C. difficile surveillance quarterly report: October-December 2010

This quarterly report provides epidemiological data on C. difficile in Northern Ireland, and includes key points, a comprehensiveoverview of all C. diff infections, rates, trends, age-specific informationand statistical process control charts. The report also provides information on surveillance methods and data for each hospital and Health and Social Care Trust in Northern Ireland.

C. difficile surveillance quarterly report: January-March 2011

This quarterly report provides epidemiological data on C. difficile in Northern Ireland, and includes key points, a comprehensive�overview of all C. diff infections, rates, trends, age-specific information�and statistical process control charts. The report also provides information on surveillance methods and data for each hospital and Health and Social Care Trust in Northern Ireland.

C. difficle surveillance quarterly report: April - June 2011

This quarterly report provides epidemiological data on C. difficile in Northern Ireland, and includes key points, a comprehensive�overview of all C. diff infections, rates, trends, age-specific information�and statistical process control charts. The report also provides information on surveillance methods and data for each hospital and Health and Social Care Trust in Northern Ireland.

C. difficile surveillance quarterly report: July - September 2011

This quarterly report provides epidemiological data on C. difficile in Northern Ireland, and includes key points, a comprehensive�overview of all C. diff infections, rates, trends, age-specific information�and statistical process control charts. The report also provides information on surveillance methods and data for each hospital and Health and Social Care Trust in Northern Ireland.

C. difficile surveillance quarterly report: October - December 2011

This quarterly report provides epidemiological data on C. difficile in Northern Ireland, and includes key points, a comprehensive�overview of all C. diff infections, rates, trends, age-specific information�and statistical process control charts. The report also provides information on surveillance methods and data for each hospital and Health and Social Care Trust in Northern Ireland.

C. difficile surveillance quarterly report: January - March 2012

This quarterly report provides epidemiological data on C. difficile in Northern Ireland, and includes key points, a comprehensive�overview of all C. diff infections, rates, trends, age-specific information�and statistical process control charts. The report also provides information on surveillance methods and data for each hospital and Health and Social Care Trust in Northern Ireland.

C. difficile surveillance quarterly report: October - December 2012

This quarterly report provides epidemiological data on C. difficile in Northern Ireland, and includes key points, a comprehensive�overview of all C. diff infections, rates, trends, age-specific information�and statistical process control charts. The report also provides information on surveillance methods and data for each hospital and Health and Social Care Trust in Northern Ireland.

Clostridium difficile infection

This leaflet provides healthcare patients, their families and carers with comprehensive information on Clostridium difficile (C. diff) infection. It provides some background on the infection�and highlights a range of key factors, including the symptoms to look out for, common causes of contamination, the appropriate course of action should you become infected, and possible treatment options. It also offers advice to visitors and carers on precautions and rules they should follow when in the presence of a patient with C. diff infection.

C. difficile surveillance quarterly report: October-December 2010

This quarterly report provides epidemiological data on C. difficile in Northern Ireland, and includes key points, a comprehensive�overview of all C. diff infections, rates, trends, age-specific information�and statistical process control charts. The report also provides information on surveillance methods and data for each hospital and Health and Social Care Trust in Northern Ireland.

C. difficle surveillance quarterly report: July-September 2015

This quarterly report provides epidemiological data on�C. difficile�in Northern Ireland, and includes key points, a comprehensive�overview of all�C. diff�infections, rates, trends, age-specific information�and statistical process control charts.

A fatal overdose of cocaine associated with coingestion of marijuana, buprenorphine, and fluoxetine. Body fluid and tissue distribution of cocaine and its metabolites determined by hydrophilic interaction chromatography-mass spectrometry(HILIC-MS).

Chromatographic separation of highly polar basic drugs with ideal ionspray mass spectrometry volatile mobile phases is a difficult challenge. A new quantification procedure was developed using hydrophilic interaction chromatography-mass spectrometry with turbo-ionspray ionization in the positive mode. After addition of deuterated internal standards and simple clean-up liquid extraction, the dried extracts were reconstituted in 500 microL pure acetonitrile and 5 microL was directly injected onto a Waters Atlantis HILIC 150- x 2.1-mm, 3-microm column. Chromatographic separations of cocaine, seven metabolites, and anhydroecgonine were obtained by linear gradient-elution with decreasing high concentrations of acetonitrile (80-56% in 18 min). This high proportion of organic solvent makes it easier to be coupled with MS. The eluent was buffered with 2 mM ammonium acetate at pH 4.5. Except for m-hydroxy-benzoylecgonine, the within-day and between-day precisions at 20, 100, and 500 ng/mL were below 7 and 19.1%, respectively. Accuracy was also below +/- 13.5% at all tested concentrations. The limit of quantification was 5 ng/mL (%Diff < 16.1, %RSD < 4.3) and the limit of detection below 0.5 ng/mL. This method was successfully applied to a fatal overdose. In Switzerland, cocaine abuse has dramatically increased in the last few years. A 45-year-old man, a known HIV-positive drug user, was found dead at home. According to relatives, cocaine was self-injected about 10 times during the evening before death. A low amount of cocaine (0.45 mg) was detected in the bloody fluid taken from a syringe discovered near the corpse. Besides injection marks, no significant lesions were detected during the forensic autopsy. Toxicological investigations showed high cocaine concentrations in all body fluids and tissues. The peripheral blood concentrations of cocaine, benzoylecgonine, and methylecgonine were 5.0, 10.4, and 4.1 mg/L, respectively. The brain concentrations of cocaine, benzoylecgonine, and methylecgonine were 21.2, 3.8, and 3.3 mg/kg, respectively. The highest concentrations of norcocaine (about 1 mg/L) were measured in bile and urine. Very high levels of cocaine were determined in hair (160 ng/mg), indicating chronic cocaine use. A low concentration of anhydroecgonine methylester was also found in urine (0.65 mg/L) suggesting recent cocaine inhalation. Therapeutic blood concentrations of fluoxetine (0.15 mg/L) and buprenorphine (0.1 microg/L) were also discovered. A relatively high concentration of Delta(9)-THC was measured both in peripheral blood (8.2 microg/L) and brain cortex (13.5 microg/kg), suggesting that the victim was under the influence of cannabis at the time of death. In addition, fluoxetine might have enhanced the toxic effects of cocaine because of its weak pro-arrhythmogenic properties. Likewise, combination of cannabinoids and cocaine might have increase detrimental cardiovascular effects. Altogether, these results indicate a lethal cocaine overdose with a minor contribution of fluoxetine and cannabinoids.

Role of the microenvironment on epithelial stem cell fate

Stratified epithelia of mammals contain adult stem/progenitor cells that are instrumental for renewal, regeneration and repair. We have recently demonstrated, using clonal and functional analysis, that all stratified epithelia contain clonogenic stem cells that can respond to skin morphogenetic signals, while cells obtained from simple or pseudo-stratified epithelia cannot. A genome-wide expression analysis favors multilineage priming rather than reprogramming. Collectively, these observations are reminiscent of epithelial metaplasia, a phenomenon in which a cell adopts the phenotype of another epithelial cell, often in response to repeated environmental stress, e.g. smoking, alcohol and micro-traumatisms. Furthermore, they support the notion that metaplasia results from the expression of an unseen potency, revealed by an environmental deficiency. The thymus supposedly contains only progenitor epithelial cells but no stem cells. We have demonstrated that the thymus also contains a small population of clonogenic cells that can function as bona fide multipotent hair follicle stem cells in response to an inductive skin microenvironment and a genome-wide expression analysis indicates that it correlates with robust changes in the expression of genes important for thymus identity. Hence, multilineage priming or reprogramming can account for the fate change of epithelial stem/progenitor cells in response to a varying microenvironment.

Teaching motivational interviewing to medical students : a pre-post test pilot study

Objective: To test the efficacy of teaching motivational interviewing (MI) to medical students. Methods: Thirteen 4th year medical students volunteered to participate. Seven days before and 7 days after an 8-hour interactive training MI workshop, each student performed a videorecorded interview with two standardized patients: a 60 year old alcohol dependent woman and a 50 year old cigarette smoking man. Students' counseling skills were coded by two blinded clinicians using the Motivational Interviewing Treatment Integrity 3.0 (MITI). Inter-rater reliability was calculated for all interviews and a test-retest was completed in a sub-sample of 10 consecutive interviews three days apart. Difference between MITI scores before and after training were calculated and tested using non-parametric tests. Effect size was approximated by calculating the probability that posttest scores are greater than pretest scores (P*=P(Pre<Post)+1/2P(Pre=Post)), P*>1/2 indicating greater scores in posttest, P*=1/2 no effect, and P*<1/2 smaller scores in posttest. Results: Median differences between MITI scores before and after MI training indicated a general progression in MI skills: MI spirit global score (median difference=1.5, Inter quartile range=1.5, p<0.001, P*=0.90); Empathy global score (med diff=1, IQR=0.5, p<0.001, P*=0.85); Percentage of MI adherent skills (med diff=36.6, IQR=50.5, p<0.001, P*=0.85); Percentage of open questions (med diff=18.6, IQR=21.6, p<0.001, P*=0.96); reflections/ questions ratio (med diff=0.2, IQR=0.4, p<0.001, P*=0.81). Only Direction global score and the percentage of complex reflections were not significantly improved (med diff=0, IQR=1, p=0.53, P*=0.44, and med diff=4.3, IQR=24.8, p=0.48, P*=0.62, respectively). Inter-rater reliability indicated weighted kappa ranged between 0.14 for Direction to 0.51 for Collaboration and ICC ranged between 0.28 for Simple reflection to 0.95 for Closed question. Test-retests indicated weighted kappa ranged between 0.27 for Direction to 0.80 for Empathy and ICC ranged between 0.87 for Complex reflection to 0.98 for Closed question. Conclusion: This pilot study indicated that an 8-hour training in MI for voluntary 4th year medical students resulted in significant improvement of MI skills. Larger sample of unselected medical students should be studied to generalize the benefit of MI training to medical students. Interrater reliability and test-retests suggested that coders' training should be intensified.

The role of LEKTI in fate determination of keratinocyte stem cells

SPINK5 (serine protease inhibitor Kazal-type 5) encodes the putative proteinase inhibitor LEKTI (lympho-epithelial Kazal-type related inhibitor). In skin, LEKTI expression is restricted to the stratum granulosum of the epidermis and the inner root sheath of hair follicles. Mutations that create premature termination codons in SPINK5 have been reported as the cause of Netherton syndrome (NS), a human autosomal recessive disorder characterized by congenital ichthyosis with defective cornification, a specific hair shaft defect known as trichorrexis invaginata or 'bamboo hair', and severe atopic manifestations, including atopic dermatitis and hayfever. Althought recombinant human LEKTI inhibits a battery of serine proteases including plasmin, trypsin, subtilisin A, cathepsin G, and elastase, the precise role of LEKTI in the physiopathology of NS remains unclear. Spink5−/− mice display a NS-like phenotype. Surprisingly, a psoriasis-like hyperplasia, basement membrane breakdown followed by evagination of spindle-shaped epidermal cells into the dermal compartment, and the presence of numerous sweat gland-like structures were also observed when the skin of Spink5−/− newborn mice, which die at birth, was transplanted onto the back of nude mice. Collectively, these observations suggest that LEKTI may play a role on cell proliferation and stem cell fate. Our current work aims at elucidating the mechanisms by which LEKTI impact these biological processes. Using keratinocyte stem cells obtained from NS patients, we have identified LEKTI as a regulator node in several signaling pathways involved in stem cell behavior.

The Impact of Instructions on Survey Translation : An Experimental Study

The experimental study described in this paper examined the impact of providing special instructions and supporting material to translators. Specifically, it addressed whether Spanish, Chinese, and French translators provided with explanatory text and guidelines were able to produce translations that were more faithful to the intended meaning of English source survey items, as well as that were more culturally appropriate and natural sounding compared to those of translators who received no such guidance. Study findings indicate that while the provision of special instructions and documentation to translators had a considerable impact on their translations, the direction of the impact (positive or negative) diff ered across the target languages, according to scale ratings of professional survey researchers who were native speakers of those languages.