thorn injury. Keywords: Mycobacterium, Iranicum, Septic arthritis, Tenosynovitis

BACKGROUND: Acid gastroesophageal reflux is a common problem in non-cystic fibrosis bronchiectasis and COPD. Invasive methods are used to diagnose gastroesophageal reflux, but the ability to detect pulmonary microaspiration of gastric contents using this method is unclear. A noninvasive option to detect pulmonary microaspiration is to measure pepsin in exhaled breath condensate (EBC), but this has not been related to esophageal pH monitoring in these lung conditions. This study aimed to measure pepsin concentrations and pH in EBC and to determine the relationship to gastroesophageal reflux in bronchiectasis or COPD. METHODS: Subjects with bronchiectasis ( n = 10) or COPD ( n = 10) and control subjects ( n = 10) completed 24-h esophageal pH monitoring for detection of acid gastroesophageal reflux, measuring the percentage of reflux time in the proximal esophagus and the DeMeester score (DMS). Concurrently, 3 samples of EBC were collected from each subject, and pH was measured and pepsin concentrations were analyzed by enzyme-linked immunosorbent assay. RESULTS: EBC pepsin was detected in subjects with bronchiectasis (44%) or COPD (56%) and in control subjects (10%). A diagnosis of gastroesophageal reflux was not associated with a higher concentration of EBC pepsin in bronchiectasis ( P = .21) or COPD ( P = .11). EBC pepsin concentration did not correlate with DMS (rs = 0.36) or proximal reflux index (rs = 0.25) in subjects with bronchiectasis or with DMS (rs = 0.28) or proximal reflux index (rs = 0.21) in patients with COPD. EBC and sputum pepsin concentrations were moderately correlated in bronchiectasis (rs = 0.56) and in COPD (rs = 0.43). CONCLUSIONS: Pepsin is detectable in EBC samples in bronchiectasis and COPD. Although no association was found between pepsin concentrations and a diagnosis of gastroesophageal reflux, a moderate relationship between sputum and EBC pepsin concentrations suggests that EBC pepsin may be a useful noninvasive marker of pulmonary microaspiration.

The computationally efficient HZETRN code has been used in recent trade studies for lunar and Martian exploration and is currently being used in the engineering development of the next generation of space vehicles, habitats, and extra vehicular activity equipment. Code development has been based on a progression of approximations first assuming all particles are produced in the initiator direction of incidence (straight-ahead) later improved by treating neutrons produced in the backward hemisphere as moving straight-back (bi-directional). A new version (3DHZETRN) capable of transporting High charge (Z) and Energy (HZE) and light ions (including neutrons) under space-like boundary conditions with enhanced neutron and light ion propagation in transverse directions is developed. Herein, new algorithms for light ion and neutron propagation with well defined convergence criteria in 3D objects is developed and tested against Monte Carlo simulations of 3D effects.

The purpose of this study was to define the pulmonary and systemic pharmacokinetics of colistin methanesulfonate (CMS) and formed colistin following intravenous (i.v.) and inhaled administration in cystic fibrosis (CF) patients. Six CF subjects were administered nebulized CMS doses of 2 and 4 million IU and an i.v. CMS infusion of 150 mg of colistin base activity. Blood plasma, sputum, and urine samples were collected for 12 to 24 h postdose. To assess the tolerability of the drug, lung function tests, blood serum creatinine concentrations, and adverse effect reports were recorded. All doses were well tolerated in the subjects. The pharmacokinetic parameters for CMS following i.v. delivery were consistent with previously reported values. Sputum concentrations of formed colistin were maintained at

In a world where the natural environment is being altered rapidly by the activities of a burgeoning human population, large predators (individuals with body mass greater than 21.5 kg which consume mainly meat; Carbone & Gittleman 2002) face increased competition for space and food in the remaining refuges they inhabit (Balme et al. 2009). As a consequence, understanding the resource requirements of large predators is imperative if we are to conserve these species. In the past decade, our understanding of large predators' prey preferences have advanced from a conglomeration of single site studies with limited connectivity to a field dedicated to the meta-analysis of predator resource acquisition (Hayward 2009). These meta-analyses have given us insight into the patterns driving prey preference in the suit of large African predators (Hayward et al. 2006).

BackgroundAcute neurological events may present as an extrapulmonary complication in patients with cystic fibrosis (CF). These events can be secondary to a range of different aetiologies.MethodsA retrospective analysis of 476 medical records of CF patients attending a large teaching hospital between 2000 and 2018 was performed. Patients presenting with acute neurological events who had MRI brain imaging were evaluated. Patients who had headaches without associated neurological symptoms were excluded from this analysis.ResultsAcute neurological presentations, excluding headaches without associated neurological symptoms, were reported in 27 index patients out of the 476 patients. Of these, 16 patients had MRI brain imaging for review. Three patients suffered pathology secondary to vascular events, both ischaemic and haemorrhagic; four patients had evidence of ischaemia or infarction not consistent with a vascular territory stroke and the remaining patients experienced a range of different neurological events. The most common presentation among these patients was seizure activity, followed by a transient motor or sensory deficit.ConclusionsNeurological complications are recognised among individuals with CF. Although rare, they can be secondary to a range of different aetiologies, including dysfunctional cell energetics. Additional studies are required to further evaluate this association.

Background and objective The aims of this observational study were (i) to examine the prevalence of symptomatic and clinically silent proximal and distal gastro-oesophageal reflux (GOR) in adults with chronic obstructive pulmonary disease (COPD) or bronchiectasis, (ii) the presence of gastric aspiration, and (iii) to explore the possible clinical significance of this comorbidity in these conditions. Methods Twenty-seven participants with COPD, 27 with bronchiectasis and 17 control subjects completed reflux symptom evaluation and dual-channel 24 h oesophageal pH monitoring. In those with lung disease, pepsin levels in sputum samples were measured using enzyme-linked immunosorbent assay, with disease severity (lung function and high-resolution computed tomography) also measured. Results The prevalence of GOR in COPD was 37%, in bronchiectasis was 40% and in control subjects was 18% (P = 0.005). Of those diagnosed with GOR, clinically silent reflux was detected in 20% of participants with COPD and 42% with bronchiectasis. While pepsin was found in 33% of COPD and 26% of bronchiectasis participants, the presence of pepsin in sputum was not related to a diagnosis of GOR based on oesophageal pH monitoring in either condition. Neither a diagnosis of GOR nor the presence of pepsin was associated with increased severity of lung disease in COPD or bronchiectasis. Conclusions The prevalence of GOR in COPD or bronchiectasis is twice that of the control population, and the diagnosis could not be based on symptoms alone. Pepsin was detected in sputum in COPD and bronchiectasis, suggesting a possible role of pulmonary aspiration, which requires further exploration.

Background Cystic fibrosis (CF) can result in distal intestinal obstruction syndrome (DIOS) due to inspissated mucus. This paper describes the clinicopathological characteristics of adult CF patients with DIOS and assesses risk factors for surgery. Methods A retrospective audit of CF patients at the Alfred Hospital from January 2007 to February 2012 was carried out. Patients who had ‘bowel obstruction or constipation’ were abstracted from the database, and medical records were reviewed for a diagnosis of DIOS. Results Forty-five encounters of 35 patients were extracted. Twenty-five (83%) patients were homozygous for the delta F508 mutations, 29 (85%) had pancreatic insufficiency and 15 (44%) had a lung transplant. Patients presented with abdominal pain (96% of encounters), nausea (76% of encounters) and vomiting (67% of encounters). Computed tomography (CT) was performed in 20 episodes. Compared with CT, abdominal X-ray had a sensitivity of 63% (95% confidence interval (CI) 30–89%) and specificity of 33% (95% CI 8–70%) for detecting DIOS with obstruction. Forty-one (91%) encounters resolved with medical management within 2–3 days. Three patients required surgical intervention in four episodes. Previous laparotomy (odds ratio (OR) 28.5, 95% CI 1.3–624, P = 0.03) and history of meconium ileus (OR 14, 95% CI 1–192, P < 0.05) were statistically significant predictors of progression to surgical management. Conclusion In most patients with DIOS, the obstruction resolves with medical management. Early consultation with a CF service, assessment for a surgical abdomen and involvement of surgeons where appropriate is recommended. A history of previous laparotomy is a risk factor for the need for surgical intervention.

Habitat assessments for biodiversity conservation are often complicated by the lack of detailed knowl- edge of a study species' distribution. As an alternative to resource-intensive field-based methods to obtain such information, remotely sensed products can be utilized in species distribution models to infer a species' distribution and ecological needs. Here we demonstrate how to arbitrate among a variety of remotely sensed predictor variables to estimate the distribution and ecological needs of an endangered butterfly species occurring mainly in inaccessible areas. We classified 19 continuous environmental pre- dictor variables into three conceptually independent predictor classes, terrain, land cover, and vertical vegetation structure, and compared the accuracy of competing Maxent habitat models consisting of dif- ferent combinations of each class. Each class contributed, though disproportionately, to our most reliable model that considered all 19 variables. We confirm that variables obtained from remote sensors can effectively estimate the distribution and ecological needs of a relatively unknown imperiled species occurring in inaccessible locations. Importantly, increasing the variety of predictor classes through multi-sensor fusion resulted in greater model accuracy than increasing the absolute number of predictor variables.

BACKGROUND: Case reports and series have suggested an association between injury during pregnancy and several nervous system and nervous system-related adverse fetal/neonatal outcomes. This study's purpose is to further determine if there is an association between injury during pregnancy and nervous system birth defects in infancy. METHODS: Through a case-control study, the association between injury during pregnancy and nervous system birth defects was tested using the Texas Birth Defects Registry (1999-2003). Semiautomated probabilistic bias analysis was used to correct for systematic error from misclassification of injury during pregnancy. RESULTS: Of the 59,750 infants eligible for this study, 4144 (6.94%) were diagnosed with a nervous system birth defect and 315 (0.53%) of the infants' mothers were injured during pregnancy. Among these 315 women, 25 (7.94%) delivered an infant with a subsequent nervous system birth defect. The adjusted odds ratio for the association between injury during pregnancy and nervous system birth defects among all study infants was 1.00; 95% confidence interval, 0.63-1.56 and 2.44; 95% confidence interval, 1.08-5.53 among breech presentation infants. Probabilistic bias analysis supported these findings. CONCLUSION: No association between injury during pregnancy and nervous system birth defects was identified. Further exploration into the association among breech presentation infants is warranted. Birth Defects Research (Part A), 2013. © 2013 Wiley Periodicals, Inc. Language: en

Brain cancer research has been hampered by a paucity of viable clinical tissue of sufficient quality and quantity for experimental research. This has driven researchers to rely heavily on long term cultured cells which no longer represent the cancers from which they were derived. Resection of brain tumors, particularly at the interface between normal and tumorigenic tissue, can be carried out using an ultrasonic surgical aspirator (CUSA) that deposits liquid (blood and irrigation fluid) and resected tissue into a sterile bottle for disposal. To determine the utility of CUSA-derived glioma tissue for experimental research, we collected 48 CUSA specimen bottles from glioma patients and analyzed both the solid tissue fragments and dissociated tumor cells suspended in the liquid waste fraction. We investigated if these fractions would be useful for analyzing tumor heterogeneity, using IHC and multi-parameter flow cytometry; we also assessed culture generation and orthotopic xenograft potential. Both cell sources proved to be an abundant, highly viable source of live tumor cells for cytometric analysis, animal studies and in-vitro studies. Our findings demonstrate that CUSA tissue represents an abundant viable source to conduct experimental research and to carry out diagnostic analyses by flow cytometry or other molecular diagnostic procedures.

Background Liver disease frequently complicates cystic fibrosis (CF), with CF liver disease (CFLD) a leading cause of death. Liver biopsy is rarely performed because of the patchy nature of the disease. Transient elastography can reliably stage liver fibrosis via liver stiffness measurement (LSM). Aims To evaluate LSM as a diagnostic tool in adults with CFLD. Methods Fifty adult patients with CF were prospectively studied: 25 with CFLD and 25 without CFLD. The presence of CFLD and portal hypertension (PHT) was assessed according to strict established criteria based on serial biochemistry and imaging. All patients underwent LSM; APRI, Hepascore® and Forns score were calculated. Results Median LSM was higher in those with CFLD [8.1 kPa (IQR 6.8–9.5) vs. 5.0 kPa (IQR 4.1–5.6); P

BACKGROUND: Provision of healthcare from a remote site may assist patients to access important services. We aimed to establish the feasibility of monitoring an assessment of exercise capacity using telehealth technology. METHODS: Adults with CF completed two 3-min step tests, monitored in-person or remotely via videoconferencing, in randomized order. Measurements were physiological responses to exercise, system usability, ease of clinician interaction, metronome acoustics, and participant comfort. RESULTS: Ten adults (5 male), mean SD age 32 7 years, and FEV 1 55.4% of predicted (range 38–90% of predicted), completed both tests. Participants reported good system usability, with a mean (95% CI) System Usability Scale score of 85.63 out of 100 (79.8–91.5). Metronome acoustics were rated as significantly poorer remotely (P .006). There were no differences in measurements of oxyhemoglobin saturation or heart rate between assessment settings. CONCLUSION: Exercise capacity assessment using the 3-min step test is feasible and accurate via remote videoconferencing in adults with CF. Key words: cystic fibrosis; telehealth; telemedicine; physical activity; exercise test. [Respir Care 2013;58(2):286–290. © 2013 Daedalus Enterprises]

It is often hypothesized that two species competing for the same resource cannot stably coexist unless they partition their resources in space and time. More recently stable isotope analyses have complemented traditional, observation-based niche research by conceptualizing many of the characteristics of communities, for example, trophic niche width and the partitioning of resources. Here we quantify resource partitioning of sympatric small mammal species in an African ecosystem by analysing stable isotope ratios of hair collected from a South African forest-grassland vegetation mosaic, and combine this with known spatial and temporal behavioural data to interpret community competition and resource partitioning. We observe niche separation to different degrees across the entire community, with different species displaying either unique isotopic dietary preferences, or partitioning resources in space and/or time. δ13C values were more enriched in species that inhabited afromontane grassland compared with those that inhabited afromontane forest, a reflection of the dominant vegetation in each habitat. Contrary to expectations, arboreal rodents occupied higher trophic positions than terrestrial rodents and approaching δ15N values similar to insectivorous shrews, suggesting that arboreal rodents feed on items such as arthropods enriched in 15N. While grassland species display phenotypic plasticity in terms of dietary preferences, small mammals that occurred in forests display narrow niche preferences, suggesting these species may be particularly sensitive to habitat modifications. Our results illustrate that the use of stable isotopes can be used in conjunction with spatial and temporal behavioural knowledge to elucidate resource partitioning in small African mammal communities.

International audience; The path to the synthesis of super heavy elements is strongly hindered by the competition between fusion and quasi-fission in heavy ions reactions at near barrier energies. We report on a recent experimental investigation performed at the ALTO facility of IPN Orsay, France on the heavy-ion collision around the Coulomb barrier of 32S+197Au. The fission-fragment mass and total kinetic energy were measured by the double arm mass spectrometer for binary fragments CORSET, using the double time of flight approach. The asymmetric structure on top of the predominant symmetric one may suggests the contribution from either quasi-fission or pre-equilibrium fission or might be driven by shell effects in the compound nucleus fission. To get further insight on such puzzling cases situated at the crossroads of the various opened channels, we extended the measurement to coincident prompt γ -rays, of low and high energy. For this purpose, the prompt γ-rays following fission were detected by the coupled high efficiency ORGAM array consisting of 10 Compton suppressed Germanium detectors (BGO shielded), located at backward angles and the first cluster of the future PARIS calorimeter consisting of 9 close packed phoswich detectors and another single phoswich, together covering a wide angular and energy range.

Objective The aim of the present study was to audit the current use of medical records to determine completeness and concordance with other sources of medical information. Methods Medical records for 40 patients from each of five Melbourne major metropolitan hospitals were randomly selected (n=200). A quantitative audit was performed for detailed patient information and medical record keeping, as well as data collection, storage and utilisation. Using each hospital’s current online clinical database, scanned files and paperwork available for each patient audited, the reviewers sourced as much relevant information as possible within a 30-min time allocation from both the record and the discharge summary. Results Of all medical records audited, 82% contained medical and surgical history, allergy information and patient demographics. All audited discharge summaries lacked at least one of the following: demographics, medication allergies, medical and surgical history, medications and adverse drug event information. Only 49% of records audited showed evidence the discharge summary was sent outside the institution. Conclusions The quality of medical data captured and information management is variable across hospitals. It is recommended that medical history documentation guidelines and standardised discharge summaries be implemented in Australian healthcare services. What is known about this topic? Australia has a complex health system, the government has approved funding to develop a universal online electronic medical record system and is currently trialling this in an opt-out style in the Napean Blue Mountains (NSW) and in Northern Queensland. The system was originally named the personally controlled electronic health record but has since been changed to MyHealth Record (2016). In Victoria, there exists a wide range of electronic health records used to varying degrees, with some hospitals still relying on paper-based records and many using scanned medical records. This causes inefficiencies in the recall of patient information and can potentially lead to incidences of adverse drug events. What does this paper add? This paper supports the concept of a shared medical record system using 200 audited patient records across five Victorian metropolitan hospitals, comparing the current information systems in place for healthcare practitioners to retrieve data. This research identifies the degree of concordance between these sources of information and in doing so, areas for improvement. What are the implications for practitioners? Implications of this research are the improvements in the quality, storage and accessibility of medical data in Australian healthcare systems. This is a relevant issue in the current Australian environment where no guidelines exist across the board in medical history documentation or in the distribution of discharge summaries to other healthcare providers (general practitioners, etc).

The 3DHZETRN code, with improved neutron and light ion (Z≤2) transport procedures, was recently developed and compared to Monte Carlo (MC) simulations using simplified spherical geometries. It was shown that 3DHZETRN agrees with the MC codes to the extent they agree with each other. In the present report, the 3DHZETRN code is extended to enable analysis in general combinatorial geometry. A more complex shielding structure with internal parts surrounding a tissue sphere is considered and compared against MC simulations. It is shown that even in the more complex geometry, 3DHZETRN agrees well with the MC codes and maintains a high degree of computational efficiency.

Context: The Radiation Assessment Detector (RAD) on the Mars Science Laboratory (MSL) has been measuring the radiation environment on the surface of Mars since August 6th 2012. MSL-RAD is the first instrument to provide detailed information about charged and neutral particle spectra and dose rates on the Martian surface, and one of the primary objectives of the RAD investigation is to help improve and validate current radiation transport models. Aims: Applying different numerical transport models with boundary conditions derived from the MSL-RAD environment the goal of this work was to both provide predictions for the particle spectra and the radiation exposure on the Martian surface complementing the RAD sensitive range and, at the same time, validate the results with the experimental data, where applicable. Such validated models can be used to predict dose rates for future manned missions as well as for performing shield optimization studies. Methods: Several particle transport models (GEANT4, PHITS, HZETRN/OLTARIS) were used to predict the particle flux and the corresponding radiation environment caused by galactic cosmic radiation on Mars. From the calculated particle spectra the dose rates on the surface are estimated. Results: Calculations of particle spectra and dose rates induced by galactic cosmic radiation on the Martian surface are presented. Although good agreement is found in many cases for the different transport codes, GEANT4, PHITS, and HZETRN/OLTARIS, some models still show large, sometimes order of magnitude discrepancies in certain particle spectra. We have found that RAD data is helping to make better choices of input parameters and physical models. Elements of these validated models can be applied to more detailed studies on how the radiation environment is influenced by solar modulation, Martian atmosphere and soil, and changes due to the Martian seasonal pressure cycle. By extending the range of the calculated particle spectra with respect to the experimental data additional information about the radiation environment is gained, and the contribution of different particle species to the dose is estimated.

Exposure to ionizing radiation in the space environment is one of the hazards faced by crews in space missions. As space radiations traverse spacecraft, habitat shielding, or tissues, their energies and compositions are altered by interactions with the shielding. Modifications to the radiation fields arise from atomic interactions of charged particles with orbital electrons and nuclear interactions leading to projectile and target fragmentation, including secondary particles such as neutrons, protons, mesons, and nuclear recoils. The transport of space radiation through shielding can be simulated using Monte Carlo techniques or deterministic solutions of the Boltzmann equation. To determine shielding requirements and to resolve radiation constraints for future human missions, the shielding evaluation of a spacecraft concept is required as an early step in the design process. To do this requires (1) accurate knowledge of space environmental models to define the boundary condition for transport calculations, (2) transport codes with detailed shielding and body geometry models to determine particle transmission into areas of internal shielding and at each critical body organ, and (3) the assessment of organ dosimetric quantities and biological risks by applying the corresponding response models for space radiation against the particle spectra that have been accurately determined from the transport code. This paper reviews current transport codes and analyzes their accuracy through comparison to laboratory and spaceflight data. This paper also introduces a probabilistic risk assessment approach for the evaluation of radiation shielding.

OBJECTIVE We present a case of postoperative herpes simplex type 1 viral meningitis after retrosigmoid craniotomy and uncomplicated removal of a vestibular schwannoma. This is a very rare complication that can mimic aseptic meningitis and could lead to devastating consequences for the patient, if unrecognized. PATIENT A healthy 49-year-old woman underwent retrosigmoid craniotomy and resection of a 2.4-cm vestibular schwannoma. She developed worsening headache and low-grade fever on postoperative Day 10 and underwent lumbar puncture showing a lymphocyte predominant pleocytosis. Polymerase chain reaction was positive for herpes simplex type 1 virus; bacterial cultures were negative. The patient subsequently developed a pseudomeningocele and mild hydrocephalus. INTERVENTION The patient was readmitted to the hospital, started on corticosteroids, and a lumbar drain was placed. She completed a 14-day course of antiviral therapy (4 d intravenous as an inpatient and 10 d oral outpatient therapy). RESULTS At 1 month follow-up, she was completely asymptomatic, and her pseudomeningocele had resolved. CONCLUSION The diagnosis of herpes simplex viral meningitis should be suspected in clinical cases of postsurgical meningitis with a lymphocyte predominant pleocytosis and negative bacterial cultures. Antiviral therapy should be initiated immediately after confirmatory polymerase chain reaction testing to avoid potential long-term sequelae of a herpes simplex infection of the central nervous system.

Recent molecular-typing studies suggest cross-infection as one of the potential acquisition pathways for Pseudomonas aeruginosa in patients with cystic fibrosis (CF). In Australia, there is only limited evidence of unrelated patients sharing indistinguishable P. aeruginosa strains. We therefore examined the point-prevalence, distribution, diversity and clinical impact of P. aeruginosa strains in Australian CF patients nationally. 983 patients attending 18 Australian CF centres provided 2887 sputum P. aeruginosa isolates for genotyping by enterobacterial repetitive intergenic consensus-PCR assays with confirmation by multilocus sequence typing. Demographic and clinical details were recorded for each participant. Overall, 610 (62%) patients harboured at least one of 38 shared genotypes. Most shared strains were in small patient clusters from a limited number of centres. However, the two predominant genotypes, AUST-01 and AUST-02, were widely dispersed, being detected in 220 (22%) and 173 (18%) patients attending 17 and 16 centres, respectively. AUST-01 was associated with significantly greater treatment requirements than unique P. aeruginosa strains. Multiple clusters of shared P. aeruginosa strains are common in Australian CF centres. At least one of the predominant and widespread genotypes is associated with increased healthcare utilisation. Longitudinal studies are now needed to determine the infection control implications of these findings.

Persistence of species in fragmented landscapes depends on dispersal among suitable breeding sites, and dispersal is often influenced by the "matrix" habitats that lie between breeding sites. However, measuring effects of different matrix habitats on movement and incorporating those differences into spatially explicit models to predict dispersal is costly in terms of time and financial resources. Hence a key question for conservation managers is: Do more costly, complex movement models yield more accurate dispersal predictions? We compared the abilities of a range of movement models, from simple to complex, to predict the dispersal of an endangered butterfly, the Saint Francis' satyr (Neonympha mitchellii francisci). The value of more complex models differed depending on how value was assessed. Although the most complex model, based on detailed movement behaviors, best predicted observed dispersal rates, it was only slightly better than the simplest model, which was based solely on distance between sites. Consequently, a parsimony approach using information criteria favors the simplest model we examined. However, when we applied the models to a larger landscape that included proposed habitat restoration sites, in which the composition of the matrix was different than the matrix surrounding extant breeding sites, the simplest model failed to identify a potentially important dispersal barrier, open habitat that butterflies rarely enter, which may completely isolate some of the proposed restoration sites from other breeding sites. Finally, we found that, although the gain in predicting dispersal with increasing model complexity was small, so was the increase in financial cost. Furthermore, a greater fit continued to accrue with greater financial cost, and more complex models made substantially different predictions than simple models when applied to a novel landscape in which butterflies are to be reintroduced to bolster their populations. This suggests that more complex models might be justifiable on financial grounds. Our results caution against a pure parsimony approach to deciding how complex movement models need to be to accurately predict dispersal through the matrix, especially if the models are to be applied to novel or modified landscapes.

To compare the effectiveness of self-collected and health care worker (HCW)-collected nasal swabs for detection of influenza viruses and determine the patients' preference for type of collection.We enrolled adult patients presenting with influenzalike illness to the Emergency Department at Mayo Clinic, Rochester, Minnesota, from January 28, 2011, through April 30, 2011. Patients self-collected a midturbinate nasal flocked swab from their right nostril following written instructions. A second swab was then collected by an HCW from the left nostril. Swabs were tested for influenza A and B viruses by real-time reverse transcription-polymerase chain reaction, and percent concordance between collection methods was determined.Of the 72 paired specimens analyzed, 25 were positive for influenza A or B RNA by at least one of the collection methods (34.7% positivity rate). When the 14 patients who had prior health care training were excluded, the qualitative agreement between collection methods was 94.8% (55 of 58). Two of the 58 specimens (3.4%) from patients without health care training were positive only by HCW collection, and 1 of 58 (1.7%) was positive only by patient self-collection. A total of 53.4% of patients (31 of 58) preferred the self-collection method over the HCW collection, and 25.9% (15 of 58) had no preference.Self-collected midturbinate nasal swabs provide a reliable alternative to HCW collection for influenza A and B virus real-time reverse transcription-polymerase chain reaction.

Summary Background and aims Inhalation of hypertonic saline (HTS) has short term positive effects on airways clearance in non-cystic fibrosis (CF) bronchiectasis, however its long term effects are unknown. The aim of this study was to determine the effect of HTS 6% on exacerbations, quality of life (QOL) and respiratory function over 12 months in non-CF bronchiectasis. Methods Forty patients were randomised to inhale isotonic saline (IS) 0.9% or HTS 6% daily for 12 months. Participants recorded their symptoms in a daily diary. Quality of life and respiratory function were measured after three, six and 12 months. Number of exacerbations and changes in sputum colonisation were recorded at 12 months. Participants, assessors and clinicians were blinded to group allocation. Results The exacerbation rate at 12 months was similar in the two groups and similar clinically significant improvements in QOL were seen in both groups. The FEV 1 increased in both groups after six months (mean 90 ml, 95% confidence interval 11–169 ml) with no difference between groups ( p = 0.394). The FEF 25–75% significantly improved at all time points (mean increase at 12 months 187 ml, 69–304 ml) with no difference between groups ( p = 0.705). There was a reduction in sputum colonisation in both groups ( p = 0.046). Conclusions Inhalation of HTS or IS has similar effects on exacerbations, QOL, sputum colonisation and respiratory function over 12 months in non-CF bronchiectasis. The trial was registered with both Clinical Trials.gov – NCT00484263 and Australian New Zealand Clinical Trials Registry – ACTRN12607000367448.

The day begins at 7:00 AM with a layer of mosquito repellent and boiled coffee in a tin cup. Our medical clinic in the small village of Rancho Pedro along the Dominican Republic-Haiti border is a small hut composed of dilapidated wooden planks fastened together under a thatched reed roof. Patients with a variety of ailments line up daily outside the clinic door in anticipation of seeing a physician, often for the first time. Most patients have been waiting for hours, usually after enduring an overnight mountainous trek from a neighboring Haitian or Dominican village. Many of the medical problems encountered can be treated effectively with simple measures of wound debridement, bandages, analgesics, or antibiotics; however, some are more complex with no referral options. The work is intense but inspiring, rewarding but often frustrating as the limitations of our abilities quickly become apparent.

Background:Adherence to protocols of accelerometer use by participants of research studies is crucial to ensure the most accurate measure of their physical activity.Methods:We used data from a study of 201 individuals 65 years of age and older to examine whether aging effects on physical and cognitive health limit the ability of an older adult to be adherent to an accelerometer protocol.Results:A comparison of participants who met the adherent person criteria with those who did not showed that the percentage of participants whose income is $20,000 or greater, the percentage of participants who reported white race, and the mean number of school grades completed were significantly different between the 2 groups. Logistic regression analyses showed that the best multivariate model to predict being a valid person included Instrumental Activities of Daily Living score, while the best multivariate model to predict being an adherent person included Modified Guralnik Lower Body Score and Mini-Mental State Examination Score.Conclusions:This study found that certain measures of physical and cognitive functioning were the best predictors of adherence to an accelerometer protocol among older adults.