Increasing the reliability of fully automated surveillance for central line–associated bloodstream infections

OBJECTIVETo increase reliability of the algorithm used in our fully automated electronic surveillance system by adding rules to better identify bloodstream infections secondary to other hospital-acquired infections.METHODSIntensive care unit (ICU) patients with positive blood cultures were reviewed. Central line–associated bloodstream infection (CLABSI) determinations were based on 2 sources: routine surveillance by infection preventionists, and fully automated surveillance. Discrepancies between the 2 sources were evaluated to determine root causes. Secondary infection sites were identified in most discrepant cases. New rules to identify secondary sites were added to the algorithm and applied to this ICU population and a non-ICU population. Sensitivity, specificity, predictive values, and kappa were calculated for the new models.RESULTSOf 643 positive ICU blood cultures reviewed, 68 (10.6%) were identified as central line–associated bloodstream infections by fully automated electronic surveillance, whereas 38 (5.9%) were confirmed by routine surveillance. New rules were tested to identify organisms as central line–associated bloodstream infections if they did not meet one, or a combination of, the following: (I) matching organisms (by genus and species) cultured from any other site; (II) any organisms cultured from sterile site; (III) any organisms cultured from skin/wound; (IV) any organisms cultured from respiratory tract. The best-fit model included new rules I and II when applied to positive blood cultures in an ICU population. However, they didn’t improve performance of the algorithm when applied to positive blood cultures in a non-ICU population.CONCLUSIONElectronic surveillance system algorithms may need adjustment for specific populations.Infect. Control Hosp. Epidemiol. 2015;36(12):1396–1400</jats:sec

Marinomonas brasilensis sp. nov., isolated from the coral Mussismilia hispida, and reclassification of Marinomonas basaltis as a later heterotypic synonym of Marinomonas communis

A Gram-negative, aerobic bacterium, designated strain R-40503(T), was isolated from mucus of the reef-builder coral Mussismilia hispida, located in the Sao Sebastiao Channel, Sao Paulo, Brazil. Phylogenetic analyses revealed that strain R-40503(T) belongs to the genus Marinomonas. The 16S rRNA gene sequence similarity of R-40503(T) was above 97% with the type strains of Marinomonas vaga, M. basaltis, M. communis and M. pontica, and below 97% with type strains of the other Marinomonas species. Strain R-40503(T) showed less than 35% DNA-DNA hybridization (DDH) with the type strains of the phylogenetically closest Marinomonas species, demonstrating that it should be classified into a novel species. Amplified fragment length polymorphism (AFLP), chemotaxonomic and phenotypic analyses provided further evidence for the proposal of a novel species. Concurrently, a close genomic relationship between M. basaltis and M. communis was observed. The type strains of these two species showed 78% DDH and 63% AFLP pattern similarity. Their phenotypic features were very similar, and their DNA G+C contents were identical (46.3 mol%). Collectively, these data demonstrate unambiguously that Marinomonas basaltis is a later heterotypic synonym of Marinomonas communis. Several phenotypic features can be used to discriminate between Marinomonas species. The novel strain R-40503(T) is clearly distinguishable from its neighbours. For instance, it shows oxidase and urease activity, utilizes L-asparagine and has the fatty acid C(12:1) 3-OH but lacks C(10:0) and C(12:0). The name Marinomonas brasilensis sp. nov. is proposed, with the type strain R-40503(T) (=R-278(T) =LMG 25434(T) =CAIM 1459(T)). The DNA G+C content of strain R-40503(T) is 46.5 mol%

Provably scale-covariant networks from oriented quasi quadrature measures in cascade

This article presents a continuous model for hierarchical networks based on a combination of mathematically derived models of receptive fields and biologically inspired computations. Based on a functional model of complex cells in terms of an oriented quasi quadrature combination of first- and second-order directional Gaussian derivatives, we couple such primitive computations in cascade over combinatorial expansions over image orientations. Scale-space properties of the computational primitives are analysed and it is shown that the resulting representation allows for provable scale and rotation covariance. A prototype application to texture analysis is developed and it is demonstrated that a simplified mean-reduced representation of the resulting QuasiQuadNet leads to promising experimental results on three texture datasets.Comment: 12 pages, 3 figures, 1 tabl

Biosynthesis of Salmonella enterica [NiFe]-hydrogenase-5 : probing the roles of system-specific accessory proteins

A subset of bacterial [NiFe]-hydrogenases have been shown to be capable of activating dihydrogen-catalysis under aerobic conditions; however, it remains relatively unclear how the assembly and activation of these enzymes is carried out in the presence of air. Acquiring this knowledge is important if a generic method for achieving production of O2-resistant [NiFe]-hydrogenases within heterologous hosts is to be developed. Salmonella enterica serovar Typhimurium synthesizes the [NiFe]-hydrogenase-5 (Hyd-5) enzyme under aerobic conditions. As well as structural genes, the Hyd-5 operon also contains several accessory genes that are predicted to be involved in different stages of biosynthesis of the enzyme. In this work, deletions in the hydF, hydG, and hydH genes have been constructed. The hydF gene encodes a protein related to Ralstonia eutropha HoxO, which is known to interact with the small subunit of a [NiFe]-hydrogenase. HydG is predicted to be a fusion of the R. eutropha HoxQ and HoxR proteins, both of which have been implicated in the biosynthesis of an O2-tolerant hydrogenase, and HydH is a homologue of R. eutropha HoxV, which is a scaffold for [NiFe] cofactor assembly. It is shown here that HydG and HydH play essential roles in Hyd-5 biosynthesis. Hyd-5 can be isolated and characterized from a ΔhydF strain, indicating that HydF may not play the same vital role as the orthologous HoxO. This study, therefore, emphasises differences that can be observed when comparing the function of hydrogenase maturases in different biological systems

A nutrition curriculum for the undergraduate level

It has been repeatedly confirmed over the last 25 years that nutrition instruction in medical schools has not kept pace with the emerging role of nutrition in the etiology, treatment and prevention of many of the country's common chronic and debilitating diseases. A perception by medical school administration and faculty that nutrition was not acknowledged as a clinical specialty and an unwillingness by recognized disciplines to grant teaching time to an additional curriculum area has contributed to this dilemma. A review of the literature indicated that medical school curricula were not offering comprehensive clinical-based nutrition education. This suggested that it would be purposeful to provide the pre-health student with a comprehensive clinical-based nutrition education curriculum. Nutrition has a vital role in our health care system and our medical training programs are the key to preparing health professionals for this role. The physician is regarded as a source of nutrrtion information by the general public and is expected to have adequate knowledge of nutrition to be able to make appropriate dietary recommendations. If the objectives of medical education are to prepare future physicians to deliver health care effectively and to keep pace with the changing needs of their patients and new scientific discoveries and correlations, then nutrition must be considered a formal part of all medical education. Although chairpersons of clinical nutrition exist in several medical schools and clinical nutrition is recognized within medical subspecialties, many problems remain with the restructuring of the existing medical school curricula. The international trend of nutrition education at a preclinical level is emerging as a successful approach to impacting an already overcrowded curriculum. Following the literature review, a conceptual scheme was developed for the proposed curriculum. Prior to formalizing this scheme, a jury of experts, including three experts in the field of medical and nutrition education and one pre-medical student were chosen for the jury. The feedback obtained from these individuals helped to provide direction in developing the conceptual scheme, which in turn, established the organizational framework of the curriculum. The curriculum included four main concepts and 23 objectives. The suggested content outlines, learning opportunities and resources were provided to assist in the attainment of each objective.California State University, Northridge. Department of Health Sciences.Includes bibliographical references (leaves 96-98

Quantitative systematic review of the effects of non‐pharmacological interventions on reducing apathy in persons with dementia

AimTo review the quantitative evidence concerning the effects of non‐pharmacological interventions on reducing apathy in persons with dementia.BackgroundApathy, a prevalent behavioural symptom among persons with Alzheimer Disease, is defined as a disorder of motivation with deficits in behavioural, emotional and cognitive domains and is associated with serious social and physical obstacles. Non‐pharmacological interventions show promise as symptom control modalities among persons with dementia.DesignQuantitative systematic review.Data sourcesCINAHL, PubMed, PSYCHinfo and Cochrane Trials databases were searched for published English language research inclusive through December 2014, with no early year limiters set.Review methodsComprehensive searches yielded 16 international randomized controlled trials or quasi‐experimental studies based on inclusion criteria and a rigorous quality appraisal process.ResultsA narrative summary analysis revealed that non‐pharmacological interventions for apathy varied substantially and lacked specificity, conceptual clarity and were methodologically heterogeneous. Select interventions demonstrated effectiveness, but lacked systematic long‐term follow‐up. Limitations include publication bias and lack of a meta‐analytic approach due to the methodological heterogeneity of included studies.ConclusionStudy results demonstrate promise for the use of non‐pharmacological interventions, particularly music‐based interventions, in reducing apathy levels in individuals with dementia. Intervening to reduce apathy may have a positive clinical impact and healthcare providers should be encouraged to incorporate positive sources of interest and intellectual stimulation into care. However, future research is needed to examine the aetiologic mechanism and predictors of apathy, to improve evidence‐based interventions and specificity and to optimize dosage and timing of non‐pharmacological interventions across the disease trajectory.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/134246/1/jan13026_am.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/134246/2/jan13026.pd

Inhibition of Salmonella Typhimurium by medium chain fatty acids in an in vitro simulation of the porcine caecum

To lower the contamination of pork meat with Salmonella, feed additives such as medium chain fatty acids (MCFA\u27s) can be applied at the primary production level. An in vitro continuous culture system, simulating the porcine caecum, was developed for investigating the effect of MCFAs on the pig intestinal microbial community. The system was monitored by plating on selective media, 16S rDNA PCR denaturing gradient gel electrophoresis (PCR-DGGE) and HPLC analysis of fermentation products. In a simulation of the porcine caecum without MCFA treatment, with Salmonella Typhimurium added after stabilization of the microbial community, the strain could establish itself at a stable population size of about 5 log cfu/ml. The effect of selected MCFAs was observed from all monitored parameters and depended on chain length and concentration applied. At a dose of 15 mM, caproate and caprinate did not show any pronounced effect, while a clear Salmonella inhibiting effect (3 log units reduction) was found for caprylate. Doubling the caprylate dose did not result in enhanced Salmonella inhibition

Coupled variability in primary sensory areas and the hippocampus during spontaneous activity

The cerebral cortex is an anatomically divided and functionally specialized structure. It includes distinct areas, which work on different states over time. The structural features of spiking activity in sensory cortices have been characterized during spontaneous and evoked activity. However, the coordination among cortical and sub-cortical neurons during spontaneous activity across different states remains poorly characterized. We addressed this issue by studying the temporal coupling of spiking variability recorded from primary sensory cortices and hippocampus of anesthetized or freely behaving rats. During spontaneous activity, spiking variability was highly correlated across primary cortical sensory areas at both small and large spatial scales, whereas the cortico-hippocampal correlation was modest. This general pattern of spiking variability was observed under urethane anesthesia, as well as during waking, slow-wave sleep and rapid-eye-movement sleep, and was unchanged by novel stimulation. These results support the notion that primary sensory areas are strongly coupled during spontaneous activity.project NORTE-01-0145-FEDER-000013, supported by the Northern Portugal Regional Operational Programme (NORTE 2020), under the Portugal 2020 Partnership Agreement, through the European Regional Development Fund (FEDER). NAPV was supported by Centro Universitario do Rio Grande do Norte, Champalimaud Foundation, and Brazilian National Council for Scientific and Technological Development (CNPq, Grant 249991/2013-6), CC-S (SFRH/BD/51992/2012). AJR (IF/00883/2013). SR by UFRN, CNPq (Research Productivity Grant 308775/2015-5), and S. Paulo Research Foundation FAPESP - Center for Neuromathematics (Grant 2013/07699-0)info:eu-repo/semantics/publishedVersio

Effects of a web-based personalized intervention on physical activity in European adults: a randomized controlled trial

Background: The high prevalence of physical inactivity worldwide calls for innovative and more effective ways to promote physical activity (PA). There are limited objective data on the effectiveness of Web-based personalized feedback on increasing PA in adults. Objective: It is hypothesized that providing personalized advice based on PA measured objectively alongside diet, phenotype, or genotype information would lead to larger and more sustained changes in PA, compared with nonpersonalized advice. Methods: A total of 1607 adults in seven European countries were randomized to either a control group (nonpersonalized advice, Level 0, L0) or to one of three personalized groups receiving personalized advice via the Internet based on current PA plus diet (Level 1, L1), PA plus diet and phenotype (Level 2, L2), or PA plus diet, phenotype, and genotype (Level 3, L3). PA was measured for 6 months using triaxial accelerometers, and self-reported using the Baecke questionnaire. Outcomes were objective and self-reported PA after 3 and 6 months. Results: While 1270 participants (85.81% of 1480 actual starters) completed the 6-month trial, 1233 (83.31%) self-reported PA at both baseline and month 6, but only 730 (49.32%) had sufficient objective PA data at both time points. For the total cohort after 6 months, a greater improvement in self-reported total PA (P=.02) and PA during leisure (nonsport) (P=.03) was observed in personalized groups compared with the control group. For individuals advised to increase PA, we also observed greater improvements in those two self-reported indices (P=.006 and P=.008, respectively) with increased personalization of the advice (L2 and L3 vs L1). However, there were no significant differences in accelerometer results between personalized and control groups, and no significant effect of adding phenotypic or genotypic information to the tailored feedback at month 3 or 6. After 6 months, there were small but significant improvements in the objectively measured physical activity level (P<.05), moderate PA (P<.01), and sedentary time (P<.001) for individuals advised to increase PA, but these changes were similar across all groups. Conclusions: Different levels of personalization produced similar small changes in objective PA. We found no evidence that personalized advice is more effective than conventional “one size fits all” guidelines to promote changes in PA in our Web-based intervention when PA was measured objectively. Based on self-reports, PA increased to a greater extent with more personalized advice. Thus, it is crucial to measure PA objectively in any PA intervention study